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Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review.
World J Emerg Surg 2017; 12:16WJ

Abstract

BACKGROUND

Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting. Moreover, a systematic literature review of comparative studies on minimally invasive techniques in necrotizing pancreatitis has been provided.

CASE PRESENTATION

A 59-year-old patient was referred to our center for acute necrotizing pancreatitis associated with multi-organ failure. No invasive procedures were attempted in the first month from the onset: enteral feeding by a naso-duodenal tube was started, and antibiotics were administered to control sepsis. After 4 weeks, CT scans showed a central walled-off pancreatic necrosis (WOPN) of pancreatic head communicating bilateral retroperitoneal collections. ETN was performed, and bile leakage was found at the right margin of the WOPN. Endoscopic retrograde cholangiopancreatography confirmed the presence of a choledocal fistula within the WOPN, and a biliary stent was placed. An ultrasound-guided PD was performed on the left retroperitoneal collection. Due to the subsequent repeated onset of septic shocks and the evidence of size increase of the right retroperitoneal collection, a VARD was decided. The CT scans documented the resolution of all the collections, and the patient promptly recovered from sepsis. After 6 months, the patient is in good clinical condition.

CONCLUSIONS

No mini-invasive technique has demonstrated significantly better outcomes over the others, and each technique has specific indications, advantages, and pitfalls. Indeed, ETN could be suitable for central WOPNs, while VARD or PD could be suggested for lateral collections. A combination of different approaches is feasible and could significantly optimize the clinical management in critically ill patients affected by complicated necrotizing pancreatitis.

Authors+Show Affiliations

Trauma Team and Emergency Surgery, Niguarda Trauma Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.Trauma Team and Emergency Surgery, Niguarda Trauma Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.Digestive Endoscopy Service, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.Trauma Team and Emergency Surgery, Niguarda Trauma Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.Intensive Care Unit, Niguarda Trauma Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.Trauma Team and Emergency Surgery, Niguarda Trauma Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162 Italy.

Pub Type(s)

Case Reports
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

28331537

Citation

Sorrentino, Luca, et al. "Combined Totally Mini-invasive Approach in Necrotizing Pancreatitis: a Case Report and Systematic Literature Review." World Journal of Emergency Surgery : WJES, vol. 12, 2017, p. 16.
Sorrentino L, Chiara O, Mutignani M, et al. Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. World J Emerg Surg. 2017;12:16.
Sorrentino, L., Chiara, O., Mutignani, M., Sammartano, F., Brioschi, P., & Cimbanassi, S. (2017). Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. World Journal of Emergency Surgery : WJES, 12, p. 16. doi:10.1186/s13017-017-0126-5.
Sorrentino L, et al. Combined Totally Mini-invasive Approach in Necrotizing Pancreatitis: a Case Report and Systematic Literature Review. World J Emerg Surg. 2017;12:16. PubMed PMID: 28331537.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. AU - Sorrentino,Luca, AU - Chiara,Osvaldo, AU - Mutignani,Massimiliano, AU - Sammartano,Fabrizio, AU - Brioschi,Paolo, AU - Cimbanassi,Stefania, Y1 - 2017/03/16/ PY - 2016/12/28/received PY - 2017/03/06/accepted PY - 2017/3/24/entrez PY - 2017/3/24/pubmed PY - 2018/10/3/medline KW - Endoscopic transgastric necrosectomy KW - Percutaneous drainage KW - Severe pancreatitis KW - Step-up approach KW - Video-assisted retroperitoneal debridement KW - Walled-off pancreatic necrosis SP - 16 EP - 16 JF - World journal of emergency surgery : WJES JO - World J Emerg Surg VL - 12 N2 - BACKGROUND: Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting. Moreover, a systematic literature review of comparative studies on minimally invasive techniques in necrotizing pancreatitis has been provided. CASE PRESENTATION: A 59-year-old patient was referred to our center for acute necrotizing pancreatitis associated with multi-organ failure. No invasive procedures were attempted in the first month from the onset: enteral feeding by a naso-duodenal tube was started, and antibiotics were administered to control sepsis. After 4 weeks, CT scans showed a central walled-off pancreatic necrosis (WOPN) of pancreatic head communicating bilateral retroperitoneal collections. ETN was performed, and bile leakage was found at the right margin of the WOPN. Endoscopic retrograde cholangiopancreatography confirmed the presence of a choledocal fistula within the WOPN, and a biliary stent was placed. An ultrasound-guided PD was performed on the left retroperitoneal collection. Due to the subsequent repeated onset of septic shocks and the evidence of size increase of the right retroperitoneal collection, a VARD was decided. The CT scans documented the resolution of all the collections, and the patient promptly recovered from sepsis. After 6 months, the patient is in good clinical condition. CONCLUSIONS: No mini-invasive technique has demonstrated significantly better outcomes over the others, and each technique has specific indications, advantages, and pitfalls. Indeed, ETN could be suitable for central WOPNs, while VARD or PD could be suggested for lateral collections. A combination of different approaches is feasible and could significantly optimize the clinical management in critically ill patients affected by complicated necrotizing pancreatitis. SN - 1749-7922 UR - https://www.unboundmedicine.com/medline/citation/28331537/Combined_totally_mini_invasive_approach_in_necrotizing_pancreatitis:_a_case_report_and_systematic_literature_review_ L2 - https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0126-5 DB - PRIME DP - Unbound Medicine ER -