PERCUTANEOUS ENDOSCOPIC NECROSECTOMY AFTER PERCUTANEOUS DRAINAGE FOR PANCREATIC CANCER WITH EXTENSIVE WALLED-OFF NECROSIS AFTER SELF-EXPANDABLE METALLIC STENT PLACEMENT: A CASE REPORT

Abstract

A 64-year-old woman who received chemotherapy for unresectable pancreatic head cancer with multiple liver metastases developed a pancreatic fistula after uncovered self-expandable metallic stent (SEMS) insertion for management of distal malignant biliary obstruction. Owing to SEMS placement, we could not perform successful endoscopic transpapillary pancreatic duct drainage. Endoscopic ultrasound-guided pancreatic duct drainage facilitated adequate dilation of the main pancreatic duct. However, walled-off necrosis (WON) spread to the iliopsoas and tailorʼs muscles with concomitant infection. Therefore, we performed percutaneous endoscopic necrosectomy (PEN) using a small-diameter endoscope in addition to percutaneous drainage to treat the WON. This case report highlights the usefulness of percutaneous drainage and PEN as alternative combination treatment for surgical drainage in cases of extensive WON.