Abstract
Endoscopic nasobiliary drainage (ENBD) was performed in a 68-year-old man with biliary pancreatitis. Since he developed infected pancreatic necrosis a few weeks after undergoing ENBD, we removed necrotic pancreas on the affected area. On the 97th day after admission, he experienced hemorrhagic shock due to bleeding from the necrotic pancreas. Laparotomy was performed to establish hemostasis. A duodenal perforation developed on the 99th day, thereby necessitating open drainage. Negative pressure wound therapy (NPWT) was initiated to drain the fluids for reducing skin irritation and to promote granulation for wound closure. In addition, we placed drains in the cavity through the perforation in order to prevent its spreading over the whole abdomen. A perforation in the transverse colon was observed on the 19th day after duodenal perforation had developed, and diverting ileostomy was performed. NPWT was continued, and the colonic perforation was eventually covered by a granular mass. No leakage of intestinal contents was observed during the treatment. The successful management of this patient with NPWT for wound surface and depths indicates that it is effective for treating infected pancreatic necrosis complicated by intestinal perforations.
