Preoperative percutaneous drainage effective for severe acute pancreatitis with gastric and duodenal and colonic necrosis; a case report

Abstract

A 38-year-old man was hospitalized with severe alcoholic acute pancreatitis. Despite treatment, he had persistent abdominal pain and fever. CT examination revealed gastric/duodenal/transverse colonic necrosis with fluid collection at twelve days of hospitalization. The patient was treated with percutaneous drainage to avoid surgery in the acute phase. After 47 days, CT indicated walled-off necrosis in the lower abdominal cavity. Percutaneous drainage was performed again. The patient’s condition stabilized, and minimal invasive treatment was employed to ensure adequate time for preparation for the surgery. Necrosectomy, necrotic intestinal resection, and reconstruction were performed 96 days after admission. Total pancreatectomy, total gastrectomy （Roux-en-Y anastomosis）, choledochojejunostomy, colostomy, and jejunostomy were completed. The patient was discharged 44 days after surgery without any postoperative complications.