Endoscopic treatment for infectious pancreatic necrosis with retroperitoneal perforation after endoscopic sphincterotomy following lithotripsy

Abstract

91-year-old woman was admitted to our hospital for treatment of the bile duct stones. We performed EST, removed the stones with balloon catheter, and placed ENBD-tube. After that the patient complained severe abdominal pain and CT showed retroperitoneal perforation and acute pancreatitis. In consideration of the risk of surgical treatment, conservative therapy was performed. Unfortunately, infectious acute necrotic collection (ANC) was confirmed by CT on the 9th day after EST. Therefore, we deployed a fully-covered self-expandable metallic stent to close the fistula, and subsequently performed EUS-guided transgastric drainage. Inflammatory reaction was continued, and ANC changed to walled-off necrosis (WON). Thus, we added the treatment of endoscopic necrosectomy (EN) twice a week in 4 weeks. Finally, WON mostly disappeared and her condition completely improved.