(Un)conventional complicated pancreatitis

Česká verzia

Authors: Rybár M. ¹; Horný I. ²
Authors place of work: Gastroenterologická ambulance, Interní oddělení, Nemocnice Český Krumlov, a. s. ¹; Gastroenterologické centrum, Interního oddělení, Nemocnice Strakonice, a. s. ²
Published in the journal: Gastroent Hepatol 2021; 75(1): 61-67
Category: Klinická a experimentální gastroenterologie: kazuistika
doi: https://doi.org/10.48095/ccgh202161

Summary

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

Keywords:

acute pancreatitis – walled-off pancreatic necrosis – EUS drainage – stent migration – complications – enterotomy

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