Zhang HY, He CC. Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report. World J Gastrointest Surg 2024; 16(2): 609-615 [PMID: 38463375 DOI: 10.4240/wjgs.v16.i2.609]
Corresponding Author of This Article
Chen-Cong He, Doctor, Attending Doctor, Department of General Medicine, Jinhua Guangfu Hospital, No. 1296 Huancheng North Road, Jinhua 321001, Zhejiang Province, China. 13575943438@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 609-615 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.609
Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report
Hong-Ying Zhang, Chen-Cong He
Hong-Ying Zhang, Department of Gastroenterology, Jinhua People's Hospital, Jinhua 321000, Zhejiang Province, China
Chen-Cong He, Department of General Medicine, Jinhua Guangfu Hospital, Jinhua 321001, Zhejiang Province, China
Author contributions: Zhang HY contributed to manuscript writing and editing, and data collection; He CC assisted in writing up the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen-Cong He, Doctor, Attending Doctor, Department of General Medicine, Jinhua Guangfu Hospital, No. 1296 Huancheng North Road, Jinhua 321001, Zhejiang Province, China. 13575943438@163.com
Received: October 8, 2023 Peer-review started: October 8, 2023 First decision: December 6, 2023 Revised: December 17, 2023 Accepted: January 15, 2024 Article in press: January 15, 2024 Published online: February 27, 2024
Abstract
BACKGROUND
Infected acute necrotic collection (ANC) is a fatal complication of acute pancreatitis with substantial morbidity and mortality. Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis; however, there is great controversy about the optimal drainage time, and better treatment should be explored.
CASE SUMMARY
We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancreatitis; conservative treatment was ineffective, and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography (CT). Endoscopic ultrasonography (EUS) suggested hyperechoic necrotic tissue within the cyst cavity. The wall was not completely mature, and the culture of the puncture fluid was positive for A-haemolytic Streptococcus. Thus, the final diagnosis of ANC infection was made. The necrotic collection was not walled off and contained many solid components; therefore, the patient underwent EUS-guided aspiration and lavage. Two weeks after the collection was completely encapsulated, pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography (ERCP) was performed, and the patient was subsequently successfully discharged. On repeat CT, the pancreatic cysts had almost disappeared during the 6-month follow-up period after surgery.
CONCLUSION
Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.
Core Tip: Infected acute necrotic collection (ANC) is a potentially fatal disease. Endoscopic ultrasound (EUS)-guided fine-needle aspiration is recommended when the diagnosis is unclear. Endoscopic drainage is the optimal treatment for infected necrosis and is generally performed 4 wk after onset. Herein, we present a case in which an infected ANC was misdiagnosed as a pancreatic pseudocyst and was successfully treated by early EUS-guided aspiration and lavage combined with late endoscopic retrograde cholangiopancreatography catheter drainage. EUS-guided aspiration and lavage may be used as a bridge while waiting for the necrotic collection to be fully encapsulated before draining.
