Sato K, Shibukawa G, Ueda K, Nakajima Y, Togashi K, Ohira H. Percutaneous endoscopic necrosectomy for walled-off necrosis in the retroperitoneal space of the elderly: A case report. World J Clin Cases 2023; 11(24): 5736-5741 [PMID: 37727710 DOI: 10.12998/wjcc.v11.i24.5736]
Corresponding Author of This Article
Kentaro Sato, MD, Doctor, Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu 969-3492, Fukushima, Japan. www.bobmilk1s.k@gmail.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/
Kentaro Sato, Goro Shibukawa, Kenta Ueda, Yuki Nakajima, Kazutomo Togashi, Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Fukushima, Japan
Author contributions: Sato K and Shibukawa G contributed equally to this work; Ueda K, Nakajima Y, Togashi K and Ohira H involved in the proofreading of manuscript.
Informed consent statement: The patient and the family provided informed written consent prior to this article.
Conflict-of-interest statement: 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: Kentaro Sato, MD, Doctor, Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu 969-3492, Fukushima, Japan. www.bobmilk1s.k@gmail.com
Received: April 8, 2023 Peer-review started: April 8, 2023 First decision: May 12, 2023 Revised: June 19, 2023 Accepted: July 21, 2023 Article in press: July 21, 2023 Published online: August 26, 2023
Abstract
BACKGROUND
Walled-off necrosis (WON) is a late complication of acute pancreatitis possibly with a fatal outcome. Even for WON spreading to the retroperitoneal space, percutaneous endoscopic necrosectomy (PEN) can be an alternate approach to surgical necrosectomy, particularly for the older individuals or patients with poor condition because of WON.
CASE SUMMARY
An 88-year-old man was admitted to our hospital with a jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to improve jaundice; however, post-ERCP pancreatitis developed. The inflammation of pancreatitis spread widely from the right retroperitoneal cavity to the pelvis, and WON was formed 4 wk later. A percutaneous drainage tube was placed into the WON under computed tomography guidance. However, the drainage did not ameliorate clinical symptoms including fever, which assured less invasive necrosectomy. A metallic stent for the upper gastrointestinal (GI) tract was placed from the percutaneous drainage route. An upper GI endoscope was inserted into the inside of the WON through the metallic stent, and the necrotic tissues were bluntly removed with a snare forceps. Ten times of these necrosectomies resulted in the near-complete removal of necrotic tissues. These procedures consequently abated his fever and remarkable improvement in blood tests.
CONCLUSION
PEN for WON occurring in the retroperitoneal space was safe and effective for very old individuals.
Core Tip: Percutaneous endoscopic necrosectomy (PEN) is an approach for the walled-off necrosis (WON) developing in the retroperitoneal space distant from the stomach or duodenum. Surgical necrosectomy is at high risk for older and frail patients, and less invasive drainage methods are ideal. We performed PEN for elderly with WON and were able to complete the treatment safely without complications.
