Noh BG, Yoon M, Park YM, Seo HI, Kim S, Hong SB, Park JK, Lee MW. Successful resolution of gastric perforation caused by a severe complication of pancreatic walled-off necrosis: A case report. World J Clin Cases 2023; 11(26): 6298-6303 [PMID: 37731568 DOI: 10.12998/wjcc.v11.i26.6298]
Corresponding Author of This Article
Myunghee Yoon, MD, PhD, Professor, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 49241, South Korea. ymh@pusan.ac.kr
Research Domain of This Article
Surgery
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 Clin Cases. Sep 16, 2023; 11(26): 6298-6303 Published online Sep 16, 2023. doi: 10.12998/wjcc.v11.i26.6298
Successful resolution of gastric perforation caused by a severe complication of pancreatic walled-off necrosis: A case report
Byeong Gwan Noh, Myunghee Yoon, Young Mok Park, Hyung-Il Seo, Suk Kim, Seung Baek Hong, Jae Kyun Park, Moon Won Lee
Byeong Gwan Noh, Myunghee Yoon, Young Mok Park, Hyung-Il Seo, Jae Kyun Park, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Suk Kim, Seung Baek Hong, Department of Radiology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Moon Won Lee, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Author contributions: Noh BG, Yoon M, Park YM, Seo HI, Kim S, Hong SB, Park JK, and Lee MW contributed to the acquisition of data for this study; Noh BG analyzed the data and wrote the manuscript; Yoon Mh designed the case report; and all authors have read and approved the final manuscript.
Supported bythe Clinical Research Grant from Pusan National University Hospital in 2023.
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 to disclose.
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: Myunghee Yoon, MD, PhD, Professor, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 49241, South Korea. ymh@pusan.ac.kr
Received: June 21, 2023 Peer-review started: June 21, 2023 First decision: July 28, 2023 Revised: August 11, 2023 Accepted: August 23, 2023 Article in press: August 23, 2023 Published online: September 16, 2023 Processing time: 79 Days and 1.2 Hours
Abstract
BACKGROUND
Pancreatic walled-off necrosis (WON) rarely causes critical gastric necrosis and perforation, which may develop when pancreatic WON squashes against the stomach. The Atlanta 2012 guidelines were introduced for acute pancreatitis and its related clinical entities. However, there are few reported cases describing the clinical course and resolution of pancreatic WON.
CASE SUMMARY
We report the case of a 45-year-old man who presented to the urgent emergency department with gastric perforation caused by a severe complication of pancreatic WON on computed tomography. The patient underwent an emergency distal pancreatectomy, splenectomy, and gastric wedge resection. Postoperative findings showed re-perforation of the gastric wall at a previously resected margin. Furthermore, endoscopic examination revealed an ulcerative area with a defect in the fundus. After diagnostic endoscopy, endoscopic vacuum-assisted closure was performed, and continuous suction was transferred over all tissues in contact with the sponge surface. The patient recovered without any further complications and was discharged in good condition at postoperative week 8. No recurrence occurred during the 6-mo follow-up period.
CONCLUSION
When managing a patient with serious gastric perforation complicated by pancreatic WON, a multidisciplinary treatment approach should be considered.
Core Tip: Pancreatic walled-off necrosis (WON) rarely causes critical gastric necrosis and perforation. Cases of successful resolution of gastric perforation complicated by pancreatic WON are hardly encountered. Due to their rarity, discussing each clinical experience is necessary.
