Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8214-8219
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8214
Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases
Ning Xu, Ya-Qi Zhai, Long-Song Li, Ning-Li Chai
Ning Xu, Ya-Qi Zhai, Long-Song Li, Ning-Li Chai, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Chai NL was the patient’s endoscopist and reviewed the literature; Chai NL and Xu N contributed to manuscript drafting; Xu N wrote the manuscript; Li LS and Zhai YQ were responsible for the revision of the manuscript for significant content; all authors issued final approval for the version to be submitted.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this manuscript.
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:
Corresponding author: Ning-Li Chai, MD, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
Received: May 8, 2021
Peer-review started: May 8, 2021
First decision: June 6, 2021
Revised: June 17, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 26, 2021
Core Tip

Core Tip: Walled-off necrosis (WON) is difficult to differentiate from pancreatic pseudocysts in clinical practice. Imaging modalities such as computed tomography show a lower accuracy than endoscopic ultrasound (EUS) in confirming the diagnosis. With the worldwide application of electrocautery lumen-apposing metal stents, direct endoscopic necrosectomy has emerged as the most effective approach for treating WON. However, bleeding might be induced by direct damage. Here, we present two cases of WON in which the diagnosis was revised by intraoperative EUS and high-risk bleeding was successfully prevented.