Successful resolution of gastric perforation caused by a severe complication of pancreatic walled-off necrosis: A case report

Figure 1 Abdominal contrast-enhanced computed tomography images in a 45-year-old man. A: Adjacent to the huge walled-off necrosis, there is a wall defect, demonstrating perforation of the stomach fundus (arrowheads) and splenic infarction (white arrow); B: Contrast-enhanced computed tomography (CT) scanning demonstrated the huge walled-off necrosis at the intra- (arrowheads) and extrapancreatic areas (white arrows); C: Axial view of contrast-enhanced CT image; D: Coronary view of portal venous phase CT on postoperative day 18 shows significant wall defect on previous staple line (arrowheads); E and F: Axial and coronary views of portal venous phase CT at the 3-mo follow-up. CT images show improved process of loculated fluid collection with air bubble at pancreatic bed and left subphrenic space.

Figure 2 Treatment. A: 45-year-old man is diagnosed with a 3-cm gastric perforation at the anastomosis site on postoperative day 18; B: A polyurethane sponge is inserted into the cavity of the anastomotic leak with nasogastric continuous suction; C: The perforation site is downsized with granulation tissue during the fourth endoscopic vacuum-assisted closure (EVAC); D: The cavity is closed after seven EVAC procedures; E: Follow-up upper gastrointestinal radiography shows no contrast leakage from the stomach.

Figure 3 Surgical specimen after distal pancreatectomy, splenectomy, and gastric wedge resection. Note that the pancreatic walled-off necrosis is ruptured during operation. Each specimen is resected separately.