Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature

Figure 1 Contrast-enhanced computed tomography on postoperative day 42. The heterogeneous enhancement and fluid collection (surrounded by white arrows) in the pancreatic body and tail, which were consistent with walled-off necrosis (WON). A: Caudal slice of the WON; B: Cranial slice of the WON.

Figure 2 Computed tomography on postoperative day 42. These computed tomography showed that the walled-off necrosis (arrows) was compressing the horizontal part of the duodenum (outlined in the white line). A: Coronal; B: Axial.

Figure 3 Endoscopic drainage of walled-off necrosis on postoperative day 50. A: Dilation of the puncture site of a gastric wall using a dilation balloon (arrow); B: Additional wire (arrow) insertion; C: Double pig tail plastic stent (arrowhead) and pigtail nasal drainage tube (arrow) placement.

Figure 4 Abdominal computed tomography showing gradual shrinkage of walled-off necrosis. A: On postoperative day 42 (before the drainage) the diameter of walled-off necrosis (WON) (surrounded by arrows) was 18.5 cm; B: On postoperative day 53 (3 days after the first drainage) the diameter of WON (surrounded by arrows) was 16 cm; C: On postoperative day 63 (13 days after the first drainage, before the second drainage) the diameter of WON (surrounded by arrows) was 18 cm; D: On postoperative day 165 (115 days after the first drainage, 78 days after the second drainage) WON (surrounded by arrows) almost disappeared.

Figure 5 Image examination proved the fistula between walled-off necrosis and the duodenum. A: The upper gastrointestinal tract contrast study showing a fistula between the walled-off necrosis (white circle) and duodenum (white arrow); B: Endoscopy showing the position of the fistula (black arrow). WON: Walled-off necrosis.