WALLED –OFF PANCREATIC NECROSIS AS COMPLICATION OF ACUTE PANCREATITIS AFTER SARS-COV-2 INFECTION: ENDOSCOPIC MANGEMENT BY USING HOT AXIOS SYSTEM. A CASE REPORT.
EAES Academy. Tontoli S. 07/05/22; 366519; P236
Dr. Simone Tontoli
Contributions
Contributions
Abstract
Aims
Approximately 15% of patients with severe acute pancreatitis will develop a serious complication called Walled-Off Pancreatic Necrosis (WOPN), defined as an encapsulated collection of pancreatic or peripancreatic necrosis with a well-defined inflammatory wall, usually occurs ≥4 weeks after onset of necrotising pancreatitis. WOPN is burdened by a very high mortality (20-30%) which can become higher (70-93%) with the presence of infected necrosis. On average, 40% of patients with necrotizing pancreatitis develop organ failure and 50% of the severe form of pancreatitis with infected necrosis or haemorrhage die post-operatively.
During the Covid Era, many cases of idiopathic, severe, acute pancreatitis in patients with SARS-CoV-2 infection or in the immediate post-negativization period were described.
We report a case in whom SARS-CoV-2 caused acute severe hemorrhagic necrotizing pancreatitis and the minimal invasive strategies implemented, which can considered maybe the only way to improve the outcomes for patients with WOPN.
Methods
A 68-year-old woman, whit a history of PCR confirmed SARS-CoV-2 infection three weeks earlier, not vaccinated, was admitted to our unit with acute abdominal pain with both laboratoristic and radiological studies suggestive of severe hemorrhagic necrotizing pancreatitis complicated by pancreatic infected pseudocysts and upper intestinal obstruction. To achieve hemodynamic stability aggressive fluid resuscitation was started. Then the patient was treated by nonsurgical approach: a percutaneous drainage was placed in the peri-splenic infected necrotic collection. She also began a targeted antibiotic therapy against E. fecium with gradual clinical improvement.
A CT scan performed two weeks after the procedure showed the reduction of collection, but persistence of a peri-pancreatic collection with compression of the gastric body. Therefore the patient underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using the Hot AXIOS metallic stent.
Results
We obtained the complete drainage of necrotic collection and resolution of occlusive symptoms; the patient was discharged in free diet and with restored glycemic control. At eight months follow-up the woman was in good condition with complete recovery.
Conclusion
Although WOPN is burdened by a very high mortality, we believe that a multidisciplinary and mini-invasive approach can be considered the first-line treatment expecially to manage septic and obstructive complications, reducing perioperative mortality.
Approximately 15% of patients with severe acute pancreatitis will develop a serious complication called Walled-Off Pancreatic Necrosis (WOPN), defined as an encapsulated collection of pancreatic or peripancreatic necrosis with a well-defined inflammatory wall, usually occurs ≥4 weeks after onset of necrotising pancreatitis. WOPN is burdened by a very high mortality (20-30%) which can become higher (70-93%) with the presence of infected necrosis. On average, 40% of patients with necrotizing pancreatitis develop organ failure and 50% of the severe form of pancreatitis with infected necrosis or haemorrhage die post-operatively.
During the Covid Era, many cases of idiopathic, severe, acute pancreatitis in patients with SARS-CoV-2 infection or in the immediate post-negativization period were described.
We report a case in whom SARS-CoV-2 caused acute severe hemorrhagic necrotizing pancreatitis and the minimal invasive strategies implemented, which can considered maybe the only way to improve the outcomes for patients with WOPN.
Methods
A 68-year-old woman, whit a history of PCR confirmed SARS-CoV-2 infection three weeks earlier, not vaccinated, was admitted to our unit with acute abdominal pain with both laboratoristic and radiological studies suggestive of severe hemorrhagic necrotizing pancreatitis complicated by pancreatic infected pseudocysts and upper intestinal obstruction. To achieve hemodynamic stability aggressive fluid resuscitation was started. Then the patient was treated by nonsurgical approach: a percutaneous drainage was placed in the peri-splenic infected necrotic collection. She also began a targeted antibiotic therapy against E. fecium with gradual clinical improvement.
A CT scan performed two weeks after the procedure showed the reduction of collection, but persistence of a peri-pancreatic collection with compression of the gastric body. Therefore the patient underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using the Hot AXIOS metallic stent.
Results
We obtained the complete drainage of necrotic collection and resolution of occlusive symptoms; the patient was discharged in free diet and with restored glycemic control. At eight months follow-up the woman was in good condition with complete recovery.
Conclusion
Although WOPN is burdened by a very high mortality, we believe that a multidisciplinary and mini-invasive approach can be considered the first-line treatment expecially to manage septic and obstructive complications, reducing perioperative mortality.
Aims
Approximately 15% of patients with severe acute pancreatitis will develop a serious complication called Walled-Off Pancreatic Necrosis (WOPN), defined as an encapsulated collection of pancreatic or peripancreatic necrosis with a well-defined inflammatory wall, usually occurs ≥4 weeks after onset of necrotising pancreatitis. WOPN is burdened by a very high mortality (20-30%) which can become higher (70-93%) with the presence of infected necrosis. On average, 40% of patients with necrotizing pancreatitis develop organ failure and 50% of the severe form of pancreatitis with infected necrosis or haemorrhage die post-operatively.
During the Covid Era, many cases of idiopathic, severe, acute pancreatitis in patients with SARS-CoV-2 infection or in the immediate post-negativization period were described.
We report a case in whom SARS-CoV-2 caused acute severe hemorrhagic necrotizing pancreatitis and the minimal invasive strategies implemented, which can considered maybe the only way to improve the outcomes for patients with WOPN.
Methods
A 68-year-old woman, whit a history of PCR confirmed SARS-CoV-2 infection three weeks earlier, not vaccinated, was admitted to our unit with acute abdominal pain with both laboratoristic and radiological studies suggestive of severe hemorrhagic necrotizing pancreatitis complicated by pancreatic infected pseudocysts and upper intestinal obstruction. To achieve hemodynamic stability aggressive fluid resuscitation was started. Then the patient was treated by nonsurgical approach: a percutaneous drainage was placed in the peri-splenic infected necrotic collection. She also began a targeted antibiotic therapy against E. fecium with gradual clinical improvement.
A CT scan performed two weeks after the procedure showed the reduction of collection, but persistence of a peri-pancreatic collection with compression of the gastric body. Therefore the patient underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using the Hot AXIOS metallic stent.
Results
We obtained the complete drainage of necrotic collection and resolution of occlusive symptoms; the patient was discharged in free diet and with restored glycemic control. At eight months follow-up the woman was in good condition with complete recovery.
Conclusion
Although WOPN is burdened by a very high mortality, we believe that a multidisciplinary and mini-invasive approach can be considered the first-line treatment expecially to manage septic and obstructive complications, reducing perioperative mortality.
Approximately 15% of patients with severe acute pancreatitis will develop a serious complication called Walled-Off Pancreatic Necrosis (WOPN), defined as an encapsulated collection of pancreatic or peripancreatic necrosis with a well-defined inflammatory wall, usually occurs ≥4 weeks after onset of necrotising pancreatitis. WOPN is burdened by a very high mortality (20-30%) which can become higher (70-93%) with the presence of infected necrosis. On average, 40% of patients with necrotizing pancreatitis develop organ failure and 50% of the severe form of pancreatitis with infected necrosis or haemorrhage die post-operatively.
During the Covid Era, many cases of idiopathic, severe, acute pancreatitis in patients with SARS-CoV-2 infection or in the immediate post-negativization period were described.
We report a case in whom SARS-CoV-2 caused acute severe hemorrhagic necrotizing pancreatitis and the minimal invasive strategies implemented, which can considered maybe the only way to improve the outcomes for patients with WOPN.
Methods
A 68-year-old woman, whit a history of PCR confirmed SARS-CoV-2 infection three weeks earlier, not vaccinated, was admitted to our unit with acute abdominal pain with both laboratoristic and radiological studies suggestive of severe hemorrhagic necrotizing pancreatitis complicated by pancreatic infected pseudocysts and upper intestinal obstruction. To achieve hemodynamic stability aggressive fluid resuscitation was started. Then the patient was treated by nonsurgical approach: a percutaneous drainage was placed in the peri-splenic infected necrotic collection. She also began a targeted antibiotic therapy against E. fecium with gradual clinical improvement.
A CT scan performed two weeks after the procedure showed the reduction of collection, but persistence of a peri-pancreatic collection with compression of the gastric body. Therefore the patient underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using the Hot AXIOS metallic stent.
Results
We obtained the complete drainage of necrotic collection and resolution of occlusive symptoms; the patient was discharged in free diet and with restored glycemic control. At eight months follow-up the woman was in good condition with complete recovery.
Conclusion
Although WOPN is burdened by a very high mortality, we believe that a multidisciplinary and mini-invasive approach can be considered the first-line treatment expecially to manage septic and obstructive complications, reducing perioperative mortality.
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