[Minimal invasive therapy in a patient with necrotizing pancreatitis and disrupted duct by percutaneous endoscopy: report of a case and review of literature].

A 68-year-old lady was admitted to a primary care centre with abdominal pain. She presented with a tender abdomen and a lipase level of 29 456 U/L. Cholecystectomy had been performed in 1971. Because her clinical state worsened the patient was transferred to our intensive care unit. Computed tomography and contrast ultrasound revealed necrotising pancreatitis. Antibiotics were started immediately. 10 days later the patient became febrile and an area of liquid necrosis between the spleen and the left kidney was drained under sonographic guidance by a 12 Fr pigtail. Every ten days the drain was replaced by a larger one. ERCP revealed a communication between the pancreatic duct and the growing necrotic cavity. A 7 Fr/ 7 cm plastic stent was put in. After 30 days an unsuccessful endoscopic necrosectomy was attempted with the cholangioscope through a 28 Fr peel-away sheath. In a further session an effective percutaneous necrosectomy was possible through a laparascopy trocar with a standard gastroscope. The patient became afebrile and signs of infection decreased. The persisting communication between the pancreatic duct and the necrotic cavity was closed with onyx. In the following days the dimensions of the necrotic cavity decreased rapidly. Finally the patient could be discharged home in good health. Antibiotics were stopped and the percutaneous drain was taken out after some weeks of ambulatory care.