Advertisement

Digestive Diseases and Sciences

, Volume 64, Issue 10, pp 3020–3023 | Cite as

Necrotizing Pancreatitis: Common and Uncommon Sequelae and Solutions

  • Amir Kalani
  • Jennifer Phan
  • Amir Taefi
  • Monica Deshmukh
  • Ashley Yamamoto
  • James H. TabibianEmail author
Case Report
  • 83 Downloads

Introduction

Acute pancreatitis is the most common indication for hospitalization in the USA among all digestive diseases [1]. Cases of acute pancreatitis may be complicated by various local as well as systemic sequelae. Fluid accumulation in and/or around the pancreas represents a common complication and can lead to pseudocyst or walled-off pancreatic necrosis (WOPN) formation, which, in some instances, may cause mass effect on surrounding structures. Here, we present the first reported case of acute portal hypertension with new onset ascites formation due to compression of the main portal vein by a large WOPN collection. In addition, we describe the multimodal approach to addressing the patient’s comorbidities, dual anti-platelet therapy need, and large-volume ascites (a relative contraindication to transluminal procedures) in the development of a comprehensive treatment plan for the WOPN and its associated complications.

Case Presentation

A 69-year-old man with hypertension,...

Keywords

Ascites Portal vein compression Therapeutic endoscopy Endoscopic stenting Multimodal imaging 

Notes

Author’s contribution

JHT, MD, and AY acquired data and images; AT and AK drafted the manuscript; JHT, JP, and MD provided critical revisions of the manuscript; all authors approved of the final manuscript.

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Peery AF, Dellon ES, Lund J, Crockett SD, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:e1171–e1173.CrossRefGoogle Scholar
  2. 2.
    Forsmark CE. The clinical problem of biliary acute necrotizing pancreatitis: epidemiology, pathophysiology, and diagnosis of biliary necrotizing pancreatitis. J Gastrointest Surg. 2001;5:235–239.CrossRefGoogle Scholar
  3. 3.
    Sahu S, Raghuvanshi S, Agarwal S, Bahl D, Sachan P. Gastric outlet obstruction due to pancreatic pseudocyst. Internet J Surg. 2006;12:1–5.Google Scholar
  4. 4.
    Podgurski L, Hou G, Shaffer K. CT imaging of a pancreatic pseudocyst: clinical and anatomic implications. Radiol Case Rep. 2015;2:107–108.CrossRefGoogle Scholar
  5. 5.
    Bang JY, Wilcox CM, Trevino J, Ramesh J, Peter S, et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol. 2013;28:1725–1732.CrossRefGoogle Scholar
  6. 6.
    Bakker O, Santvoort H, Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–1061.CrossRefGoogle Scholar
  7. 7.
    Varadarajulu S, Bang J, Sutton B, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583–590.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Amir Kalani
    • 1
  • Jennifer Phan
    • 1
  • Amir Taefi
    • 2
  • Monica Deshmukh
    • 3
  • Ashley Yamamoto
    • 3
  • James H. Tabibian
    • 4
    Email author
  1. 1.UCLA Gastroenterology Fellowship Training ProgramVatche and Tamar Manoukian Division of Digestive DiseasesLos AngelesUSA
  2. 2.Division of Gastroenterology and HepatologyUC Davis Medical CenterSacramentoUSA
  3. 3.Department of RadiologyOlive View-UCLA Medical CenterSylmarUSA
  4. 4.Division of Gastroenterology, Department of MedicineOlive View-UCLA Medical CenterSylmarUSA

Personalised recommendations