Abstract :
Background: Acute pancreatitis has multiple aetiologies. Acute pancreatitis is divided into interstitial oedematous pancreatitis or necrotizing pancreatitis based on morphology. According to the revised Atlanta classification necrotizing pancreatitis is further subdivided into acute necrotic collection if the disease develops within 4 weeks or walled-off necrosis if the disease develops after 4 weeks.
Case Presentation: We report a case of 40 years male, with acute pancreatitis for 1 month, presenting with decreased appetite, loss of weight, and tremors of extremities. CT featured active necrotizing pancreatitis with peripancreatic necrosis, collections, and superadded infection which was drained by percutaneous pigtail catheter.
Discussion: Percutaneous pigtail insertion controls the symptoms and this procedure is effective in the management of patients with necrotizing pancreatitis. It serves as definitive or intermediate therapy to surgical necrosectomy in patients who are unfit for surgery. Percutaneous pigtail insertion can be done following a peritoneal or retroperitoneal approach, both approaches have different advantages and it is the choice of the radiologist and the location of the residual collections. The disadvantages are duct leak and it needs multiple check CT’s but in well trained and experienced hands the disadvantages are minimized.
Conclusion: Percutaneous pigtail insertion is an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery. It can prevent life-threatening complications and it can be considered as a primary modality in treating a patient with walled-off necrosis.
Percutaneous pigtail insertion an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery can be considered as the primary modality of choice in treating patients with walled-off necrosis of the pancreas.
Keyword :
Walled off necrosis, Interstitial oedematous pancreatitis, Necrosectomy, Percutaneous pig tail insertion, Peritoneal and retroperitoneal approach