Department of Internal Medicine I, Krankenhaus Siloah, Klinikum Region Hannover, Hannover, Germany.
Eur J Gastroenterol Hepatol. 2010 Feb;22(2):237-40. doi: 10.1097/MEG.0b013e32832dd7f9.
A 73-year-old male developed fever and jaundice 6 months after an episode of acute necrotizing pancreatitis. During endoscopic retrograde cholangiography, a distal bile duct compression was documented and stent insertion led to resolution of jaundice, however, the febrile condition persisted. A pancreatic necrosis measuring 11x7 cm was shown by computed tomography (CT) and the patient was referred for necrosectomy. During the first endoscopic session, spontaneous drainage of pus was observed in the duodenal bulb. Therefore, the pancreatic necrosis was first punctured under endoscopic ultrasound-guidance transduodenally. The pancreatic necrosis was then additionally punctured transgastrically and the necrotic cavity was entered with a standard upper gastrointestinal scope. Despite extensive irrigation and necrosectomy we felt the transgastric approach was not sufficient enough to treat the large necrotic cavity and decided to perform the further treatment by using both accesses. Endoscopic debridement was repeated daily through the transgastric as well as the transduodenal approach over 5 days. The clinical condition of the patient dramatically improved and he became afebrile. Two months after the initial endoscopic necrosectomy, a CT scan showed nearly complete resolution of the pancreatic necrosis and the bile duct stenosis resolved. Six months later, CT scans showed no residual necrosis and an atrophic but otherwise normal pancreas.
一位 73 岁男性在急性坏死性胰腺炎发作 6 个月后出现发热和黄疸。在行内镜逆行胰胆管造影时，发现胆总管下段受压，支架置入后黄疸消退，但发热持续存在。计算机断层扫描（CT）显示胰腺坏死 11x7cm，患者被转介行坏死组织清除术。在第一次内镜检查时，十二指肠球部观察到脓液自发性引流。因此，首先在内镜超声引导下经十二指肠穿刺胰腺坏死灶。然后经胃穿刺胰腺坏死灶，并使用标准上消化道内镜进入坏死腔。尽管进行了广泛的灌洗和坏死组织清除术，但我们认为经胃入路不足以治疗大的坏死腔，决定使用两种入路进行进一步治疗。经胃和经十二指肠入路每天重复进行内镜清创，共 5 天。患者的临床状况显著改善，体温恢复正常。初次内镜坏死组织清除术后 2 个月，CT 扫描显示胰腺坏死几乎完全消退，胆管狭窄也得到缓解。6 个月后，CT 扫描显示无残留坏死，胰腺呈萎缩但功能正常。
