Branco Joana C, Cardoso Mariana F, Lourenço Luís Carvalho, Santos Liliana, Horta David Valadas, Coimbra Élia, Reis Jorge A
Serviço de Gastrenterologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal.
Serviço de Imagiologia, Hospital Cruz Vermelha, Lisbon, Portugal.
GE Port J Gastroenterol. 2018 Sep;25(5):253-257. doi: 10.1159/000484939. Epub 2017 Dec 7.
Walled-off necrosis (WON) is a potentially lethal late complication of acute pancreatitis (AP) and occurs in less than 10% of AP cases. It can be located in or outside the pancreas. When infected, the mortality rate increases and can reach 100% if the collection is not drained. Its treatment is complex and includes, at the beginning, intravenous antibiotics, which permit sepsis control and a delay in the therapeutic intervention, like drainage. Nowadays, a minimally invasive approach is advised. Depending on the location of the collection, computed tomography (CT)-guided drainage or endoscopic necrosectomy are the primary options, then complemented by surgical necrosectomy if needed. Infected WON of the abdominal wall has been rarely described in the literature and there is no report of any infection with .
We present the case of a 61-year-old man with necrotizing AP complicated by WON of the left abdominal wall, infected with that was successfully treated with CT-guided percutaneous drainage and intravenous antibiotics.
Infected WON accounts for considerable mortality and its location in the abdominal wall is rare; it can be treated with antibiotics and CT-guided drainage with no need for further intervention.
包裹性坏死(WON)是急性胰腺炎(AP)一种潜在致命的晚期并发症,发生率不到AP病例的10%。它可位于胰腺内或胰腺外。感染时死亡率会升高,如果积液不引流,死亡率可达100%。其治疗复杂,一开始包括静脉使用抗生素,这有助于控制脓毒症并延迟如引流等治疗干预。如今,建议采用微创方法。根据积液位置,计算机断层扫描(CT)引导下引流或内镜坏死组织清除术是主要选择,必要时辅以手术坏死组织清除术。腹壁感染性WON在文献中鲜有描述,且无任何感染报告。
我们报告一例61岁男性,坏死性AP并发左腹壁WON,感染 ,经CT引导下经皮引流和静脉使用抗生素成功治疗。
感染性WON导致相当高的死亡率,且其位于腹壁的情况罕见;可通过抗生素和CT引导下引流治疗,无需进一步干预。