Department of Gastroenterology and Hepatology, Chonnam National University Medical School, Gwangju, South Korea.
Medicine (Baltimore). 2021 Apr 23;100(16):e25466. doi: 10.1097/MD.0000000000025466.
Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears.
A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever.
The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN.
EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy.
In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.
内镜超声引导下组织获取（EUS-TA）已成为诊断胰腺实性病变的标准方法。EUS-TA 相对安全，但也可能发生各种并发症。感染性胰腺坏死（IPN）是一种罕见但严重的并发症。最新指南建议，所有 IPN 患者的侵袭性干预都应延迟至出现隔离性坏死。
一名 73 岁男性因胆囊和胰腺双重原发性癌就诊于我院。我们对转移性胰尾癌进行了 EUS-TA 以确认组织学诊断。术后 6 天，他出现腹痛和发热。
患者的实验室检查结果显示白细胞增多和 C 反应蛋白升高。CT 扫描显示胰尾和胃周围有积液，患者被诊断为 IPN。
对 IPN 进行了 EUS 引导下内镜经壁引流（EUS-TD）治疗。在进行抗生素治疗两天后，他的 CRP 水平急剧下降，在术后 5 天开始接受化疗治疗胰腺导管腺癌（PDAC）。在化疗后 15 天，他无并发症出院。
在选择的 PDAC 患者中，对于 EUS-TA 并发症引起的 IPN，早期内镜引流可能是一种推荐的治疗方法。
