Successful management of necrotizing pancreatitis by percutaneous necrosectomy after orthotopic liver transplant for paracetamol induced acute liver failure: a case report.
OBJECTIVE
Acute pancreatitis, which can develop after any whole-organ transplant, is often associated with immunosuppression. Pancreatitis that complicates a liver transplant can be a significant problem that results in a high mortality rate.


METHODS
We describe the successful use of minimally invasive techniques to treat severe acute pancreatitis. To our knowledge, this is the first reported case in which major laparotomy was precluded by the use of percutaneous necrosectomy to manage necrotizing pancreatitis in a liver transplant recipient. We also briefly review the published literature on severe acute pancreatitis in liver transplant recipients.


RESULTS
Our patient, who had a Model for End- Stage Liver Disease score of 39 when transplanted and an Acute Physiology and Chronic Health Evaluation II score of 19 when infected necrosis in his pancreas was diagnosed, recovered completely after 92 days of hospitalization. He underwent 2 percutaneous drainage procedures and 3 percutaneous necrosectomies to treat his pancreatic complication. A review of the literature revealed that severe acute pancreatitis significantly increases morbidity and mortality in liver transplant recipients. Unlike necrotizing pancreatitis, which develops outside the context of liver transplant where there is a distinct shift towards minimally invasive procedures, infected necrosis associated with fulminant liver failure or a liver transplant is usually treated with open necrosectomy.


CONCLUSIONS
Severe acute pancreatitis in liver transplant recipients should be managed exactly as it is in patients who have not received a liver transplant. Anatomically guided minimally invasive necrosectomy appears to be beneficial, especially when patients are critically unwell, as they are following a liver transplant.
Lochan
Rajiv
R
Department of Hepato-Pancreato-Biliary and Organ Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Charnley
Richard M
RM
French
Jeremy J
JJ
Al-Mukhtar
Ahmed
A
Hudson
Mark
M
Manas
Derek M
DM
White
Steve A
SA
D000082:Acetaminophen / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010180:Pancreatectomy / Q000379:methods; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen