Minimally invasive necrosectomy using resectoscope for intractable necrotic abscess after severe acute pancreatitis: report of a case.
METHODS
A 43-year-old male was admitted to a regional hospital after being diagnosed with severe acute pancreatitis. The patient developed a pancreatic abscess with multiple organ failure. He was transferred to our hospital in critical condition. Computed tomography scans revealed enormous pancreatic abscesses expanding from the pancreatic body to the pelvic area. Pigtail catheters were inserted for percutaneous drainage. Even after the drainage, the abscesses did not improve. Percutaneous necrosectomy was performed using a resectoscope through a fistulous tract. After two necrosectomies, the CT scans showed remarkable decreases in the size of the cystic abscesses, and finally, no abscesses were detectable on the 117 th hospital day.


CONCLUSIONS
We herein present the first description of a minimally invasive technique, using resectoscopy, for treating intractable pancreatic abscesses. Future studies are warranted to examine the efficacy and safety of this procedure for difficult cases, as presented in this report.
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan. kiku@m.ehime-u.ac.jp.
Satoshi
S
Kikuchi
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Yuji
Y
Watanabe
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Koichi
K
Sato
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Hironori
H
Matsumoto
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Kensuke
K
Umakoshi
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Emergency Medicine, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Mayuki
M
Aibiki
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Minimum invasion; Pancreatitis; Surgical therapy