title: A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis.
abstract: BACKGROUND
  In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites.
  
  
  METHODS
  A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography (CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fluid administration, and electrolyte replacement. However, on the 14(th) day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fluid. Percutaneous transgastric drainage was performed and a 14 French gauge (Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space.
  
  
  RESULTS
  After drainage, the patient recovered well and the last catheter was removed on day 123 of admission.
  
  
  CONCLUSIONS
  Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Takero
authors.initials: T
authors.lastname: Terayama
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa 761-0793, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kiriu
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Koido
authors.affiliation: Division of Radiology, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ichinose
authors.affiliation: Division of Radiology, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Morimoto
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan.
authors.forename: Kuroda
authors.initials: K
authors.lastname: Yasuhiro
keywords: Acute necrotizing pancreatitis; Minimally invasive technique; Percutaneous drainage