title: Dual drainage using a percutaneous pancreatic duct technique contributed to resolution of severe acute pancreatitis.
abstract: A 66-year-old man was admitted for severe acute alcoholic pancreatitis with infected pancreatic necrosis (IPN). Abdominal computed tomography revealed an inflamed pancreatic head, a dilated main pancreatic duct (MPD), and a large cavity with heterogeneous fluid containing gas adjacent to the pancreatic head, and extending to the pelvis. The cavity was drained percutaneously near the pancreatic head on admission; another tube was inserted into the pelvic cavity on hospital day 3. The drained fluid contained pus with high amylase concentration. Nasopancreatic drainage tube placement was unsuccessfully attempted on hospital day 9. On hospital day 23, percutaneous puncture of the MPD and placement of a pancreatic duct drainage tube was performed. Pancreatography revealed major extravasation from the pancreatic head. The IPN cavity receded; the percutaneous IPN drainage tube was removed on hospital day 58. On hospital day 83, the pancreatic drainage was changed to a transpapillary pancreatic stent, and the patient was discharged. Measuring the amylase concentration of peripancreatic fluid collections can aid in the diagnosis of pancreatic duct disruption; moreover, dual percutaneous necrotic cavity drainage plus pancreatic duct drainage may be essential for treating IPN. If transpapillary drainage tube placement is difficult, percutaneous pancreatic duct drainage may be feasible.
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan. tatsunori-sato@i.shizuoka-pho.jp.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Satoh
authors.affiliation: Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kikuyama
authors.affiliation: Department of Surgery, Shinshiro Municipal Hospital, Aichi, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yokoi
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawaguchi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000681:Amylases / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods*; D006801:Humans; D008297:Male; D009336:Necrosis / Q000175:diagnosis / Q000628:therapy; D010179:Pancreas / Q000473:pathology; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D019512:Pancreatitis, Alcoholic / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D000681:Amylases
keywords: Amylase; Infected pancreatic necrosis; Nasopancreatic drainage; Pancreatic duct disruption; Pancreatic fistula