Endoscopic necrosectomy - When the gastroenterologist faceshis greatest nightmare

ABSTRACT

A 69-year-old woman with severe acute necrotizing pancreatitis underwent a CT-scan, which revealed a peripancreatic collection near the pancreatic body/tail, with heterogeneous content and gas inside, suggestive of an infected walled-off-pancreatic-necrosis (WOPN). The patient was proposed to WOPN transgastric endoscopic drainage. Due to persistence of sepsis, endoscopic necrosectomy was deemed necessary. During the fifth session, the endoscopist noted a large pulsatile vessel at the posterior wall of the collection. Given location and morphologic features, it was assumed that vessel was the splenic artery. The procedure was suspended. (AU)