BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive inte...BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.展开更多
Acute pancreatitis is a common acute inflammatory disease involving the pancreas and peripancreatic tissues or remote organs.The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild,mod...Acute pancreatitis is a common acute inflammatory disease involving the pancreas and peripancreatic tissues or remote organs.The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild,moderately severe and severe groups.Major changes of the classification include acute fluid collection terminology.However,some inappropriate terms of the radiological diagnosis reports in the daily clinical work or available literature may still be found.The aim of this review article is:to present an image-rich overview of different morphologic characteristics of the early-stage(within 4 wk after symptom onset)local complications associated with acute pancreatitis by computed tomography or magnetic resonance imaging;to clarify confusing imaging concepts for pancreatic fluid collections and underline standardised reporting nomenclature;to assist communication among treating physicians;and to facilitate the implications for clinical management decision-making.展开更多
文摘BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.
文摘Acute pancreatitis is a common acute inflammatory disease involving the pancreas and peripancreatic tissues or remote organs.The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild,moderately severe and severe groups.Major changes of the classification include acute fluid collection terminology.However,some inappropriate terms of the radiological diagnosis reports in the daily clinical work or available literature may still be found.The aim of this review article is:to present an image-rich overview of different morphologic characteristics of the early-stage(within 4 wk after symptom onset)local complications associated with acute pancreatitis by computed tomography or magnetic resonance imaging;to clarify confusing imaging concepts for pancreatic fluid collections and underline standardised reporting nomenclature;to assist communication among treating physicians;and to facilitate the implications for clinical management decision-making.
