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Case report
Walled-off pancreatic necrosis: a staged multidisciplinary step-up approach
  1. Débora Sousa1,
  2. Ana Carolina Freitas Ferreira2,
  3. Pedro Raimundo1 and
  4. Rui Maio3
  1. 1Department of Internal Medicine, Hospital da Luz Lisboa, Lisboa, Portugal
  2. 2Department of Internal Medicine, Hospital do Divino Espírito Santo de Ponta Delgada EPE, Ponta Delgada, Ilha de São Miguel, Portugal
  3. 3Department of Surgery, Hospital da Luz Lisboa, Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Débora Sousa; dsofia.sousa{at}


Walled-off pancreatic necrosis (WOPN) is a rare complication of pancreatitis. We present the case of a woman in her eighties admitted for diffuse abdominal pain. She had a palpable abdominal mass and the CT scan showed necrosis throughout the tail of the pancreas, a peripancreatic and retrogastric hydroaerial collection (19 cm of diameter) and a calculus in the main biliary duct, thus establishing a diagnosis of emphysematous necrotising obstructive pancreatitis. A step-up approach was decided, first with removal of the biliary calculus, followed by a waiting period of 4 weeks in which the patient was under intravenous antibiotics. At re-evaluation, the CT scan showed a smaller and more organised collection, bounded by a wall, defining WOPN. At this stage, transgastric drainage via echoendoscopy was attempted, without success, followed by percutaneous CT-guided drainage, also with little effect. Surgical necrosectomy was then executed, as a final step, with a successful outcome.

  • pancreatitis
  • gastrointestinal surgery
  • hepatitis and other GI infections
  • pancreas and biliary tract

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  • Contributors DS and ACFF contributed equally in writing the manuscript and reviewing the literature. PR and RM reviewed the manuscript. All the authors were involved with patient care in this case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.