PT - JOURNAL ARTICLE AU - Débora Sousa AU - Ana Carolina Freitas Ferreira AU - Pedro Raimundo AU - Rui Maio TI - Walled-off pancreatic necrosis: a staged multidisciplinary step-up approach AID - 10.1136/bcr-2019-232952 DP - 2020 Mar 01 TA - BMJ Case Reports PG - e232952 VI - 13 IP - 3 4099 - http://casereports.bmj.com/content/13/3/e232952.short 4100 - http://casereports.bmj.com/content/13/3/e232952.full SO - BMJ Case Reports2020 Mar 01; 13 AB - 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.