Successful Open and Endoscopic Transgastric Necrosectomy for Huge Infected Walled-Off Pancreatic Necrosis: A Case Report

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To the Editor:
Severe acute pancreatitis is associated with high mortality.1 Surgery for severe acute pancreatitis is a morbid procedure associated with complications in 69% of patients and mortality in 19%.2 Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates up to 15%, reaching 30% in cases complicated by infection.3 Walled-off pancreatic necrosis (WOPN) consists of necrotic tissue contained within an enhancing wall of reactive tissue. It is a mature, encapsulated collection of pancreatic and/or peripancreatic necrosis and has a well-defined inflammatory wall; usually, this maturation occurs 4 weeks or more after the onset of necrotizing pancreatitis.1 Recently, many approaches have been applied in the treatment of necrotizing pancreatitis. We report a case of successful endoscopic and open transgastric necrosectomy for huge infected WOPN and review the literature on the topic.
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