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Endoscopic internal drainage of pancreatic necrosis is considered as a first line therapeutic approach to tackle this pathology. Percutaneous drainage remains the second option if the above procedure fails or expertise is not available. Many centers are however still averse to doing the percutaneous drainage due to high risk of various complications and technical intricacies such as pancreatico-cutaneous fistula, risk of intraperitoneal leakage around the tube and lack of safe access route in all cases [1-4]. CT guided transgastric drainage of pancreatic collection conflates the advantage of both internal and percutaneous drainage [1], and is offered as a primary management approach at our Institute. The transgastric approach minimizes risk of formation of pancreaticocutaneous fistula, as the contents of the collection leak into gastric lumen [1-4]. Previous studies have shown that the tube removal following the transgastric drainage can be done after 6 weeks during which a mature track is formed between the collection and stomach [2]. Thick gastric wall prevents the leakage of gastric content into the peritoneum and the gastrocutaneuous fistula eventually heals [3]. We discuss a specific emergency clinical situation and our modus operandi thereby during one such procedure. The informed consent has been taken from the patient and manuscript has been approved by Institutional Review Board (IRB).

Bleeding During CT Guided Percutaneous Transgastric Drainage of Pancreatic Necrotic Collection