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Pancreatic necrosis and the necrosis of surrounding tissues are found to be local complications occurring in 15% of patients suffering from acute pancreatitis. Walled-off pancreatic necrosis (WOPN) is in fact pancreatic fluid collection surrounded by a well-defined wall and inclusive of liquefied necrosis and elements (debris) of necrotic tissues. Endotherapy is an efficient method of treatment for patients with symptomatic WOPN. Often single transmural access to the necrotic collection is sufficient. However, in some patients with infected WOPN, the application of an extra way of access to pancreatic necrosis is a must. In these particular patients the optimal strategy is joining a few minimally invasive methods, which allows multiplexing of access to the collection. Herein we described the case of treatment with the use of minimally invasive techniques in a patient suffering from an infected WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary. Only joining together both minimally invasive techniques-transmural drainage and percutaneous drainage had become efficient enough and led to complete healing of the patient.

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report