Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report

Figure 1 Abdominal computed tomography scan showing a huge multilocular walled-off necrosis replacing the body and tail of the pancreas, which extended to the pelvis. Gas bubbles were observed in the cavity.

Figure 2 Successful deployment of a wide-caliber fully covered TTS Niti-S esophageal stent. Purulent fluid was observed in the gastric lumen.

Figure 3 A 7-Fr double-pigtail plastic stent and a 7-Fr nasocystic catheter were deployed through the fully covered metal stent.

Figure 4 Computed tomography one week after initial drainage showed an undrained subcavity, located mainly at the left anterior pararenal space that extended to the left pelvis.

Figure 5 Endoscopic view of the cavity of walled-off necrosis by a modified single transluminal gateway transcystic multiple drainage technique. An upper endoscope was inserted into the walled-off necrosis (WON) through the fistula and a narrow connection route within the main cavity to the subcavity could be identified directly (white arrow).

Figure 6 Fluoroscopic view of modified single transluminal gateway transcystic multiple drainage technique. With a direct view of the connection route, a 0.025-inch guidewire was inserted into the subcavity (A) and two 7-Fr double-pigtail plastic stents were deployed (B).

Figure 7 Follow-up computed tomography obtained one month after discharge revealed the WON had mostly collapsed.