article · ACG Case Reports Journal
Necrotizing pancreatitis with multidrug-resistant infection and portal vein thrombosis poses major therapeutic challenges. We report a critically ill 28-year-old man with walled-off pancreatic necrosis, portal and superior mesenteric vein thrombosis, and multidrug-resistant infection refractory to surgery, endoscopic retrograde cholangiopancreatography, and multiple percutaneous drainages. Percutaneous direct endoscopic necrosectomy using a mature surgical tract and stent-assisted working channel enabled 4-staged necrosectomy sessions with progressive source control, clinical recovery, and complete portal vein recanalization. This case highlights percutaneous direct endoscopic necrosectomy as a minimally invasive salvage option in complex necrotizing pancreatitis when surgery and transluminal approaches are high-risk or not feasible.
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DOI: 10.14309/crj.0000000000002118
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