# Complex Management of an Infected Pancreatic Collection With Walled-Off Necrosis in Acute Pancreatitis: A Case Report

## TL;DR

A 38-year-old man with severe pancreatitis and a pancreatic collection required complex treatment including drainage and antibiotics to manage infection and septic shock.

## Contribution

This case report highlights the effectiveness of a multidisciplinary approach in managing infected pancreatic collections with walled-off necrosis.

## Key findings

- Endoscopic transluminal drainage followed by targeted antibiotics improved the patient's condition.
- Polymicrobial infection required extended antibiotic and antifungal therapy.
- A multidisciplinary approach led to successful clinical improvement and discharge.

## Abstract

A 38-year-old man, post a 17-day hospitalization for severe necrotizing pancreatitis (NP) with complications of a pancreatic collection and splenic vein thrombosis, presented to the emergency department with severe epigastric pain. Despite initial stability, abdominopelvic angio-CT revealed an enlarged pancreatic collection with active bleeding. Hemorrhagic shock ensued, leading to ICU admission and subsequent multiorgan failure, elevated intra-abdominal pressure, and suspected pancreatic collection infection. Endoscopic transluminal drainage (ETD) was performed, followed by empiric antibiotics, later adjusted to cefuroxime based on collection fluid cultures. The patient developed septic shock with Pseudomonas aeruginosa isolation in blood cultures, prompting targeted ceftazidime therapy. Repeat ETD with necrosectomy addressed the ongoing infection, with polymicrobial cultures necessitating an extended course of targeted antibiotics and antifungals. Clinical improvement ensued, culminating in discharge home. This case underscores the challenges in managing severe NP and highlights the efficacy of a multidisciplinary approach for improved patient outcomes.