Acute necrotizing pancreatitis treatment: Endoscopic sphincterotomy and minimal invasive step–up approach of liver hydatid cysts

INTRODUCTION: Hydatid disease is a zoonosis that generally arises from echinococcus granulosus. Abdominal pain, cholangitis and jaundice may develop as a result of spontaneous rupture of the liver cyst into the biliary tract. Rarely, in some of these cases, pancreatitis may develop as a complication of hydatid cysts and there is no clear consensus on treatment options in patients with diffuse bile duct obstruction that occurs with a necrotizing pancreatitis clinic. The present study aims to establish a common consensus in patients presenting with liver cyst hydatid pancreatitis and jaundice clinic.
METHODS: In a retrospective, clinical–based multicenter study, ERCP and minimally invasive approaches are presented in the treatment of four patients who developed liver bile duct obstruction and necrotizing pancreatitis from the liver hydatid cyst.
RESULTS: All patients had abdominal pain and jaundice. Acute pancreatitis was detected in all cases using computed tomography. All patients underwent endoscopic sphincterotomy. Infected cystic material and germinal membranes were removed from the biliary tract. With endoscopic sphincterotomy, necrotizing pancreatitis clinic improved rapidly in three patients, while one patient progressed to necrotizing pancreatitis. All patients underwent laparoscopic cystectomy and cholecystectomy in combination. In patients who were followed up for necrotizing pancreatitis, the wall formation (encapsulation) period of necrosis was waited, and four weeks later, percutaneous drainage was applied to the walled necrosis areas. While the patients were discharged, Andazol® treatment was applied during the 6–month follow–up period.
DISCUSSION AND CONCLUSION: One of the complications of ERCP is that it may increase the severity of pancreatitis. However, ERCP is the most important endoscopic intervention for the treatment of pancreatitis filled with common bile duct hydatid cyst to ensure safe and effective biliary tract drainage in the early period. In addition, percutaneous drainage provides safe and rapid recovery in necrotizing pancreatitis complications when the wall of necrosis phenomenon is expected.