CLINICAL HISTORY:

Procedure:

PROCEDURE:
Patient was placed in the semi right lateral decubitus position in the GI procedure room. This procedure was a rendezvous procedure in conjunction with the gastroenterologist Dr. ____

***Please refer to his separate report for the endoscopic necrosectomy procedure***

The existing tube was released from the skin and over a floppy-tipped atraumatic 035 wire, the existing 28 French drain was removed and profuse local anesthesia using 1% lidocaine was given along the tract in preparation for dilation. A marker catheter was placed to measure the distance from the skin to the peripheral margin of the pancreatic necrotic tissue. This was measured to be 10 cm as demonstrated on the CT scan. The location was marked and noted prior to balloon dilation:

At this time, I assisted Dr. _____ with percutaneous tract balloon dilation (15mm) and placement of a long 2 cm diameter by 8 cm long covered Wallstent which was dilated up to 15 mm using a high pressure balloon.

Necrosectomy procedure was then performed by endoscopic technique by the gastroenterologist.

After the endoscopic procedure, I replaced the 28 French drain into the pancreatic bed for continual drainage for future access for additional necrosectomy per request of the gastroenterologist.

IMPRESSION:

Successful assistance to gastroenterologist during percutaneous balloon tract dilation and subsequent endoscopic pancreatic necrosectomy. Fluoroscopy was used in conjunction with endoscopic technique. A 28 French drainage catheter was replaced.

No immediate procedural or sedation complications occurred during the procedure.