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.
Frequently Asked Questions
What is a pancreatic necrosectomy?
A pancreatic necrosectomy is a surgical procedure to remove dead or infected tissue from the pancreas, typically following pancreatitis. This can be done using endoscopic or percutaneous techniques and often involves collaboration between interventional radiologists and gastroenterologists to ensure precise removal and drainage.
During an endoscopic pancreatic necrosectomy, a flexible tube with a camera (endoscope) is inserted through the mouth into the stomach and intestines to access the pancreas. The procedure allows doctors to visually locate and remove necrotic tissue using tools passed through the endoscope, minimizing the need for large incisions.
What role does fluoroscopy play in pancreatic necrosectomy?
Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. In pancreatic necrosectomy, it helps guide the placement of instruments and stents, ensuring accuracy and minimizing complications during procedures involving the pancreas.
Why is local anesthesia used during pancreatic necrosectomy?
Local anesthesia, such as 1% lidocaine, is used to numb the area where the procedure will occur. This helps prevent pain during the procedure, especially when accessing the pancreatic necrotic tissue through the skin, ensuring patient comfort and reducing sedation requirements.
What is a 28 French drain and why is it used?
A 28 French drain is a tube with a diameter equivalent to about 9.3 mm, used to drain fluids from the body. In pancreatic necrosectomy, it helps remove fluids and necrotic material from the pancreas, preventing infection and allowing for future access if additional procedures are needed.
What are the potential complications of a pancreatic necrosectomy?
Potential complications of a pancreatic necrosectomy include bleeding, infection, damage to surrounding organs, and leakage of pancreatic fluids. However, the use of imaging techniques like fluoroscopy and careful surgical techniques help minimize these risks significantly.
What is the purpose of balloon dilation in pancreatic procedures?
Balloon dilation is a technique used to widen a narrowed tract or opening in the body. In pancreatic procedures, it is used to enlarge the tract through which instruments are passed, allowing for easier access to the pancreas and facilitating the removal of necrotic tissue.
What is a covered Wallstent and why is it used in pancreatic necrosectomy?
A covered Wallstent is a type of stent with a synthetic lining that prevents tissue ingrowth. In pancreatic necrosectomy, it is used to keep the tract open for drainage and to facilitate subsequent procedures, ensuring the pathway remains clear and accessible.