A case of successful transgastric fistuloplasty for walled-off necrosis after acute pancreatitis

A 29-year-old man with a history of alcohol-induced severe acute pancreatitis presented to our hospital with epigastric pain. Laboratory studies showed elevated C-reactive protein levels and pancreatic enzyme levels. Abdominal contrast-enhanced computed tomography findings showed walled-off necrosis (WON) with extravasation from a branch of the left gastric artery; therefore, we performed transcatheter arterial embolization. Ten days later, epigastric pain recurred with fever, and laboratory studies showed further increase in peripheral white blood cell count and C-reactive protein levels. The WON was considered infected, and a lumen-apposing metal stent (LAMS) was inserted transgastrically. Subsequently, the WON area reduced, and the patient recovered. The treatment with LAMS was effective in draining the infected WON. It is important to seek appropriate treatment based on the details of the WON and the patient's progress.