Successful Management of Pancreatic Walled-Off Necrosis (WON) by Dr. Ksheetij Kothari

Pancreatic Walled-Off Necrosis (WON) is a severe complication of acute pancreatitis, where necrotic pancreatic tissue becomes encapsulated, leading to persistent infections and organ dysfunction. Globally, acute pancreatitis affects approximately 34 per 100,000 people annually, with nearly 15% to 20% of severe cases progressing to WON. If left untreated, WON can result in sepsis and multi-organ failure, making early diagnosis and intervention crucial. Advancements in minimally invasive endoscopic procedures have significantly improved outcomes, reducing the need for open surgery and accelerating recovery.

Details

Doctor’s name – Dr. Ksheetij Kothari

Clinic/ Hospital Name – Dr. Ksheetij Kothari

Patient’s name – (confidential)

Patient’s age – Middle-aged

Patient Background

A middle-aged male patient presented with persistent fever spikes despite being on antibiotics. His condition showed no improvement, prompting further diagnostic evaluation. Advanced imaging confirmed the presence of Pancreatic Walled-Off Necrosis (WON), a severe complication of pancreatitis requiring urgent medical intervention. The patient had been experiencing progressive discomfort, affecting his daily life and overall well-being.

Patient Symptoms

Symptoms of WON can be severe and disruptive. The patient exhibited the following key symptoms:

Persistent High Fever: Despite antibiotic treatment, fever spikes continued, signaling an underlying infection.

Abdominal Pain: A deep, gnawing pain in the upper abdomen that intensified with movement or after meals.

Weakness and Fatigue: The patient experienced significant energy depletion, making daily activities challenging.

Nausea and Vomiting: Difficulty in food intake due to persistent nausea and occasional vomiting episodes.

Unexplained Weight Loss: A noticeable decline in weight due to poor appetite and digestive issues.

Diagnostic Methods

Early and precise diagnosis is crucial for effective treatment. The team utilized the following diagnostic techniques:

Endoscopic Ultrasound (EUS): This advanced imaging technique helped visualize the necrotic pancreatic tissue and fluid accumulation, providing real-time insights into the extent of the disease.

CT Scan: A high-resolution computed tomography (CT) scan assessed the severity of necrosis and fluid collection, enabling a detailed pre-surgical evaluation.

Blood Tests: Elevated inflammatory markers confirmed the presence of a severe pancreatic infection.

Disease Diagnosed

After a thorough evaluation, the patient was diagnosed with Pancreatic Walled-Off Necrosis (WON)—a serious complication of acute pancreatitis where dead pancreatic tissue forms encapsulated fluid-filled pockets.

Dr. Kothari, an acclaimed Gastroenterologist trusted by patients to provide the best pancreatitis treatment in Pune, explains:

“WON requires timely and advanced intervention to prevent life-threatening complications such as sepsis and multi-organ failure. Without appropriate drainage and necrosectomy, the infection can spread, leading to a critical decline in health. Endoscopic treatment has revolutionized the management of WON, allowing for effective removal of necrotic tissue with minimal surgical trauma.”

Treatment Plan and Post-Surgery Care

Pre-operative Preparation & Guidelines

Before the procedure:

The team stabilized the patient with IV fluids, pain management, and nutritional support.
Broad-spectrum antibiotics were administered to control the infection.
To optimize surgical success, the medical team provided detailed pre-surgery instructions, including fasting and medication adjustments.

Step-by-Step Treatment Approach

The procedure was performed under general anesthesia to ensure the patient’s comfort.

EUS-Guided Cystogastrostomy:

Using Endoscopic Ultrasound (EUS), the surgeon created a connection between the stomach and the necrotic cavity.
A metallic stent was placed to facilitate continuous drainage of infected fluid, alleviating symptoms and preparing for further intervention.
A fluoroscopy guidance helped confirm the correct placement of the stent and ensure proper drainage.

The following day, the doctor performed an endoscopic pancreatic necrosectomy under sedation.

Pancreatic Necrosectomy:

A gastroscope with specialized tools was inserted through the previously placed stent to remove the necrotic debris.
The necrotic tissue was carefully debrided, ensuring minimal disruption to surrounding healthy pancreatic tissue.
Repeated irrigation was conducted to flush out any remaining debris, reducing the risk of secondary infections.
Post-procedure imaging was performed to assess the clearance of necrotic material and confirm treatment success.

Post-Surgery Guidelines

Recovery after WON management requires consistent monitoring and adherence to post-operative guidelines:

Monitor for Signs of Infection or Recurrence:

The patient was instructed to monitor body temperature, abdominal pain, and appetite changes as early indicators of complications.
Routine blood tests (CRP, WBC count, liver enzymes) were scheduled to detect infections or inflammatory markers.
Imaging studies, including follow-up CT scans, ensured complete resolution of necrotic tissue.

Follow a Modified Diet:

A soft, low-fat diet was recommended to minimize pancreatic stress and aid digestion.
Small, frequent meals were advised to prevent overloading the pancreas.
Adequate hydration was emphasized to prevent electrolyte imbalances and support recovery.

Regular Follow-Ups:

Scheduled gastroenterology consultations helped assess overall healing and stent functionality.
Endoscopic stent removal was planned once the cavity had fully healed.
Long-term enzyme supplementation was considered if pancreatic function remained compromised.

Dr. Kothari advises:

“The patient’s compliance with post-operative guidelines plays a crucial role in long-term recovery and preventing recurrence. Lifestyle modifications, dietary adjustments, and regular monitoring ensure that the pancreas heals effectively. With proper care, the risk of future complications can be minimized significantly.”

Outcome of the Treatment

With prompt intervention and a well-structured treatment plan, the patient experienced:

Significant Symptom Relief: Fever resolved, pain diminished, and digestive functions improved.

Faster Recovery: The use of minimally invasive techniques enabled a smoother and quicker healing process.

No Major Complications: The patient remained stable post-surgery, with no signs of infection or adverse effects.

Long-Term Expectations

Patients recovering from WON require ongoing care and lifestyle modifications to prevent recurrence and maintain digestive health:

Full Recovery with Continued Medical Supervision:

Regular gastroenterology visits and periodic imaging were recommended to monitor pancreatic function.
The patient was advised to avoid alcohol and high-fat diets, which could trigger further pancreatic stress.

Minimal Risk of Recurrence:

By following strict dietary modifications and maintaining a healthy BMI, the risk of WON recurrence was significantly reduced.
Any early warning signs, such as digestive discomfort or pain, were to be reported immediately.

Improved Quality of Life:

With proper post-surgical care, the patient resumed normal activities within weeks.
Digestive enzyme therapy helped in cases of pancreatic insufficiency, ensuring optimal nutrient absorption.
The patient’s overall well-being and energy levels improved due to the resolution of chronic symptoms.

Patient Feedback

“Before my diagnosis, I struggled with intense pain, fever, and exhaustion. It impacted my work and personal life significantly. After undergoing treatment, I felt a drastic improvement. The procedure was smooth, and my recovery was much quicker than I expected. I am grateful for the exceptional care I received, and today, I can lead a normal life without constant discomfort.”

Are you experiencing persistent abdominal pain or unexplained fever despite treatment?

These symptoms may indicate a severe pancreatic condition that requires expert evaluation. Timely diagnosis and intervention can make a significant difference in recovery outcomes.

Consult a qualified gastroenterologist today to explore the best pancreatitis treatment in Pune and ensure long-term digestive health.

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