Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

Figure 1 Contrast-enhanced computed tomography. A: On February 13, 2023, multiple cysts were seen in the hepato-gastric space, low-attenuated, homogeneous fluid collections, with a maximum diameter of 89 mm × 76 mm, the cyst was communicates with the pancreatic duct (orange triangle); B: The cyst size was about 40 mm × 59 mm after 3 d of the first intervention; C: Two weeks later, computed tomography examination before the second intervention showed that the cyst size was similar to the last check; D: After 3 months of follow-up, the size of the cyst was about 27 mm × 22 mm; E: After 6 months of follow-up, the size of the cyst was about 6 mm × 8 mm.

Figure 2 Endoscopic ultrasound-guided aspiration and lavage. A: The size of the cyst cavity was 56 mm × 36 mm, with necrotic debris (orange triangle), and the necrotic collection was not walled-off (orange arrows); B: The cystic cavity almost disappeared after intervention.

Figure 3 Endoscopic retrograde cholangiopancreatography pancreatic duct stent drainage. A: The guidewire was inserted into the pancreatic duct through an incision knife; B: Iodophor angiography; C: A 5-7 Fr plastic pancreatic stent was placed in the main pancreatic duct under fluoroscopy; D: X-ray fluoroscopy stent was in a good position.