Endoscopic ultrasound-guided insertion of a large diameter fully covered self-expandable metallic stent as rescue therapy for recurrent infected walled off pancreatic necrosis after surgical necrosectomy

A 39-year-old man developed severe necrotizing gallstone pancreatitis complicated by infected pancreatic necrosis. Surgical necrosectomy was performed to control the on-going sepsis. Subsequently, there was a recurrence of an infected necrotic collection at the site of surgical necrosectomy, in the region of the pancreatic body and tail. He did not respond to conservative treatment with intravenous antibiotics. Pancreatic duct stenting was performed to treat pancreatic duct leak, followed by endoscopic ultrasound guided insertion of a large diameter fully covered self-expandable metallic stent to drain the infected collection. There was rapid and complete clinical recovery.