PMC6044201_01
Under fluoroscopic, a guide wire is inserted through the
previous catheter which is removed. The tract is dilated
increasing size step by step until reach 30 F sheath
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Owing to the subsequent repeated onset of febrile episodes, a left lateral VARD was performed eight weeks of evolution of acute necrotizing pancreatitis (Figures 1 and 2).
A left lateral video-assisted retroperitoneal debridement was
performed. A cystoscope was introduced through the previously
described 30 F sheath. An incomplete necrosectomy was performed
duo to fixed and adhered tissue.
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Owing to the subsequent repeated onset of febrile episodes, a left lateral VARD was performed eight weeks of evolution of acute necrotizing pancreatitis (Figures 1 and 2).
Second VARD using a full covered esophagic metallic stent as
a dilatator tract, achieving a complete pancreatic necrosectomy
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After a transient recovery, a relapse occurred and a second VARD was attempted, this time using a partially covered esophagic metallic stent as a dilatator tract, removed inmediatelly after the procedure (Figure 3) and achieving a complete necrosectomy.
Computed tomography presented acute peri-pancreatic collections and
necrosis
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In the days thereafter the patient appeared to be recovering; however, 1-2 weeks before the admission he deteriorated once more with fever, leukocytosis, an increase in abdominal pain; the contrast enhanced computed tomography presented acute peri-pancreatic collections and necrosis (Figure 4). 
Reduction of peri-pancreatic collection at follow-up CT scan
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