Endoscopic treatment of complex walled-off necrosis with two simultaneous lumbar imposing metal stands. This is a case of a 41 years old male who has presented necrotizing pericarditis two months before the procedure. Meanwhile, he presented fever jaundice and delayed gastric emptying. Now we show an abdominal CT scans performed in March this year showing a 26 per 14 per 12 centimeters septate collection made by two non-communicating collections. The patient have been to a MRCP. It showed biliary tract dilation external to the posterior inferior collection in green and now the anterior superior collection in red. Finally, we performed an endoscopic ultrasound. We can see a bulging posterior gastric wall and also bulging duodenal wall. In the ultrasound image we see the periduodenal collection with 7 per 4.6 centimeter and non-communicating collections and now the big perigastric collection with 10 per 14 centimeters. The compressed common bioduct with 14 millimeters. The first lens placement. We make the puncture in the ultrasound vision. The first planche deployment. We traction it. In endoscopic vision we see the second flange deployment with satisfactory purulent drainage. The second lens deployment of the perigastric lesion follow the same steps as the first one. The puncture, the first planche deployment, traction and the second flange deployment in endoscopic vision, which also had a purulent drainage. The control CD scans show us the two transmural lens. The clinical evolution was good. The resolution of infection delayed the gastric emptying. It also followed the bilirubins. An ERCP was performed three weeks after the endoscopic ultrasound that showed us distal biliary fistula and main pancreatic dilation. We place a biliary and pancreatic stents. At the endoscopic evaluation we see all the stents and we see the biliary stent through the residual peridural collection. Now the direct endoscopic necrosectomy. We see a bunch of necrosis. We can see a great amount of necrosis followed by irrigation with saline and hydrogen peroxide and necrosectomy with SNARE. This is the final aspect followed by placement of three trangastric pigtail plastic stents of seven flange per seven centimeters. An MRCP performed three months after drainage. An MRCP was performed three months after drainage that showed us residual 14 ml collection. Follow-up six months after drainage the patient was well as well as the laboratory tests. Thank you.

endoscopic treatment

complex walled-off necrosis

41-year-old male

necrotizing pericarditis

fever