Natural course of asymptomatic walled off pancreatic necrosis

Abstract

Introduction: There is paucity of data on natural course of asymptomatic walled off necrosis (WON).

Objective: To study the natural course as well as outcome of conservative management in patients with asymptomatic WON.

Methods: Retrospective analysis of prospectively maintained data base of patients with asymptomatic WON presenting to us 4-6 weeks after an episode of acute necrotising pancreatitis (ANP).

Results: Forty three patients (37 M; mean age: 38.2 ± 10.4 years) with asymptomatic WON were studied. The size of WON ranged from 5 to 16 cm (mean 8.2 ± 2.2 cm). The site of WON was head, body and tail in 5 (11%), 34 (79%) and 4 (10%) patients respectively. Thirty of 43 patients (70%) patients did not have any complications during the expectant management period of 3 weeks-32 months with 13 (30%) patients having spontaneous resolution within 6.2 ± 3.4 months. Thirteen (30%) patients became symptomatic or developed complication within 3.2 ± 1.3 months. These were refractory pain (n = 7), infection (n = 4), spontaneous rupture into gastrointestinal tract (n = 5; stomach in 3, duodenum in 1 and colon in 1 patient respectively) and bleeding from splenic artery pseudoaneursym in 1 patient.

Conclusions: Majority of patients with asymptomatic WON have an uneventful clinical course. However, one third patients will develop symptoms/complications requiring interventional treatment.

Keywords: Acute pancreatitis; Computed tomography; Endosonography; Pancreatic necrosis.