{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 25, Ep 3 of 3: Necrosis, Vascular Traps, and Recurrence","html":"","width":"100%","height":180,"duration":1008,"description":"Episode three picks up where the pancreas has declared itself necrotic and organizes the collection nomenclature on timing and content. Necrosis is managed by delay, drain, then debride, with endoscopic transmural drainage now favored because it never crosses the peritoneum. The vascular complications split by vessel: venous thrombosis usually self-resolves, while a pseudoaneurysm mandates CT angiography and embolization before any drainage. The post-ERCP triad attacks three independent nodes, and recurrent disease is worked up by escalation from baseline labs to MRCP to endoscopic ultrasound for microlithiasis, with the pancreas divisum trap waiting at the end.\n \nTopics covered\n\nRecognizing necrosis and infected necrosis\nCollection nomenclature by timing and content\nStep-up management: delay, drain, debride\nEndoscopic versus surgical step-up\nSplanchnic venous thrombosis and left-sided portal hypertension\nArterial pseudoaneurysm and pre-drainage angiography\nPost-ERCP pancreatitis and its prevention triad\nRecurrent and idiopathic disease workup\nPancreas divisum and prevention by stopping the cause\n \n \nKey decisions\n\nDiagnose necrosis by non-enhancing parenchyma on contrast CT and read gas in a peripancreatic collection, absent recent intervention, as essentially diagnostic of infected necrosis.\nName collections by timing and content: acute peripancreatic fluid collection and pseudocyst without necrosis, acute necrotic collection and walled-off necrosis with necrosis, split at four weeks.\nFollow the step-up principle of delay past four weeks, drain percutaneously or endoscopically first, and debride only when drainage fails or solid debris obstructs it, favoring endoscopic transmural drainage with a lumen-apposing metal stent.\nWithhold anticoagulation for isolated splenic vein thrombosis, reserving it for clot extending into the portal or superior mesenteric vein, and treat bleeding gastric varices from left-sided portal hypertension with splenectomy.\nImage the...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}