Infected Pancreatic Walled-off Necrosis Following Hypertriglyceridemia-Induced Necrotizing Pancreatitis: A Case Report

Infected walled-off necrosis (WON) is a serious complication of necrotizing pancreatitis that requires timely, evidence-based management.We describe the case of a 41-year-old man with a history of severe hypertriglyceridemia-associated necrotizing pancreatitis who presented with an encapsulated pancreatic/peripancreatic collection containing intralesional gas, consistent with infected WON.Contrastenhanced computed tomography showed no evidence of new pancreatic parenchymal necrosis, and the available findings did not establish a recurrent episode of acute necrotizing pancreatitis.The patient underwent endoscopic ultrasound-guided transmural drainage followed by two endoscopic necrosectomies as part of a step-up approach, combined with antimicrobial therapy.Cultures obtained from the necrotic collection identified uncommon microorganisms, including Rothia mucilaginosa, Solobacterium moorei, and Peptostreptococcus anaerobius.During an endoscopic procedure, the patient developed narrow-complex tachycardia with transient hypotension.Subsequent electrocardiographic evaluation revealed ventricular pre-excitation consistent with Wolff-Parkinson-White syndrome, although the mechanism of the acute arrhythmia could not be definitively established.Following multidisciplinary management, the patient demonstrated favorable clinical improvement during hospitalization and was discharged.This case highlights the role of minimally invasive step-up management in appropriately selected patients, the importance of interpreting unusual microbiological findings in their clinical context, and the need to recognize cardiovascular conditions that may influence procedural safety.Further investigation is warranted to clarify the clinical significance of uncommon microorganisms isolated from infected WON.