Hydrogen Peroxide Flushes for Necrotizing Pancreatitis in a High-Risk Surgical Patient: A Pathway for Durable Response Without Additional Endoscopic Intervention.

Necrotizing pancreatitis (NP) is characterized by severe pancreatic inflammation with necrosis and a systemic inflammatory response. We describe the case of a 32-year-old female with NP successfully treated with a modified protocol using hydrogen peroxide (H2O2) flushes performed through percutaneous drains (PCDs). She was deemed high risk for endoscopic necrosectomy due to her significant cardiorespiratory comorbidities. As such H2O2-assisted necrosectomy involving H2O2 instillation into the necrotic collections via the PCDs was performed. Sequential close clinical follow-up to 1 year showed a durable response without adverse effects. To our knowledge, an extended, durable clinical response has not been previously reported. Further research is required to define clear guidelines on dosing, administration regimen, and follow-up on PCD drainage.