Misplaced Lumen apposing metallic stent (LAMS) leading to incomplete drainage of the infected pancreatic necrosis which was removed by open surgery

A 35- year female with a history of gall stone-induced acute necrotizing pancreatitis was referred to us in the second week of illness, she was managed conservatively with antibiotics and supportive measures given sepsis for a week. CECT (contrast-enhanced computed tomography) abdomen showed walled-off pancreatic necrosis (WOPN) and the necrosis was abutting the antro-pyloric region of the stomach. Endoscopic lumen apposing metallic stent was placed following endoscopic ultrasonography. One week later patient's symptoms were not relieved and she had multi-organ failure requiring ventilator support and a repeat CECT scan showed a displaced  LAMS [Fig-1], given her clinical condition, the patient was planned for endoscopic removal of the stent, which was a failure. A percutaneous catheter was placed to stabilize her clinical condition but her clinical condition did not improve.  Giver her clinical condition patient was operated on. On midline laparotomy, multiple adhesions lesser sac was entered with great difficulty because of multiple adhesions and the stent was removed [Fig 2]. Postoperatively the patient was discharged on postoperative day 20. On follow-up, the patient has no symptoms.