Are Some Cases of Infected Pancreatic Necrosis Treatable without Intervention?

Abstract

Background: Infected pancreatic necrosis is considered an absolute indication for interventional management such as percutaneous drainage or surgery. The presence of retroperitoneal air is a sign of anaerobic sepsis. Method: A retrospective review of case records of patients presenting with severe acute pancreatitis and pancreatic necrosis was performed to identify cases in whom conservative treatment was followed by a satisfactory outcome. Results: Four patients were identified over a 3-year period who had pancreatic necrosis and retroperitoneal air; they were treated with antibiotics and intensive care, and they improved without any interventional treatment. Conclusions: Some patients with infected pancreatic necrosis are treatable medically. The clinical status of the patients may well be a more important factor governing the choice of the treatment approach than bacteriological findings of infection alone.

Multiorgan Failure Predicts Mortality in Emphysematous Pancreatitis

“…However, in the early 2000s, several studies showed percutaneous drainage was associated with decreased mortality when compared to open necrosectomy for acute necrotizing pancreatitis 31,32,33 . Subsequent investigations suggested that medical management alone without any procedural intervention could even be considered in certain cases of infected pancreatic necrosis 10,13,16,34,35 . Since then, there have been numerous publications supporting a conservative management strategy for infected pancreatic necrosis 36,37 .…”

Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes

“…There are existing data to suggest that some patients with infected necrosis may not need intervention at all. [20][21][22] Patients with symptomatic WOPN are typically those who fail to progress clinically, have gastric outlet obstruction secondary to the necrosum, or have a deteriorating clinical condition despite maximal medical therapy without overt infection on Gram stain of the necrosum. Whether these patients would have improved without intervention remains a significant question; however, the clinical outcomes reported herein would suggest that DMD has a beneficial effect in such individuals.…”

Surgery for pancreatic necrosis: “Whom, when and what”

“…This has developed not from randomised data but observational studies over time that seemed to show a reduction in the previously reported mortality [3][4][5] . A small number of recent reports [6][7][8] have attempted to cast doubt on whether all patients with infected pancreatic necrosis should undergo surgery. So should a randomised controlled trial be undertaken?…”