Interventions for Necrotizing Pancreatitis: A Multidisciplinary Approach

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

“…In the introduced patient the key to successful treatment of WOPN is the creation of an appropriate irrigation system, enabling aggressive active drainage, and providing passive drainage in the later phase. The endoscopic treatment of WOPN remains an alternative for surgical treatment, [7,13,14] nevertheless surgery still plays an important role in the treatment of pancreatic necrosis, particularly when minimally invasive techniques of treatment became inefficient. [7,20] The therapy for the consequences of acute necrotizing pancreatitis should take place in reference centres, where strict co-operation between a gastroenterologist, endoscopist, radiologist and surgeon is possible.…”

“…[4][5][6] Due to the development of minimally invasive techniques of treatment of pancreatic necrosis the access to the necrotic collection is possible through transperitoneal, retroperitoneal, transmural and transpapillary way. [7,8] The optimal strategy in many patients is joining a few minimally invasive methods, which allows multiplexing of access to the collection. [7,9] The randomized trial certified that the application of minimally invasive techniques in WOPN's treatment ("the step-up approach") significantly reduces the rate of complications and mortality compared to open a necrosectomy procedure.…”

“…[7,8] The optimal strategy in many patients is joining a few minimally invasive methods, which allows multiplexing of access to the collection. [7,9] The randomized trial certified that the application of minimally invasive techniques in WOPN's treatment ("the step-up approach") significantly reduces the rate of complications and mortality compared to open a necrosectomy procedure. [10] Herein we describe a case of treatment with use of minimally invasive techniques in a patient suffering from WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary.…”

Revised Atlanta classification and roadmap of radiologist

“…Hafif tablo kendiliğinden gerilerken, orta-ağır ve ağır tabloda 48 saatten az Radyolog, revize Atlanta sınıflamasını kullanarak koleksiyon türüne göre tedavi şekil-lerinin belirlenmesinde klinisyene yardımcı olabilir. Lokal komplikasyon yönetiminde perkütan drenaj, endoskopik kistogastrostomi, endoskopik debridman ve cerrahi nekrozektomi kullanılabilir [17]. BT ve ultrason perkütan drenaja ya da perkütan kistogastrostomiye yol gösterici olabilir.…”

The management of the patient with acute pancreatitis: from evidence to clinical practice

“…3,115,130,131 Infection of extrapancreatic sites (lung, urinary, biliary, CVC related) should be identified and treated with antibiotic therapy. Empirical therapy will be discontinued if culture tests are negative.…”