Managing Infected Pancreatic Necrosis

Thomson, John-Edwin; Dijk, Sven M. van; Brand, Martin; Santvoort, Hjalmar C. van; Besselink, Marc G.

doi:10.21614/chirurgia.113.3.291

Cited by 15 publications

(8 citation statements)

References 65 publications

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“…Imaging signs such as gas in peripancreatic collections with or without a rapid accumulation on serial imaging are accurate predictors of IPN in the majority of patients [48][49][50]. The diagnosis of IPN, indeed, can be suspected by the patient's clinical course, by the presence of gas within the heterogeneous or homogeneous collection seen on contrast enhancement CT or when percutaneous, image-guided, fine-needle aspiration (FNA) is positive for bacteria and/or fungi on Gram stain and culture [3,47].…”

Section: Discussionmentioning

confidence: 99%

Open necrosectomy is feasible as a last resort in selected cases with infected pancreatic necrosis: a case series and systematic literature review

et al. 2020

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Background Acute pancreatitis is a common inflammatory pancreatic disorder, often caused by gallstone disease and frequently requiring hospitalization. In 80% of cases, a rapid and favourable outcome is described, while a necrosis of pancreatic parenchyma or extra-pancreatic tissues is reported in 10–20% of patients. The onset of pancreatic necrosis determines a significant increase of early organ failure rate and death that has higher incidence if infection of pancreatic necrosis (IPN) or extra-pancreatic collections occur. IPN always requires an invasive intervention, and, in the last decade, the advent of minimally invasive techniques has gradually replaced the employment of the open traditional approach. We report a series of three severe cases of IPN managed with primary open necrosectomy (ON) and a systematic review of the literature, in order to understand if emergency surgery still has a role in the current clinical practice. Methods From January 2010 to January 2020, 3 cases of IPN were treated in our Academic Department of General and Emergency Surgery. We performed a PubMed MEDLINE search on the ON of IPN, selecting 20 from 654 articles for review. Results The 3 cases were male patients with a mean age of 61.3 years. All patients referred to our service complaining an evolving severe clinical condition evocating a sepsis due to IPN. CT scan was the main diagnostic tool. Patients were initially conservatively managed. In consideration of clinical worsening conditions, and at the failure of conservative and minimal invasive treatment, they were, finally, managed with emergency ON. Patients reported no complications nor procedure-related sequelae in the follow-up period. Conclusion The ON is confirmed to be the last resort, useful in selected severe cases, with a defined timing and in case of proven non-feasibility and no advantage of other minimally invasive approaches.

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Section: Discussionmentioning

confidence: 99%

Open necrosectomy is feasible as a last resort in selected cases with infected pancreatic necrosis: a case series and systematic literature review

et al. 2020

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“…Imaging techniques like computed tomography (CT) scans can reveal non-enhanced areas in the pancreas, indicating necrosis. In infected necrosis, gas bubbles, fluid collections, or abscesses may be visible on imaging [21,22]. A comparison between the different types of collections seen after acute pancreatitis is depicted in Table 1.…”

Section: Pancreatic Necrosismentioning

confidence: 99%

“…Treatment for sterile pancreatic necrosis is usually conservative and supportive, focusing on pain control, intravenous fluids, nutritional support, and monitoring for complications. In some cases, drainage procedures may be necessary to manage fluid collections [22]. Infected pancreatic necrosis requires a combination of medical and surgical interventions [22,23].…”

Section: Pancreatic Necrosismentioning

confidence: 99%

Late Complications of Acute Pancreatitis: A Surgical Approach

Coral

2023

OAJS

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Acute pancreatitis, a severe inflammatory pancreas disorder, often leads to significant morbidity and mortality due to its late complications, including fluid collections, pseudocysts, necrosis, obstruction, fistulation, and abdominal compartment syndrome. Despite its rising incidence and associated healthcare costs, the surgical management of these complications remains a clinical challenge due to the complex nature of the disease and patient comorbidities. Current literature provides an understanding of the pathophysiology, epidemiology, and standard management of these complications. However, there's a need to focus on the surgical approach to address these complications more effectively. This article reviewed these late complications and discussed their clinical presentation and diagnostic methods, emphasizing surgical management and prognosis. The primary goal of the review was to provide clinicians with a comprehensive understanding of the surgical management of these complications, thereby improving patient outcomes. Our analytical methods involved a thorough review of current literature, including clinical studies, reviews, and case reports. The review revealed that surgical intervention plays a pivotal role in managing severe or complicated cases. However, the surgical technique choice depends on the complication's type and severity, the patient's overall condition, and the surgeon's expertise. Further research is recommended to develop standardized protocols for the surgical management of these complications.

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“…Ten to fourteen d after the onset of the disease, however, some patients have obvious symptoms of infection and enter a period of systemic infection (10). The causes of SAP infection are as follows: 1) translocation of intestinal flora; 2) a retrograde infection caused by percutaneous catheter drainage; 3) biliary calculi and obstruction complicated by infection; 4) respiratory insufficiency and hypoxemia; and 5) reduced immunity (22). Most of the pathogens responsible are Gram-negative bacteria, and Escherichia coli is the most common (23).…”

Section: Infection Controlmentioning

confidence: 99%