Necrotizing Pancreatitis: Current Management and Therapies

Abstract

Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. In this review, we summarize the current management and therapies for acute necrotizing pancreatitis.

Gastrointestinal tract involvement in acute pancreatitis: initial findings and follow-up by magnetic resonance imaging

“…Optimal feeding has always been regarded as an important means to improve the outcome in AP patients. Starting early enteral feeding as soon as possible was thought to be important, but until recently, no scientific study was available to determine the exact time and it remains debatable (46,47). In clinical therapy, if patients can tolerate an oral diet without abdominal pain, nausea, vomiting, or ileus, they may be allowed to have oral food (48).…”

Review of Current Evidence in Acute Pancreatitis

“…Antibiotics must be administered in accordance with the sensitivity, and the duration of usage should depend on the clinical response and negativity of the cultures [80][81][82]. The use of prophylactic antibiotics has not been indicated in case of mild AP, and moderately severe, severe, or sterile necrosis, as it increases the prevalence of fungal infections and the development of multidrug resistance in microorganisms [80][81][82][83].…”

“…CT, in this case, demonstrates gas in the presence of necrosis. If sterile, it is managed conservatively and requires therapy only in rare cases exhibiting obstruction of a nearby viscus, such as that in the stomach, duodenum, or bile duct [83,101].…”

“…If the patient exhibits progressive sepsis or is in unstable conditions, percutaneous drainage of the collection is sufficient to reduce the sepsis, allowing the delay of four weeks to be continued. It is possible to treat almost 60% of the patients with PAN non-invasively with a low risk of death [83].…”

“…The drained liquid is Gram stained and cultured. Only a small percentage of patients with infected PAN may be treated only with the use of antibiotics [83,101].…”