Pancreatic abscess: 10 years experience

Givvimani, Srikanth; Sikora, Sadiq S.; Baijal, Sanjay Saran; Ayyagiri, A; Kumar, Ashok; Saxena, Rajan; Kapoor, Vinay K.

doi:10.1046/j.1445-2197.2002.02584.x

Cited by 25 publications

(12 citation statements)

References 15 publications

(23 reference statements)

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“…The success rates for drainage of fluid collections, pseudocysts or simple abscesses in variable sites are reported to be around 90% [20][21][22][23][24] . In contrast, reports on percutaneous drainage in patients with acute necrotizing pancreatitis were overall disappointing showing drainage therapy to be often inefficient with subsequent need for open surgery [15,25] .…”

Section: Discussionmentioning

confidence: 99%

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Bruennler

Langgartner²,

Lang³

et al. 2008

WJG

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INTRODUCTIONThe course of acute pancreatitis ranges from a mild transitory edematous to a severe necrotizing form. Necrotizing pancreatitis occurs in about 20% of all patients suffering from acute pancreatitis [1] . If infection of the necrotic tissue occurs mortality rates of up to 50% are reported with sepsis and multiorgan failure as most frequent causes [2][3][4][5] . It is generally accepted that in infected necrotizing pancreatitis the infected non-vital solid tissue has to be removed in order to control the sepsis. The standard treatment has traditionally been surgery [5,6] . By using modern surgical techniques like open packing, repeated laparatomies, closed packing or closed continuous lavage mortality rates could be decreased to 20%-40% [7][8][9][10][11][12] . However, these techniques are associated with a considerable surgical trauma which often causes escalation of multiorgan failure and sepsis [7,13] . Moreover, total anaesthesia is mandatory. Thus, in the last decade minimal invasive treatment regimes and in particular percutaneous drainage therapy were included in the management of infected necrotizing pancreatitis. Ultrasound (US) or computed tomography (CT) guided placement of drainages is reported to be effective in up to 90% for drainage of fluid collections or abscesses with purely liquid content [14] . However, the success rates Abstract AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.

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Section: Discussionmentioning

confidence: 99%

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Bruennler

Langgartner²,

Lang³

et al. 2008

WJG

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“…24Y28 Additional support for the idea that the source of primary infection in AP is the gut comes from the pattern of organisms in pancreatic infections. 5,35,39 Clinical and experimental data suggest that the use of antibiotics for prophylaxis against infection in the setting of AP has led to a selection for more gram-positive and fungal infections, including multidrug-resistant organisms. The bacteriology of infected pancreatic necrosis tends to be monomicrobial in 40% to 87% of cases.…”

Section: Pathophysiology and Microbiology Of Pancreatic Infectionmentioning

confidence: 99%

“…33,35,56 The key difference between infected necrosis and infected fluid collections/pseudocysts is the presence of solid debris in the former, which necessitates different management approaches and carries a mortality rate approximately twice that of the latter. 33,35,58 Infected Pancreatic Necrosis Pancreatic necrosis is defined as areas of nonviable pancreatic parenchyma and/or the peripancreatic tissues. 33,35,58 Infected Pancreatic Necrosis Pancreatic necrosis is defined as areas of nonviable pancreatic parenchyma and/or the peripancreatic tissues.…”

Section: Infected Pseudocysts or Abscessesmentioning

confidence: 99%

Infectious Complications of Acute Pancreatitis

Parvin¹,

Louie²,

Pitchumoni³

2013

Infectious Diseases in Clinical Practice

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In most cases, acute pancreatitis is a self-limited condition that improves with supportive treatment. In 15% to 20%, severe acute pancreatitis develops, characterized by necrosis, multiorgan failure, infection, and other complications. There is an early and a late peak of severity in the natural course of acute pancreatitis. Pancreatic infections occur in 3 settings: free fluid collections, pseudocysts, and necrosis.

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“…For example, when severe cases with a Ranson score of 5 or more (Level 2b)57 and cases having multiple abscesses (Level 4)58 were included in the study, the one‐stage healing rates of percutaneous drainage declined to 30%–47%. When no improvement in clinical findings is observed after percutaneous drainage, surgical drainage should be performed immediately instead of monitoring the clinical course 59…”

Section: Pancreatic Abscessmentioning

confidence: 99%

JPN Guidelines for the management of acute pancreatitis:surgical management

Isaji

Takada

Kawarada

et al. 2006

J Hepatobiliary Pancreat Surg

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surgical intervention should be performed only in selected cases, such as those with persistent organ complications or severe clinical deterioration despite maximum intensive care; (4) early surgical intervention is not recommended for necrotizing pancreatitis; (5) necrosectomy is recommended as the surgical procedure for infected pancreatic necrosis; (6) simple drainage should be avoided after necrosectomy, and either continuous closed lavage or open drainage should be performed; (7) surgical or percutaneous drainage should be performed for pancreatic abscess; (8) pancreatic abscesses for which clinical findings are not improved by percutaneous drainage should be subjected to surgical drainage immediately; (9) pancreatic pseudocysts that produce symptoms and complications or the diameter of which increases should be drained percutaneously or endoscopically; and (10) pancreatic pseudocysts that do not tend to improve in response to percutaneous drainage or endoscopic drainage should be managed surgically. Key words

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Pancreatic abscess: 10 years experience

Cited by 25 publications

References 15 publications

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Infectious Complications of Acute Pancreatitis

JPN Guidelines for the management of acute pancreatitis:surgical management

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