Walled-off pancreatic necrosis

Abstract

Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.

Surgical Management of Giant Walled-off Necrosis

“…This necrotic pancreatic parenchyma and/or necrotic peripancreatic tissues is the site where WOPN derives and in time lesion could be infected, sometimes multiple, and may be present at sites distant from the pancreas [1][2][3]. Although WOPN is usually seen as aseptic necrosis, the most common seen bacterias in infected WOPN are E.Coli, K.Pneumoniae, E.Faecalis and S.Aureus [3,4]. In our case, the peroperative culture result was negative.…”

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

“…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. It increases the chances for full recovery of the patients.…”

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

“…However, this is succesful only in a few cases and drainage or surgical intervention follows [6,28,40,44]. According to those who are pro drainage in the treatment of sterile acute peripancreatic fluid collections, drainage can be applied effectively [1, 3,4,14,21,25,34,35,40,44]. Acute compartment syndrome caused by massive acute peripancreatic fliud collection can be treated effectively with PD [9].…”

“…To determine the correct rate of iatregenous infections treated without drainage or puncture a prospective randomized trial should be performed which is not available at this time. With regard to the management of infected acute peripancreatic fluid collections, views are not as varied in these cases: percutaneous drainage is suggested [1,5,8,18,21,22,25,33,34]. Surgery can often be avoided by drainage treatment, and in other cases the intervention is suitable for delaying operative treatment.…”

“…Surgery can often be avoided by drainage treatment, and in other cases the intervention is suitable for delaying operative treatment. In such cases, when drainage is not effective, operation is suggested [5,6,8,18,21,22,25,34,35,44].…”