Current Treatment Options in Gastroenterology

, Volume 10, Issue 5, pp 341–346 | Cite as

Management of severe pancreatic necrosis

Article

Opinion statement

Pancreatic necrosis is a form of severe pancreatitis associated with high morbidity and mortality. In this condition there is necrosis of pancreatic tissue with pancreatic duct disruption leading to release and activation of pancreatic enzymes. This in turn causes peripancreatic necrosis and formation of fluid collections. The diagnosis of pancreatic necrosis is made by contrast-enhanced CT scan of the abdomen. The management of pancreatic necrosis is controversial. No randomized clinical trials are available for guidance in treatment of pancreatic necrosis. Experience, collaboration, and knowledge of the managing teams play a major role in successful treatment. Early percutaneous drainage with frequent monitoring of the catheters is the hallmark of our approach. Using this approach, it is possible to significantly decrease the rate of morbidity and mortality associated with this disease and its treatment.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    United Kingdom guidelines for the management of acute pancreatitis: British Society of Gastroenterology. Gut 1998, 42(Suppl 2):S1–S13.Google Scholar
  2. 2.
    Banks PA: Practice guidelines in acute pancreatitis. Am J Gastroenterol 1997, 92:377–386.PubMedGoogle Scholar
  3. 3.
    Bradley EL, Allen KA: A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg 1991, 161:19–25.PubMedCrossRefGoogle Scholar
  4. 4.
    McFadden W, Reber HA: Indications for surgery in severe acute pancreatitis. Int J Pancreatol 1994, 15:83–90.PubMedGoogle Scholar
  5. 5.
    Rau B, Uhl W, Büchler MW, et al.: Surgical treatment of infected necrosis. World J Surg 1997, 21:155–161.PubMedCrossRefGoogle Scholar
  6. 6.
    McKay CJ, Evans S, Sinclair M, et al.: High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 1999, 86:1302–1305.PubMedCrossRefGoogle Scholar
  7. 7.
    Büchler MW, Gloor B, Müller CA, et al.: Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000, 232:619–626.PubMedCrossRefGoogle Scholar
  8. 8.
    Baron T, Morgan DE: Acute necrotizing pancreatitis. N Engl J Med 1999, 340:1412–1417.PubMedCrossRefGoogle Scholar
  9. 9.
    Ho HS, Frey CF: The role of antibiotic prophylaxis in severe acute pancreatitis. Arch Surg 1997, 132:487–493.PubMedGoogle Scholar
  10. 10.
    Imrie CW: Underdiagnosis of acute pancreatitis. Adv Acute Pancreatitis 1997, 1:3–5.Google Scholar
  11. 11.
    Rattner DW, Legermate DA, Lee MJ, et al.: Early surgical debridement of symptomatic pancreatic necrosis is benefi-cial irrespective of infection. Am J Surg 1992, 162:137–143.Google Scholar
  12. 12.
    Doglietto GB, Gui D, Pacetti F, et al.: Open vs. closed treatment of secondary pancreatic infections: a review of 42 cases. Arch Surg 1994, 129:689–693.PubMedGoogle Scholar
  13. 13.
    Neoptolemos JP, Rarty M, Finch M, et al.: Acute pancreatitis: the substantial human and financial cases. Gut 1998, 42:886–891.PubMedCrossRefGoogle Scholar
  14. 14.
    Bradley EL: A clinically based classification system for acute pancreatitis. Arch Surg 1993, 128:586–590.PubMedGoogle Scholar
  15. 15.
    Lau ST, Simchuk EJ, Kozarek RA, Traverso LW: A pancreatic duct leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg 2001, 181:411–415.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarkorafas GH, Tsiotos GG, Sarr MG: Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under-appreciated entity. J Am Coll Surg 1999, 188:643–648.CrossRefGoogle Scholar
  17. 17.
    Takeda K, Matsuno S, Sunamura M, Kakugawa Y: Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis. Am J Surg 1996, 171:394–398.PubMedCrossRefGoogle Scholar
  18. 18.
    Besselink MG, van Santvoort HC, Schaapherder AF, et al.: Feasibility of minimally invasive approaches in patients with infected necrotizing pancreatitis. Br J Surg 2007, 94:604–608.PubMedCrossRefGoogle Scholar
  19. 19.
    Freeny PC, Hauptmann E, Althaus SJ, et al.: Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 1998, 170:969–975.PubMedGoogle Scholar
  20. 20.
    Bradley EL: Confusion in the imaging ranks. Time for a change? Pancreas 2006, 33:321–322.PubMedGoogle Scholar
  21. 21.
    Traverso LW, Kozarek RA: Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg 2005, 9:436–439.PubMedCrossRefGoogle Scholar
  22. 22.
    Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA: Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg 2000, 179:352–355.PubMedCrossRefGoogle Scholar
  23. 23.
    Heinrich S, Schäfer M, Rousson V, Clavien PA: Evidencebased treatment of acute pancreatitis: a look at established paradigms. Ann Surg 2006, 243:154–168.PubMedCrossRefGoogle Scholar
  24. 24.
    Gmeinwieser J, Feuerbach S, Zirngibl H, et al.: Percutaneous treatment of infected necrotizing pancreatitis. Eur IHPBA 1997, 23:575–578.Google Scholar
  25. 25.
    Echenique A, Sleeman D, Yrizarry J, et al.: Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Intervent Radiol 1998, 9:565–571.CrossRefGoogle Scholar
  26. 26.
    Gouzi J, Bloom E, Julio C, et al.: Percutaneous drainage of infected pancreatic necrosis: an alternative to surgery [in French]. Chirurgie 1999, 124:31–37.PubMedCrossRefGoogle Scholar
  27. 27.
    Szentkereszty Z, Kerekes L, Hallay J, et al.: CT guided percutaneous drainage in the treatment of acute necrotizing pancreatitis [in Hungarian]. Magy Seb 2001, 54:11–14.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Radiology C5-XRVirginia Mason Medical CenterSeattleUSA

Personalised recommendations