Interventionen bei der Pankreatitis

Interventions for pancreatitis

Zusammenfassung

Bei etwa 20 % der Patienten mit einer akuten Pankreatitis entwickeln sich im Verlauf Komplikationen, die eine Operation oder Intervention notwendig machen. Die Radiologie ist dabei sowohl für die Bildgebung (Verlauf der Verhalte, Detektion einer Superinfektion sowie von Komplikationen, Evaluation der Nekrosen) als auch in der Behandlung der vaskulären und nichtvaskulären Komplikationen von zentraler Bedeutung. Bei der Behandlung einer schweren oder nekrotisierenden Pankreatitis sollte ein multidisziplinäres Stufenkonzept zum Einsatz kommen mit initial möglichst minimal-invasiven Therapien wie endoskopische oder perkutane Drainagen. Durch die Applikation von ausreichend vielen und kaliberstarken Drainagen und unter strikter Spültherapie mit Umpositionierung der Drainagen können die pankreatischen und peripankreatischen Verhalte oftmals erfolgreich ohne die Notwendigkeit eines späteren chirurgischen Débridements behandelt werden. Die arteriellen Komplikationen betreffen 1–10 % aller Patienten mit einer Pankreatitis, dabei handelt es sich überwiegend um rupturierte Pseudoaneurysmata, welche die gefährlichsten Blutungskomplikationen der Pankreatitis darstellen und mittels Blutungsembolisation und/oder endovaskulärer Stentgraftapplikation mit einer hohen technischen Erfolgsrate behandelt werden können.

Abstract

Approximately 20% of patients with acute pancreatitis develop complications that require surgical or radiological intervention. Radiology plays a central role, not only for imaging (course of the disease, detection of superinfection and their related complications, and development of necrosis) but also for the treatment of vascular and nonvascular complications. In the treatment of severe or necrotizing pancreatitis, a multidisciplinary staged approach with minimally invasive therapies such as endoscopic or percutaneous drainage should be used. Applying a sufficient number of drains of sufficient size, strict irrigation therapy under computed tomographic (CT) control and repositioning of the drains can successfully treat pancreatic and peripancreatic necrosis often without the need for subsequent surgical debridement. Arterial complications affect 1–10% of all patients with pancreatitis, most of which are ruptured pseudoaneurysms, which represent the most dangerous bleeding complication of pancreatitis and can be treated with a high technical success rate through embolization and/or use of an endovascular stent–graft.

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Correspondence to Prof. Dr. B. Radeleff EBIR FCIRSE.

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Interessenkonflikt

K. Dubasz, M. Misbahuddin, C. Graeb und B. Radeleff geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dubasz, K., Misbahuddin, M., Graeb, C. et al. Interventionen bei der Pankreatitis. Radiologe (2021). https://doi.org/10.1007/s00117-021-00856-w

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Schlüsselwörter

  • Nekrotisierende Pankreatitis
  • Computertomographie
  • Drainage
  • Arterielle Blutung
  • Pseudoaneurysma

Keywords

  • Necrotizing pancreatitis
  • Computed tomography
  • Drainage
  • Arterial bleeding
  • Pseudoaneurysm