Skip to main content
SpringerLink
Log in

Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Uhl W, Warshaw A, Imrie C et al (2002) IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology 2:565–573

    Article  PubMed  Google Scholar 

  2. Werner J, Uhl W, Hartwig W et al (2003) Modern phase-specific management of acute pancreatitis. Dig Dis 21:38–45

    Article  PubMed  Google Scholar 

  3. Beger HG, Bittner R, Block S, Buchler M (1986) Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 91:433–438

    PubMed  CAS  Google Scholar 

  4. Isenmann R, Rau B, Beger HG (1999) Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 86:1020–1024

    Article  PubMed  CAS  Google Scholar 

  5. UK guidelines for the management of acute pancreatitis (2005) Gut 54(Suppl 3):iii1–iii9

  6. Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232:619–626

    Article  PubMed  CAS  Google Scholar 

  7. Carter R (2003) Management of infected necrosis secondary to acute pancreatitis: a balanced role for minimal access techniques. Pancreatology 3:133–138

    Article  PubMed  Google Scholar 

  8. Connor S, Alexakis N, Raraty MG et al (2005) Early and late complications after pancreatic necrosectomy. Surgery 137:499–505

    Article  PubMed  CAS  Google Scholar 

  9. Connor S, Ghaneh P, Raraty M et al (2003) Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy. Br J Surg 90:1542–1548

    Article  PubMed  CAS  Google Scholar 

  10. Frey CF, Bradley EL, Beger HG (1988) Progress in acute pancreatitis. Surg Gynecol Obstet 167:282–286

    PubMed  CAS  Google Scholar 

  11. Rau B, Uhl W, Buchler MW, Beger HG (1997) Surgical treatment of infected necrosis. World J Surg 21:155–161

    Article  PubMed  CAS  Google Scholar 

  12. Werner J, Feuerbach S, Uhl W, Buchler MW (2005) Management of acute pancreatitis: from surgery to interventional intensive care. Gut 54:426–436

    Article  PubMed  CAS  Google Scholar 

  13. Hartwig W, Maksan SM, Foitzik T, Schmidt J, Herfarth C, Klar E (2002) Reduction in mortality with delayed surgical therapy of severe pancreatitis. J Gastrointest Surg 6:481–487

    Article  PubMed  Google Scholar 

  14. Mier J, Leon EL, Castillo A, Robledo F, Blanco R (1997) Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 173:71–75

    Article  PubMed  CAS  Google Scholar 

  15. Gmeinwieser J, Feuerbach S, Zirngibl H, Agha E, Holstege A, Jauch K et al (1997) Percutaneus treatment of infected necrotizing pancreatitis. European International Hepato-Pancreato-Biliary Association Congress. Mandozzi Editori, Bologna, pp 575–578

  16. Echenique AM, Sleeman D, Yrizarry J et al (1998)Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Interv Radiol 9:565–571

    Article  PubMed  CAS  Google Scholar 

  17. Zorger N, Hamer OW, Feuerbach S, Borisch I (2005) Percutaneous treatment of a patient with infected necrotizing pancreatitis. Nat Clin Pract Gastroenterol Hepatol 2:54–57; quiz 8

    Article  PubMed  Google Scholar 

  18. Gmeinwieser J, Holstege A, Zirngibl H et al (2005) Successful percutaneous treatment of infected necrosis of the body of the pancreas associated with segmental disruption of the main pancreatic duct. Gastrointest Endosc 523:413–415

    Google Scholar 

  19. Cheung MT, Ho CN, Siu KW, Kwok PC (2005) Percutaneous drainage and necrosectomy in the management of pancreatic necrosis. ANZ J Surg 75:204–207

    Article  PubMed  Google Scholar 

  20. Szentkereszty Z, Kerekes L, Hallay J, Czako D, Apy P (2002) CT-guided percutaneous peripancreatic drainage: a possible therapy in acute necrotizing pancreatitis. Hepatogastroenterology 49:1696–1698

    PubMed  Google Scholar 

  21. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170:969–975

    PubMed  CAS  Google Scholar 

  22. Lee MJ, Rattner DW, Legemate DA et al (1992) Acute complicated pancreatitis: redefining the role of interventional radiology. Radiology 183:171–174

    PubMed  CAS  Google Scholar 

  23. Balthazar EJ, Freeny PC, van Sonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193:297–306

    PubMed  CAS  Google Scholar 

  24. vanSonnenberg E, Wittich GR, Casola G et al (1989) Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases. Radiology 170:757–761

    PubMed  CAS  Google Scholar 

  25. Connor S, Raraty MG, Howes N et al (2005) Surgery in the treatment of acute pancreatitis-minimal access pancreatic necrosectomy. Scand J Surg 94:135–142

    PubMed  CAS  Google Scholar 

  26. van Santvoort HC, Besselink MG, Bollen TL, Buskens E, van Ramshorst B, Gooszen HG; Dutch Acute Pancreatitis Study Group. (2007) Case-matched comparison of the retroperitoneal approach with laparotomy for necrotizing pancreatitis. World J Surg 31:1635–1642

    Google Scholar 

  27. Endlicher E, Volk M, Feuerbach S, Scholmerich J, Schaffler A, Messmann H (2003) Long-term follow-up of patients with necrotizing pancreatitis treated by percutaneous necrosectomy. Hepatogastroenterology 50:2225–2228

    PubMed  CAS  Google Scholar 

  28. Connor S, Ghaneh P, Raraty M et al (2003) Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 20:270–277

    Article  PubMed  CAS  Google Scholar 

  29. Risse O, Auguste T, Delannoy P, Cardin N, Bricault I, Letoublon C (2004) Percutaneous video-assisted necrosectomy for infected pancreatic necrosis. Gastroenterol Clin Biol 28:868–871

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital of Regensburg, 93042, Regensburg, Germany

    N. Zorger, T. Herold, S. Feuerbach & O. W. Hamer

  2. Department of Internal Medicine 1, University Hospital of Regensburg, 93042, Regensburg, Germany

    T. Bruennler, J. Langgartner, S. Lang, B. Salzberger & J. Schoelmerich

Authors
  1. T. Bruennler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Langgartner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Zorger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Herold
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Salzberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Feuerbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Schoelmerich
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O. W. Hamer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Bruennler.

Additional information

T. Bruennler and J. Langgartner share first authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bruennler, T., Langgartner, J., Lang, S. et al. Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis. Eur Radiol 18, 1604–1610 (2008). https://doi.org/10.1007/s00330-008-0928-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-0928-7

Keywords

Search

Navigation