Necrotizing Pancreatitis: Necrosectomy and Closed Continuous Lavage of the Lesser Sac. The Ulm Experience
Acute pancreatitis ranges from a mild, self-limiting disease to a severe illness with sometimes fatal outcome. In about 80% of patients, acute pancreatitis takes the cause of an edematous—interstitial inflammation mainly caused by gallstones (30%) or overindulgence in alcohol (50%). A necrotizing form of acute pancreatitis develops in up to 20% of patients [1–3]. This type of acute pancreatitis, even if with slight or moderate morphologic alterations, often proceeds to local or systemic complications and may become life threatening. From a morphologic point of view, necrotizing pancreatitis shows an interstitial—edematous inflammation combined with more or less extensive necrosis of the pancreatic exocrine and endocrine parechyma, and sometimes even extensive fatty tissue necrosis in the peripancreatic and retroperitoneal tissue compartments . The fluid collection around the pancreatic area in necrotizing pancreatitis contains vasoactive and toxic substances such as phospholipase A2, endotoxin, prostacyclin, activated trypsin, complement break-down products, thromboxane, elastase, and many other undefined harmful substances . The crucial risk in necrotizing pancreatitis is a bacterial infection of pancreatic necrosis [6–8].
KeywordsAcute Pancreatitis Severe Acute Pancreatitis Pancreatic Necrosis Necrotizing Pancreatitis Infected Pancreatic Necrosis
Unable to display preview. Download preview PDF.
- 2.Beger HG, Büchler M (1986) Decision-making in surgical treatment of acute pancreatitis: operative or conservative management of necrotizing pancreatitis? Theor Surg 1:61–68Google Scholar
- 4.Beger HG, Uhl W (1990) Severe acute pancreatitis. II. The surgical approach. Clin Int Care 1:223–227Google Scholar
- 6.Beger HG, Krautzberger W, Bittner R, Büchler M, Block S (1986) Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 91:433–438Google Scholar
- 8.Bassi C, Falconi M, Girelli R, Nifosi F, Elio A, Martini N, Pederzoli P (1989) Microbiological findings in severe pancreatitis. Surg Res Commun 5:1–4Google Scholar
- 15.Balhazar EJ (1989) CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 27:19–37Google Scholar
- 21.Gudgeon AM, Heath D, Hurley P, Shenkin A, Jehanli A, Patel G, Wilson C, Austen BM, Imrie CW (1988) Trypsinogen activation peptide (TAP) assay in severity assessment of acute pancreatitis. Pancreas 3:598Google Scholar
- 22.Gudgeon AM, Heath D, Jehanli A, Patel G, Hurley P, Austen B, Shenkin A, Imrie CW, Hermon-Taylor J (1989) Zymogen activation peptide (ZAP) assay in the severity prediction of acute pancreatitis. Digestion 43:145Google Scholar
- 26.Cox AG (1977) Death from acute pancreatitis. M.R.C. multicentre trial of glucagon and aprotini. Lancet 2(24):632–635Google Scholar
- 29.Usadel KH, Überla KK, Leuscher U (1985) Treatment of acute pancreatitis with somatostatin: results of the multicenter double-blind trial (APTS-study) (Abstr). Dig Dis Sci 30:992Google Scholar
- 30.Büchler M, Malfertheiner P, Uhl W, Stöckmann F, Schölmerich J, Adler G, Rolle K, Ditschuneit H, Beger HG (1990) The German multicenter doubleblind randomized study of gabexate mesilate (4g/day i.v.) in acute pancreatitis Gastroenterology 1993 (in press)Google Scholar
- 31.Gerzof SG, Banks PA, Robbins AH (1984) Role of guided percutaneous aspiration in early diagnosis of pancreatic sepsis. Dig Dis Sci 29:950Google Scholar