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Decision Making in Necrotizing Pancreatitis.
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- Author(s): Hackert T;Hackert T; Büchler MW
- Source:
Digestive diseases (Basel, Switzerland) [Dig Dis] 2016; Vol. 34 (5), pp. 517-24. Date of Electronic Publication: 2016 Jun 22.- Publication Type:
Journal Article- Language:
English - Source:
- Additional Information
- Source: Publisher: S. Karger Country of Publication: Switzerland NLM ID: 8701186 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1421-9875 (Electronic) Linking ISSN: 02572753 NLM ISO Abbreviation: Dig Dis Subsets: MEDLINE
- Publication Information: Original Publication: Basel ; New York : S. Karger, [c1986-
- Subject Terms: Decision Making*; Pancreas/*pathology ; Pancreatitis, Acute Necrotizing/*diagnosis; Anti-Bacterial Agents/therapeutic use ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Disease Management ; Drainage ; Enteral Nutrition/methods ; Humans ; Male ; Pancreas/surgery ; Pancreatitis, Acute Necrotizing/therapy ; Tomography, X-Ray Computed
- Abstract: The management of acute necrotizing pancreatitis (ANP) has undergone a change of paradigms during the last 2 decades with a decreasing impact of surgical interventions. Modern ANP management is done conservatively as long as possible and therapeutic approaches aim at volume resuscitation, pain management and early enteral nutrition. The diagnostic gold standard of contrast-enhanced CT scan helps to evaluate the extent of necrosis of the pancreas, which correlates with the risk of tissue infection. The crucial point for decision making is the proven existence of infected pancreatic necrosis. This can be achieved by diagnostic needle aspiration of the necrotic material and staining to prove bacterial and/or fungal infection. In case of infected necrosis - besides calculated antimicrobial treatment - an interventional or surgical approach is required to prevent systemic septic progression of the disease. As the first step, percutaneous interventional drainage and spilling of the necrosis are preferable. In case of insufficient clearing of the infectious focus, a step-up approach must be considered, which implies a retroperitoneoscopic or transabdominal minimally invasive necrosectomy and drain placement. Postoperatively, a continuous lavage should be performed using these drains. In case of further deterioration of the patient or development of associated intra-abdominal complications (e.g. bowel perforation or uncontrolled bleeding), an open surgical intervention must always be regarded as a salvage therapy and this offers the possibility to control complications and perform a further necrosectomy and extensive lavage for focus control. However, associated morbidity (e.g. pancreatic fistula, fluid collections, pseudocysts) is about 50-60% and mortality up to 20%. In summary, ANP is managed primarily by a conservative therapy. In case of infected necrosis, interventional and minimally invasive approaches are the therapy of choice. Open surgery should be considered for patients deteriorating despite other measures and should be postponed as long as possible.
(© 2016 S. Karger AG, Basel.) - Accession Number: 0 (Anti-Bacterial Agents)
- Publication Date: Date Created: 20160623 Date Completed: 20170119 Latest Revision: 20181202
- Publication Date: 20231215
- Accession Number: 10.1159/000445232
- Accession Number: 27332898
- Source:
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