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. 2011 Jan 21;17(3):366-71.
doi: 10.3748/wjg.v17.i3.366.

Analysis of the delayed approach to the management of infected pancreatic necrosis

Nilesh Doctor  1 , Sujith Philip, Vidhyachandra Gandhi, Maharra Hussain, Savio G Barreto
Affiliations

Analysis of the delayed approach to the management of infected pancreatic necrosis

Nilesh Doctor et al. World J Gastroenterol. .

Abstract

Aim: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP).

Methods: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed.

Results: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.

Conclusion: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.

Keywords: Infected necrosis; Inflammation; Necrosectomy; Pancreas; Severe acute pancreatitis.

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Figures

Figure 1
Figure 1
Contrast-enhanced computed tomography of the abdomen showing a large hypodense collection with air pockets in the location of the pancreatic body and tail (white arrow) indicative of an infected pancreatic necrosis.
Figure 2
Figure 2
Post-operative photograph demonstrating a complete necrotic pancreas.
See this image and copyright information in PMC

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