Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 May 19;4(1):e000308.
doi: 10.1136/tsaco-2019-000308. eCollection 2019.

Step-up approach for the management of pancreatic necrosis: a review of the literature

Melanie Kay Sion  1 , Kimberly A Davis  2
Affiliations
Review

Step-up approach for the management of pancreatic necrosis: a review of the literature

Melanie Kay Sion et al. Trauma Surg Acute Care Open. .

Abstract

Infected necrotizing pancreatitis is a challenging condition to treat because of the profound inflammatory response these patients undergo which can then be exacerbated by interventions. Treatment of this condition has evolved in timing of intervention as well as method of intervention and includes less invasive options for treatment such as percutaneous drainage and endoscopic drainage, in addition to less invasive endoscopic and video-assisted or laparoscopic debridements. The precise optimal treatment strategy for these patients is an ongoing topic of discussion and may be different for each patient as this is a heterogenous condition.

Keywords: acute pancreatitis; pancreas; pancreatitis; severe acute pancreatitis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Periduodenal collection (red arrow).
Figure 2
Figure 2
Collection confined to the lesser sac (red arrow).
Figure 3
Figure 3
Collection extending to the root of the mesentery (red arrow).
Figure 4
Figure 4
Collection extending down the left paracolic gutter and across midline to the pelvis and right lower quadrant (red arrow).
Figure 5
Figure 5
Collections in discontinuity in the left paracolic gutter and right lower quadrant (red arrows).
Figure 6
Figure 6
Generalized treatment flow with advent of step-up method for infected necrotizing pancreatitis. Abx, antibiotics; MIS, minimally invasive surgery; Perc, percutaneous; VARD, video-assisted retroperitoneal debridement.
See this image and copyright information in PMC

References

    1. Underlying cause of death 1999-2017. data are from the multiple cause of death files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the vital statistics cooperative program. 2018.
    1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group . Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102–11. 10.1136/gutjnl-2012-302779 - DOI - PubMed
    1. Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology 2016;16:698–707. 10.1016/j.pan.2016.07.004 - DOI - PubMed
    1. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. The Lancet 2015;386:85–96. 10.1016/S0140-6736(14)60649-8 - DOI - PubMed
    1. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, et al. . A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–502. 10.1056/NEJMoa0908821 - DOI - PubMed

LinkOut - more resources