Treatment for Infected Pancreatic Necrosis Should be Delayed, Possibly Avoiding an Open Surgical Approach

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Claudio Ricci ◽  
Nico Pagano ◽  
Carlo Ingaldi ◽  
Leonardo Frazzoni ◽  
Marina Migliori ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Open Surgical Approach

Current Surgical Management of Infected Pancreatic Necrosis

2010 ◽  
Vol 76 (10) ◽  
pp. 1096-1099 ◽  
Author(s):  
Brendan Boland ◽  
Steven Colquhoun ◽  
Vijay Menon ◽  
Amanda Kim ◽  
Simon Lo ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Challenging Problem ◽  
Surgical Service ◽  
Single Procedure ◽  
Pancreatic Debridement ◽  
Single Intervention ◽  
The Mean ◽  
Mean Time

Infected pancreatic necrosis (IPN) continues to be a challenging problem for the surgeon. We reviewed the experience on a hepatobiliary surgical service with patients who required operative intervention for IPN with emphasis on surgical approach, timing of surgery, and complications. Between 2002 and 2008, 21 patients underwent surgery for IPN. The initial surgical approach in these 21 patients included either direct pancreatic debridement (DPD, n = 13) or transgastric debridement using cyst-gastrostomy (CG, n = 8). Fifteen patients (71%) required only a single procedure, whereas three (14%) required two procedures and three (14%) required three procedures. The mean time from onset of pancreatitis to operation was 77 days. Patients requiring a single intervention had a longer interval from onset of pancreatitis to surgery compared with those requiring multiple interventions. When comparing CG and DPD groups, there was a longer interval from onset of pancreatitis to debridement, a lower chance of needing multiple debridements, and fewer pancreatic fistulae in the CG group. Overall survival was 95 per cent. Our results demonstrate that CG can be successfully used in select patients with IPN. Patients undergoing CG are less likely to require repeat surgical debridement and to develop pancreatic fistulae compared with patients undergoing DPD.

scholarly journals Advanced technologies for treatment of infected pancreatic necrosis: differentiated approach

2020 ◽  
Vol 25 (1) ◽  
pp. 69-78
Author(s):  
E. A. Gallyamov ◽  
M. A. Agapov ◽  
O. E. Lutsevich ◽  
V. V. Kakotkin
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Medical Science ◽  
Main Idea ◽  
Infected Pancreatic Necrosis ◽  
Surgical Approaches ◽  
Endoscopic Drainage ◽  
Main Task ◽  
Minimal Damage ◽  
Key Steps

This work is based on analysis of publications devoted to the problem of surgical approach to treatment of acute pancreatitis over the last 30 years. The main aim of this review is to identify the key steps of evolution of surgical approach to treatment of infected pancreatic necrosis and also to determine the most promising approach among existing methods. The analysis of the most modern clinical recommendations adopted in different countries of the world, as well as the search for such problems, the solution of which will be the main task of world medical science in the near future, is carried out. It has been established that medical communities of different countries give preference to minimally invasive methods of debridement: percutaneous and transluminal endoscopic drainage. According to the most advanced recommendations, the method of choice for surgical treatment of infected pancreatic necrosis is transluminal endoscopic drainage, with inefficiency – percutaneous puncture drainage. The main idea that defines the search vector for treatment methods for the disease is the recognition of the fact that all surgical approaches are aimed at achieving one goal – removing the maximum possible volume of necrotic masses with minimal damage to surrounding tissues. Only a method that satisfies both requirements can be recognized as leading.

Serum calprotectin in infected pancreatic necrosis

2013 ◽  
Vol 51 (05) ◽  
Author(s):  
V Terzin ◽  
I Földesi ◽  
R Róka ◽  
Z Szepes ◽  
T Wittmann ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis

scholarly journals Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Needle Aspiration ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided ◽  
Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

scholarly journals Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: Early intervention does not compromise outcome

2021 ◽  
Vol 09 (03) ◽  
pp. E490-E495
Author(s):  
David Albers ◽  
Alexander Meining ◽  
Alexander Hann ◽  
Younan Kabara Ayoub ◽  
Brigitte Schumacher
Keyword(s):  
Early Intervention ◽  
Pancreatic Necrosis ◽  
Early Stage ◽  
Clinical Success ◽  
Infected Pancreatic Necrosis ◽  
Metal Stents ◽  
Optimal Timing ◽  
Stent Insertion ◽  
Endoscopic Necrosectomy ◽  
Walled Off Necrosis

Abstract Background and study aims Infection of pancreatic necrosis is a dreaded complication requiring an intervention. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. This retrospective two-center study evaluated direct endoscopic necrosectomy using lumen apposing metal stents in case of proven or suspected infected pancreatic necrosis in an early stage of the disease. Patients and methods Forty-nine patients with infected pancreatic necrosis were included. Sequent direct endoscopic necrosectomies after lumen apposing metal stent insertion (LAMS) were performed until the resolution of necrosis. In all patients, the first endoscopic intervention was performed within the first 30 days after first proof of pancreatic necrosis. Primary outcome parameters were inflammatory activity, days spent in the Intensive Care Unit (ICU), and mortality. Results The patient cohort received median 4 necrosectomies (3–5) after a median of 7 days (3–11) after first proof of pancreatic necrosis. Technical and clinical success were achieved in 98.3 % and 87.8 %, respectively; the mortality rate was 8.2 %. The median C-reactive protein level decreased from 241 mg/L (182.9–288.9) before the intervention to a median of 23.3 mg/L (18–60) after therapy. The median time period in the ICU was 5 days (3–9). Conclusions Early endoscopic therapy in the form of direct endoscopic necrosectomy after LAMS placement within the first 30 days after proof of pancreatic necrosis is effective and does not result in poor outcome. Our retrospective data suggest that early intervention before walled-off necrosis is formed is tenable when it is essential due to the patient's clinical deterioration.

scholarly journals HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

2021 ◽  
Vol 19 ◽  
pp. 205873922110005
Author(s):  
Bei Lu ◽  
Yang Cai ◽  
Junjie Yin ◽  
Jingrui Wang ◽  
Zhong Jia ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Acute Pancreatitis ◽  
Nervous System ◽  
Herpes Simplex ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Percutaneous Catheter Drainage ◽  
Central Nervous System Complication ◽  
Simplex Virus

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

scholarly journals Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain

2012 ◽  
Vol 50 (1) ◽  
pp. 95-103
Author(s):  
Fernando Lopez ◽  
Vanessa Suarez ◽  
Maria Costales ◽  
Carlos Suarez ◽  
Jose L. Llorente
Keyword(s):  
Surgical Approach ◽  
Early Stage ◽  
Tumour Size ◽  
Vascular Supply ◽  
Open Approach ◽  
Tertiary Centre ◽  
Preauricular Approach ◽  
Conventional Open Approach ◽  
Open Surgical Approach

Background: The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. Methods: From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. Results: Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. Conclusions: These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

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