TY - JOUR
T1 - Conservative management of infected necrosis complicating severe acute pancreatitis
AU - Adler, Douglas G.
AU - Chari, Suresh T.
AU - Dahl, Tamela J.
AU - Farnell, Michael B.
AU - Pearson, Randall K.
PY - 2003/1/1
Y1 - 2003/1/1
N2 - OBJECTIVES: Patients with severe necrotizing pancreatitis are at risk for infection, a major cause of morbidity and mortality. Most patients with infected pancreatic tissue require surgical intervention (necrosectomy), which is associated with high morbidity and mortality. A subset of these patients can be managed successfully with conservative management combined with prolonged courses of antibiotics. METHODS: Three cases of severe acute pancreatitis seen at our institution are described, in which the patients developed aspirate-proven pancreatic infections. The patients were nonetheless stable from a clinical standpoint and were treated with long courses of antibiotics known to penetrate the pancreas; emergent surgery was deferred. RESULTS: In two patients, surgery was completely avoided, with good clinical outcome. In the third patient, elective surgery was undertaken 12 wk after the episode of acute pancreatitis, to perform necrosectomy on organized pancreatic necrosis and to evaluate the patient's biliary tree. There were no postoperative complications. CONCLUSIONS: A subset of patients with severe acute pancreatitis complicated by infection can be successfully managed with long term antibiotics and other supportive measures. High risk necrosectomy can, in some instances, be delayed or avoided entirely.
AB - OBJECTIVES: Patients with severe necrotizing pancreatitis are at risk for infection, a major cause of morbidity and mortality. Most patients with infected pancreatic tissue require surgical intervention (necrosectomy), which is associated with high morbidity and mortality. A subset of these patients can be managed successfully with conservative management combined with prolonged courses of antibiotics. METHODS: Three cases of severe acute pancreatitis seen at our institution are described, in which the patients developed aspirate-proven pancreatic infections. The patients were nonetheless stable from a clinical standpoint and were treated with long courses of antibiotics known to penetrate the pancreas; emergent surgery was deferred. RESULTS: In two patients, surgery was completely avoided, with good clinical outcome. In the third patient, elective surgery was undertaken 12 wk after the episode of acute pancreatitis, to perform necrosectomy on organized pancreatic necrosis and to evaluate the patient's biliary tree. There were no postoperative complications. CONCLUSIONS: A subset of patients with severe acute pancreatitis complicated by infection can be successfully managed with long term antibiotics and other supportive measures. High risk necrosectomy can, in some instances, be delayed or avoided entirely.
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U2 - 10.1111/j.1572-0241.2003.07162.x
DO - 10.1111/j.1572-0241.2003.07162.x
M3 - Article
C2 - 12526943
AN - SCOPUS:0037256842
SN - 0002-9270
VL - 98
SP - 98
EP - 103
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 1
ER -