Conservative management of infected necrosis complicating severe acute pancreatitis

Douglas G. Adler, Suresh T. Chari, Tamela J. Dahl, Michael B. Farnell, Randall K. Pearson

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)98-103
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume98
Issue number1
DOIs
StatePublished - Jan 1 2003

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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