Quando e como tratar as complicações na necrose pancreática infectada

Silva, Rodrigo Altenfelder; Pacheco-Junior, Adhemar Monteiro; Moricz, André de; Campos, Tércio De

doi:10.1590/s0102-67202010000400013

Cited by 1 publication

(1 citation statement)

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“…Severe necrotizing pancreatitis 1 , 12 is a common complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis up to 30% in case of infected one associated with multi-organ failure 9 , 11 . Less invasive techniques, including percutaneous drainage, endoscopic (trans-gastric) drainage, and minimally invasive retroperitoneal necrosectomy, are increasingly being used 2 , 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Pancreatitis: Description of Videoscopic Assisted Retroperitoneal Debridement (Vard) Technique With Covered Metallic Stent

Houghton

Vázquez

Zeledón

et al. 2018

ABCD, arq. bras. cir. dig.

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Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

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