Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

Rasslan, Roberto; Novo, Fernando da Costa Ferreira; Rocha, Marcelo Cristiano; Bitran, Alberto; Rocha, Manoel de Souza; Bernini, Celso de Oliveira; Rasslan, Samir; Utiyama, Edivaldo Massazo

doi:10.6061/clinics/2017(02)04

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…They treated eight patients exclusively with antibiotics. Rasslan et al 45 presented a series of six patients with necrosis and gas in the retroperitoneum treated exclusively with antibiotics.…”

Section: Is There a Role For Non-surgical Treatment?mentioning

confidence: 99%

Management of infected pancreatic necrosis: state of the art

Rasslan

Novo

Bitran

et al. 2017

Rev. Col. Bras. Cir.

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Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.

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Section: Is There a Role For Non-surgical Treatment?mentioning

confidence: 99%

Management of infected pancreatic necrosis: state of the art

Rasslan

Novo

Bitran

et al. 2017

Rev. Col. Bras. Cir.

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“…Confounding factors existed in the results. Previous studies by Rasslan et al [10] and Mouli et al [11] also indicate that some IPNs can be cured with antibiotics alone, and surgical intervention such as drainage might not be needed. The author’s perspective is that the inclusion criteria of POINTER research objects are fairly strict and patients’ basic physical condition is stable, which limits the interpretation of experimental findings.…”

Section: The Timing Of Surgical Intervention In Ipnmentioning

confidence: 99%

Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review

Cao

Mei

2022

Journal of Pancreatology

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ancreatic necrosis occurs in approximately 15% to 20% of patients with acute pancreatitis (AP); 1/3 of patients are diagnosed with infected pancreatic necrosis (IPN), which has a mortality rate of 30%. It is the chief reason for the second "death peak" of AP patients in the later stage of the disease. [1] As one of the most vital treatment methods for IPN, pancreatic necrosectomy has developed rapidly in the past 30 years, including improvements and breakthroughs in surgical timing, approach, and strategies, and a significant reduction in postoperative mortality from the initial 30% to 40%. In particular, with the innovation of laparoscopic and endoscopic techniques, pancreatic surgeons have more choices in the face of IPN. Currently, how to optimize treatment and maximize the benefits for IPN patients has become a topic of great concern and controversy in the treatment of IPN.Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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