A Fifteen-Year Experience with Open Drainage for Infected Pancreatic Necrosis

Bradley, Edward L.

doi:10.1097/00019048-199407000-00021

Cited by 55 publications

(86 citation statements)

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“…It is thought that in the majority of cases infection is caused by bacterial translocation from the gut lumen, a hypothesis which animal experiments have generally supported (Olah et al, 2002;Rayes et al, 2002a). Unfortunately attempts to confirm the link between bacterial translocation and morbidity and mortality in AP in human beings have been largely unsuccessful (Bradley, 1993;Rayes et al, 2002b). Experimental studies have shown that bacterial overgrowth occurs very early, within 24 h after onset, in the course of AP and reduction of the bacterial load in the proximal small bowel by intraluminal antibiotics reduces the risk of infection of pancreatic necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recent advances in intensive care management, the mortality rate of severe acute pancreatitis (SAP) remains high, and secondary infection of pancreatic necrosis is associated with particularly high mortality rates as high as 40% (Bradley, 1993;Miller et al, 1994;Branum et al, 1998). Sepsis and multiple organ failure, mainly owing to pancreatic or peripancreatic infection, have emerged as the most serious complications and now account for more than 80% of deaths.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis

et al. 2007

Eur J Clin Nutr

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Objective: To study the effect of the Lactobacillus plantarum (LP) enteral feeding on the gut permeability and sepsis in the patients with acute pancreatitis. Subjects: Seventy-six subjects who stayed over 1 week in the hospital completed the study. Subjects were not treated with any lactobacillus supplement before the intervention. Methods: Seventy-six patients with acute pancreatitis were randomly divided into two groups, parenteral nutrition (PN) group (n ¼ 38) and ecoimmunonutrition (EIN) group supplied by LP enteral feeding (n ¼ 36). The acute physiology and chronic health evaluation score, Balthazar CT score, CRP, fecal bacterial species and DNA fingerprint profiles as well as the potentially pathologenic organisms in nasogastric aspirate were determined on the day of admission and on the 8 day. The intestinal permeability was assessed by measurement of the ratio of lactulose/rhamnose on the day of admission and on days 5 and 8. The rate of organ failure, septic complications and death cases were evaluated at the 8 day. Results: Following 7 days treatment, 38.9% patients in the EIN group were colonized with multiple organisms compared to 73.7% in the PN group (Po0.01), and 30.6% patients in the EIN grew potentially pathogenic organisms compared to 50% patients in PN group (Po0.05). The fecal bacterial DNA fingerprint profiles were less, the amount of lactobacteria and bifydobacteria decreased, and the amount of enterococci increased in PN group as compared with EIN group, Po0.05. By day 8, the lactulose/rhamnose ratio in EIN group were lower than that in PN group at days 5 and 8, Po0.05. The patients with LP got a better clinical outcomes as compared with the patients with PN. Conclusion: EIN enteral feeding can attenuate disease severity, improve the intestinal permeability and clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis

et al. 2007

Eur J Clin Nutr

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“…Necrotizing pancreatitis occurs in about 20% of all patients suffering from acute pancreatitis [1] . If infection of the necrotic tissue occurs mortality rates of up to 50% are reported with sepsis and multiorgan failure as most frequent causes [2][3][4][5] . It is generally accepted that in infected necrotizing pancreatitis the infected non-vital solid tissue has to be removed in order to control the sepsis.…”

Section: Introductionmentioning

confidence: 99%

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Bruennler

Langgartner²,

Lang³

et al. 2008

WJG

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INTRODUCTIONThe course of acute pancreatitis ranges from a mild transitory edematous to a severe necrotizing form. Necrotizing pancreatitis occurs in about 20% of all patients suffering from acute pancreatitis [1] . If infection of the necrotic tissue occurs mortality rates of up to 50% are reported with sepsis and multiorgan failure as most frequent causes [2][3][4][5] . It is generally accepted that in infected necrotizing pancreatitis the infected non-vital solid tissue has to be removed in order to control the sepsis. The standard treatment has traditionally been surgery [5,6] . By using modern surgical techniques like open packing, repeated laparatomies, closed packing or closed continuous lavage mortality rates could be decreased to 20%-40% [7][8][9][10][11][12] . However, these techniques are associated with a considerable surgical trauma which often causes escalation of multiorgan failure and sepsis [7,13] . Moreover, total anaesthesia is mandatory. Thus, in the last decade minimal invasive treatment regimes and in particular percutaneous drainage therapy were included in the management of infected necrotizing pancreatitis. Ultrasound (US) or computed tomography (CT) guided placement of drainages is reported to be effective in up to 90% for drainage of fluid collections or abscesses with purely liquid content [14] . However, the success rates Abstract AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.

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“…The gastropancreatic fistula was dilated with the use of a high pressure balloon up to 10 mm. Two double pigtail 7 Fr and 10 Fr stents were led through the stomy into the lumen of necrotic cavity together with nasocystic 8 Fr drain (see Figures 3,4) in order to irrigate the collection (200 ml saline solution every four hours). The performed culture of the collection's content showed the presence of Enterococcus faecalis, Enterococcus faecium and Escherichia coli.…”

Section: Case Presentationmentioning

confidence: 99%

“…Applied procedures of open necrosectomies are found to be burdened with high morbidity and mortality. [4][5][6] Due to the development of minimally invasive techniques of treatment of pancreatic necrosis the access to the necrotic collection is possible through transperitoneal, retroperitoneal, transmural and transpapillary way. [7,8] The optimal strategy in many patients is joining a few minimally invasive methods, which allows multiplexing of access to the collection.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

Jagielski

Smoczyński

Studniarek

et al. 2016

CRIM

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Pancreatic necrosis and the necrosis of surrounding tissues are found to be local complications occurring in 15% of patients suffering from acute pancreatitis. Walled-off pancreatic necrosis (WOPN) is in fact pancreatic fluid collection surrounded by a well-defined wall and inclusive of liquefied necrosis and elements (debris) of necrotic tissues. Endotherapy is an efficient method of treatment for patients with symptomatic WOPN. Often single transmural access to the necrotic collection is sufficient. However, in some patients with infected WOPN, the application of an extra way of access to pancreatic necrosis is a must. In these particular patients the optimal strategy is joining a few minimally invasive methods, which allows multiplexing of access to the collection. Herein we described the case of treatment with the use of minimally invasive techniques in a patient suffering from an infected WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary. Only joining together both minimally invasive techniques-transmural drainage and percutaneous drainage had become efficient enough and led to complete healing of the patient.

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A Fifteen-Year Experience with Open Drainage for Infected Pancreatic Necrosis

Cited by 55 publications

References 0 publications

Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis

Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

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