Acute necrotizing pancreatitis: role of CT-guided percutaneous catheter drainage

Segal, Dmitri; Mortelé, Koenraad J.; Banks, Peter A.; Silverman, Stuart G.

doi:10.1007/s00261-007-9221-5

Cited by 54 publications

(40 citation statements)

References 37 publications

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“…Overall, unless a patient has a contraindication, or the goal of the study is to diagnose choledocholithiasis, a contrast-enhanced CT scan remains the imaging procedure of choice due to improved accessibility, lower cost, ease of performance, and increased sensitivity in the detection of gas bubbles (potentially indicating pancreatic infection). [31][32][33] Ordering a CT scan or other imaging at admission is not necessary in the diagnosis of acute pancreatitis if the patient's presentation is classic. At admission, however, a CT scan may be reasonable to exclude other serious causes of abdominal pain, such as a perforated ulcer.…”

Section: Choosing the Appropriate Imaging Modalitymentioning

confidence: 99%

“…32 Patients who are clinically unstable with fever, tachycardia, leukocytosis, or organ failure may require percutaneous sampling to evaluate for infected necrosis. 33 If the pancreatic tissue is sterile, the patient is determined to have ''sterile necrosis.'' If the patient with sterile necrosis is clinically unstable then prophylactic antibiotics may be indicated.…”

Section: Management Of Pancreatic Necrosismentioning

confidence: 99%

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Acute pancreatitis

Munsell

Buscaglia

2010

Journal of Hospital Medicine

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Acute pancreatitis is a common disease most frequently caused by gallstone disease or excess alcohol ingestion. Diagnosis is usually based on characteristic symptoms, often in conjunction with elevated serum pancreatic enzymes. Imaging is not always necessary, but may be performed for many reasons, such as to confirm a diagnosis of pancreatitis, rule out other causes of abdominal pain, elucidate the cause of pancreatitis, or to evaluate for complications such as necrosis or pseudocysts. Though the majority of patients will have mild, self‐limiting disease, some will develop severe disease associated with organ failure. These patients are at risk to develop complications from ongoing pancreatic inflammation such as pancreatic necrosis, fluid collections, pseudocysts, and pancreatic duct disruption. Validated scoring systems can help predict the severity of pancreatitis, and thus, guide monitoring and intervention.Treatment of acute pancreatitis involves supportive care with fluid replacement, pain control, and controlled initiation of regular food intake. Prophylactic antibiotics are not recommended in acute pancreatitis if there is no evidence of pancreatic infection. In patients who fail to improve, further evaluation is necessary to assess for complications that require intervention such as pseudocysts or pancreatic necrosis. Endoscopy, including ERCP and EUS, and/or cholecystectomy may be indicated in the appropriate clinical setting. Ultimately, the management of the patient with severe acute pancreatitis will require a multidisciplinary approach. Journal of Hospital Medicine 2010;5:241–250. © 2010 Society of Hospital Medicine.

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Section: Choosing the Appropriate Imaging Modalitymentioning

confidence: 99%

Section: Management Of Pancreatic Necrosismentioning

confidence: 99%

Acute pancreatitis

Munsell

Buscaglia

2010

Journal of Hospital Medicine

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“…The drained fluid shlould be sent for bacterological analysis in each case. More drains can be inserted at a time if necessary [5,8,10,11,12,18,21,32,33,35,39,42,44]. The drain is usually placed without active suction.…”

Section: How To Drain?mentioning

confidence: 99%

“…The insertion of the drain can be guided by CT or ultrasound and fluoroscopy or without it [5,6,8,10,11,12,18,21,28,32,39,42,44]. The catheter with the main wire is led into the fluid collection and following verification of its placement the wire is removed (Figure 1-2).…”

Section: How To Drain?mentioning

confidence: 99%

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The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Szentkereszty¹,

Kotán²,

Sápy³

2012

Acute Pancreatitis

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What to drain? Acute peripancreatic fluid collection (APFC)According to the Atlanta Classification peripancreatic fluid collection develops in the early phase of acute pancreatitis in about 40% of cases. The acute fluid collection usually develops around the pancreas but sometimes emerges in the glandular area and does not contain a high quantity of necrosis. Not rarely, it spreads into the chest, mediastinum and/or into the pararenal area. Several fluid collections can develop at the same time and can shuttle together. The rich pancreatic enzyme content of the fluid can indicate communication with the pancreatic duct or indicate parenchymal necrosis. They do not have definite walls, and are limited by the walls of the surrounding organs. In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9]. In other cases they can cause compression symptoms (jaundice, duodenal obstruction) or bleeding can develop inside of them. Another frequent complication is the

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Impact of Radiologic Intervention on Mortality in Necrotizing Pancreatitis

Rocha¹

2009

Arch Surg

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Acute necrotizing pancreatitis: role of CT-guided percutaneous catheter drainage

Cited by 54 publications

References 37 publications

Acute pancreatitis

Acute pancreatitis

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Impact of Radiologic Intervention on Mortality in Necrotizing Pancreatitis

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