Double-catheter lavage combined with percutaneous flexible endoscopic debridement for infected pancreatic necrosis failed to percutaneous catheter drainage

Pi, Li; Song, Jun; Ke, Huajing; Lv, Nonghua; Zhu, Yin; Zeng, Hao; Zhu, Yong; Xia, Liang; He, Wenhua; Li, Ji; Huang, Xin; Lei, Yifeng

doi:10.1186/s12876-017-0717-3

Cited by 21 publications

(35 citation statements)

References 26 publications

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“…We speculated that these procedures might explain the refractory postoperative pancreatic fistula. In the therapeutic strategy for acute severe pancreatitis, continuous local lavage is currently accepted as an effective treatment option [34–37]. In our case, continuous local lavage was performed via a transnasal infusion and a transgastric drainage, with the pancreatic drainage tube placed in a retrograde fashion (Figure 4D).…”

Section: Discussionmentioning

confidence: 95%

“…Historically, only surgical approaches have been recommended for treating necrotizing and infected pancreatitis [38,39]. Today, however, continuous local lavage is currently accepted as an effective treatment for severely infected pancreatitis [34–37]. We suggest that continuous local lavage may have a therapeutic potential even for pancreatic juice-related complications, including postoperative pancreatic fistula.…”

Section: Discussionmentioning

confidence: 99%

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Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

et al. 2019

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Patient: Male, 70 Final Diagnosis: Splenic artery aneurysm Symptoms: Asymptomatic Medication: — Clinical Procedure: Surgery and Endoscopy Specialty: Surgery Objective: Unknown ethiology Background: Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. We report the case of a patient who with a SAA extending almost the full length of his splenic artery. Case Report: A solitary true aneurysm that extended almost the entire length of the splenic artery was incidentally detected in an asymptomatic 70-year-old male patient with a history of myasthenia gravis and diabetes mellitus. His SAA was severely calcified, but other arteries showed no calcification. The aneurysm had been slightly enlarged toward the celiac artery for 2 years, and aneurysmectomy and splenectomy were performed. Vascular clips were carefully placed at the intact splenic artery without disturbing arterial flows from the celiac artery. Arterial branch from the SAA was ligated at an intact area, and the pancreatic capsule was densely adherent with the calcified aneurysm wall. The pancreas was preserved, although the pancreatic parenchyma was widely exposed during aneurysmectomy. Pathological examination revealed no atherosclerotic changes. Postoperatively, a pancreatic fistula developed, which was treated by placing an intraperitoneal drain and retrograde pancreatic drainage tube. Nevertheless, the intractable pancreatic fistula triggered a bacteriogenic infection, resulting in intraperitoneal abscess. Continuous local lavage via transnasal continuous infusion and endoscopic transgastric drainage was performed, until the fistula closed. He was healthy at 9 months after surgery. Conclusions: A SAA that had the rare form and solitary origin was treated. Continuous local lavage has a therapeutic potential for a pancreatic juice-related bacteriogenic complication.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

et al. 2019

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“…Among them, continuous positive drainage via a large-bore double-lumen irrigation-suction tube is one of the key techniques. The significance of positive drainage system has been confirmed by several studies [4,13,14]. The procedure of ON consist of a laparotomy through a bilateral subcostal incision, after blunt removal of pancreatic and peri-pancreatic necrosis, several large-bore double-lumen irrigation-suction tube inserted for postoperative CPD (Fig.…”

Section: Treatmentmentioning

confidence: 88%

“…On one hand, 45.4% patients were detected with GI fistula after performing open necrosectomy. DLI, ileostomy or colostomy was performed for 65.3% colonic fistulas [13,14]. On the other hand, with a low threshold for colonic resection due to unreliable detection of ischemia or imminent perforation by outside inspection during surgery for IPN, histologically examined specimens showed that colonic resection was unnecessary in 20-50% [12,15,16].…”

Section: Introductionmentioning

confidence: 99%

Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

Niu

Huang

et al. 2020

BMC Gastroenterol

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Background: To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). Methods: Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation-suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). Results: The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). Conclusion: ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.

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“…In pancreatitis therapy, minimally-invasive drainage ( e.g ., percutaneous and transluminal approaches) is currently considered useful, especially for necrotizing and infected pancreatitis[5-7]. Recently, continuous local lavage (CLL) has been reevaluated as effective treatment for severe infected pancreatitis[8-11].…”

Section: Introductionmentioning

confidence: 99%

Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

Hori

Ogawa

Yamamoto

et al. 2019

WJCC

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BACKGROUNDPostoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess. This refractory complication can be fatal; therefore, intensive treatment is important. Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis, and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL. We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.CASE SUMMARYThe first patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and pancreatic leakage was observed postoperatively. Intractable pancreatic fistula led to intraperitoneal abscess, and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8. The abscess resolved after 7 d of CLL. The second patient underwent distal pancreatectomy. Pancreatic leakage was observed, and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump. CLL was instituted from POD 9, and the abscess resolved after 4 d of CLL. The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma. Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula; however, intraperitoneal abscess was detected on POD 59. We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult. CLL was instituted from POD 63, and the abscess resolved after 1 wk of CLL.CONCLUSIONCLL has therapeutic potential for postoperative pancreatic fistula.

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Double-catheter lavage combined with percutaneous flexible endoscopic debridement for infected pancreatic necrosis failed to percutaneous catheter drainage

Cited by 21 publications

References 26 publications

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

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