Maximum Extent of Pancreatic Necrosis and Not Site of Necrosis Guide the Therapeutic Modality in Severe Acute Pancreatitis

Babu, Yalakanti R.; Gupta, Rajesh; Chandrasekaran, Prasanna; Kang, Mandeep; Bhasin, Deepak K.; Rana, Surinder Singh; Singh, Rajinder

doi:10.1016/s0016-5085(11)64385-0

Cited by 1 publication

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“…While <30% pancreatic necrosis are at low risk (10%) to develop infections, >50% necrosis is associated with an increased risk of organ failure (65%), infection, and need for interventions. [ 54 55 56 ] Hence, extensive necrosis may be an indication for prophylactic antibiotics. Selective digestive decontamination (SDD) is thought to benefit patients with necrotizing pancreatitis by decreasing potentially harmful gut flora.…”

Section: Role Of Antibioticsmentioning

confidence: 99%

Current concepts in the management of acute pancreatitis

Srinivasan

Venkatakrishnan

Sambandam

et al. 2016

J Family Med Prim Care

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Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.

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Section: Role Of Antibioticsmentioning

confidence: 99%