Necrotizing pancreatitis: A review for the acute care surgeon

Leonard-Murali, Shravan; Lezotte, Jonathan; Kalu, Richard; Blyden, Dionne; Patton, Joe H.; Johnson, Jeffrey L.; Gupta, Arielle Hodari

doi:10.1016/j.amjsurg.2020.08.027

Cited by 17 publications

(19 citation statements)

References 62 publications

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“…Fonte: Leonard-Murali e colaboradores. 29 Fonte: Leonard-Murali e colaboradores. 29 retroperitoneal videoassistido com lavagem pósoperatória (VARD), seguido de necrosectomia aberta.…”

Section: Resultados E Discussão (Figuras 1-4)unclassified

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Pancreatite Necrosante: Atualização da Abordagem Intervencionista

Fernandes¹,

Farias²,

Bastos³

et al. 2022

RCHSI

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A pancreatite aguda é uma doença de grande relevância epidemiológica, levando a grande número de internações no Brasil e no mundo. Pode evoluir para quadro grave associado a complicação local, necrose pancreática, que eleva as taxas de morbimortalidade. O tratamento desta complicação vem em evolução ao longo dos anos com manejos que vão desde a necrosectomia aberta até as atuais técnicas minimamente invasivas. O presente artigo objetiva realizar uma revisão e atualização sobre as melhores condutas intervencionistas para tratamento da pancreatite com necrose infectada. Os resultados desta revisão identificaram menor morbidade associada ao tratamento com o manejo da abordagem stepup, mantendo a necrosectomia aberta como opção para tratamento de casos refratários ou desconexão total de ducto principal.

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“…Fonte: Leonard-Murali e colaboradores. 29 Fonte: Leonard-Murali e colaboradores. 29 retroperitoneal videoassistido com lavagem pósoperatória (VARD), seguido de necrosectomia aberta.…”

Section: Resultados E Discussão (Figuras 1-4)unclassified

“…29 Fonte: Leonard-Murali e colaboradores. 29 retroperitoneal videoassistido com lavagem pósoperatória (VARD), seguido de necrosectomia aberta. 7 A abordagem endoscópica transgástrica consiste na drenagem guiada por USG na parede posterior do estômago ou duodeno, seguida de necrosectomia.…”

Section: Resultados E Discussão (Figuras 1-4)unclassified

Pancreatite Necrosante: Atualização da Abordagem Intervencionista

Fernandes¹,

Farias²,

Bastos³

et al. 2022

RCHSI

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“…Patients were treated by our standard management of pancreatitis protocol and practice guidelines for AP, with gastrointestinal decompression, trypsin inhibitors, H 2 receptor antagonists, fluid resuscitation, antibiotics, redress of water-electrolyte and acid-base imbalance. [11][12][13] Computed tomography (CT) and transabdominal ultrasound were performed within 48 hours of admission. The images obtained were double-checked by two experienced radiologists to determine CTSI.…”

Section: General Managementmentioning

confidence: 99%

Abdominal paracentesis drainage improves outcome of acute pancreatitis complicated with intra-abdominal hypertension in early phase

Wen¹,

Zhuo²,

Liang³

et al. 2023

The American Journal of the Medical Sciences

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“…However, neither etiologic factors (gallstones, alcohol use, etc.) nor demographics features are conclusively risk factors to necrosis formation ( 9 ). A series of studies have evaluated the prediction potential of a variety of biomarkers and scoring systems for NP or infected NP, but none are robust enough.…”

Section: Introductionmentioning

confidence: 99%

Gut microbiota on admission as predictive biomarker for acute necrotizing pancreatitis

et al. 2022

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BackgroundAcute necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), has higher mortality and worse outcome than non-necrotizing pancreatitis (non-NP). Infected NP is a devastating subgroup of NP. To date neither NP nor infected NP has robust prediction strategies, which may delay early recognition and timely intervention. Recent studies revealed correlations between disturbed gut microbiota and AP severity. Some features of intestinal microbiota have the potential to become biomarkers for NP prediction.MethodsWe performed 16S rRNA sequencing to analyze gut microbiota features in 20 healthy controls (HC), and 58 AP patients on hospital admission. The AP patients were later classified into NP and non-NP groups based on subsequent diagnostic imaging features. Random forest regression model and ROC curve were applied for NP and infected NP prediction. PIRCUSt2 was used for bacterial functional pathway prediction analysis.ResultsWe found that the three groups (HC, NP, and non-NP) had distinct microorganism composition. NP patients had reduced microbial diversity, higher abundance of Enterobacteriales, but lower abundance of Clostridiales and Bacteroidales compared with the non-NP group. Correlation analyses displayed that intestine bacterial taxonomic alterations were related to severity, ICU admission, and prognosis. By pathway prediction, species more abundant in NP patients had positive correlation with synthesis and degradation of ketone bodies, and benzoate degradation. Enterococcus faecium (ASV2) performed best in discriminating NP and non-NP patients. Finegoldia magna (ASV3) showed the maximal prediction capacity among all ASVs and had comparable accuracy with Balthazar CT to detect patients with infected NP.ConclusionsOur study suggests that NP patients have distinct intestinal microbiota on admission compared to non-NP patients. Dysbiosis of intestinal microbiota might influence NP progression through ketone body or benzoate metabolism. Enterococcus faecium and Finegoldia magna are potential predictors for NP and infected NP. Our findings explore biomarkers which may inform clinical decision-making in AP and shed light on further studies on NP pathophysiology and management.

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Necrotizing pancreatitis: A review for the acute care surgeon

Cited by 17 publications

References 62 publications

Pancreatite Necrosante: Atualização da Abordagem Intervencionista

Pancreatite Necrosante: Atualização da Abordagem Intervencionista

Abdominal paracentesis drainage improves outcome of acute pancreatitis complicated with intra-abdominal hypertension in early phase

Gut microbiota on admission as predictive biomarker for acute necrotizing pancreatitis

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