Pancreatic necrosis: Complications and changing trend of treatment

Rashid, Mamoon Ur; Hussain, Ishtiaq; Jehanzeb, Sundas; Ullah, Waqas; Ali, Saeed; Jain, Akriti G; Khetpal, Neelam; Ahmad, Sarfraz

doi:10.4240/wjgs.v11.i4.198

Cited by 29 publications

(19 citation statements)

References 147 publications

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“…Infection of these collections can occur in up to 40% of the cases, which can lead to systemic sepsis [6,7]. These infected collections are initially managed conservatively unless the systemic effects are not responding to antibiotics and conservative measures [8]. When interventions for debridement and drainage of these acute collections are required, a step-up approach is preferred [9].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Kanchana¹,

Dharmapala²,

Dassanayake³

et al. 2021

Case Reports in Surgery

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Introduction. Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day. Conclusion. The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Kanchana¹,

Dharmapala²,

Dassanayake³

et al. 2021

Case Reports in Surgery

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“…Overall mortality of AP is around 1-2% in the US population (23) but in severe cases with parenchymal necrosis, mortality is increased to nearly 40% (24). Pancreatic necrosis can lead to a multitude of local complications including infection, hemorrhage, bowel perforation, and fistula formation which considerably increases the mortality rate (25).…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention

et al. 2021

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Objective: Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP. Material and Methods: This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson’s score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups. Results: A total of 100 patients with AP were treated during out study period. Ranson’s score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p< 0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p< 0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson’s score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p< 0.05). Conclusion: We validate SIRS, Ranson’s, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.

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“…The enzymatic destruction of pancreatic and extra-pancreatic tissue occurs in necrotizing pancreatitis, which leads to the destruction of blood vessels and formation of pseudoaneurysms. 15,16 Carr et al determined in their study that the management of pancreatic pseudocyst associated pseudoaneurysms is more challenging problem and is associated with high death rate. 7 Operation and angiographic embolization play complementary management roles.…”

Section: Discussionmentioning

confidence: 99%

Management of visceral arterial pseudoaneurysms in patients with acute and chronic pancreatitis: a retrospective study from South Indian tertiary care centre

Bagwan¹,

Chidambaram²,

Sankareswaran³

et al. 2021

Int Surg J

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Background: Visceral artery pseudoaneurysms (VAP) are defined as those affecting celiac, superior or inferior mesenteric arteries and their branches. In this study, role of various therapeutic modalities in the management of VAP caused by acute and chronic pancreatitis were analysed which can influence choice of treatment for a given patient.Methods: The study was conducted in institute of surgical gastroenterology, Madras medical college and Rajiv Gandhi government general hospital Chennai, based on retrospective analysis of 41 patients diagnosed with VAP caused by acute and chronic pancreatitis admitted between the periods of September 2014 and January 2020. The medical records of all patients were retrieved and descriptive statistical analyses was carried out regarding various details including demographics, presentation, management and complications.Results: This study includes 41 patients with mean age of 39.73±10.54 (SD) years and 40 (97.56%) of them were males. Fifteen patients (36.59%) had acute pancreatitis and 26 patients (63.41%) had chronic pancreatitis. Pseudocysts were found in 25 (60.98%) patients. Pseudoaneurysm arose most commonly from splenic artery (n=32; 78.04%). The most common symptom was abdominal pain (n=40) followed by gastrointestinal bleeding (n=28). Sixteen patients (39%) received primary radiological reintervention (n=16). Twenty-five patients (60.98%) underwent primary surgical treatment (n=25). Rebleeding was seen in 3 patients (7.32%). Twenty-three patients (56.1%) developed complications. Mortality rate was 5/41 (12.2%).Conclusions: Pseudoaneurysms are fatal complications of pancreatitis. Angiographic embolization, when available, is the initial treatment of choice in hemodynamically stable patients. Surgery in experienced hands will still remain main modality in treating these patients in centres that lack a full-fledged angiographic facility with acceptable outcomes.

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Pancreatic necrosis: Complications and changing trend of treatment

Cited by 29 publications

References 147 publications

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention

Management of visceral arterial pseudoaneurysms in patients with acute and chronic pancreatitis: a retrospective study from South Indian tertiary care centre

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