Results of surgical treatment of necrotizing pancreatitis

Hg, Beger; Krautzberger, W.; Bittner, R.; Block, S.; Büchler,

doi:10.1007/bf01655406

Cited by 148 publications

(56 citation statements)

References 30 publications

(46 reference statements)

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“…14, 15 Beger et al, 16 in a review of 205 patients undergoing surgery for severe acute pancreatitis, found that the presence and extent of necrosis were the principal determinants of not only the severity of the clinical course but also of overall survival: the risk of death increased with the increased amount of necrosis. In data from surgical and autopsy series, necrotizing pancreatitis accounted for 70% to 86% of the deaths from acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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ObjectiveTo assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). Summary Background DataSurgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. MethodsA retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. ResultsOne hundred thirty-five aspirations were performed in 82 patients (57 male patients, 25 female patients) with a mean age of 40 years (range 17-68). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0 -9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. ConclusionsHistorically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.Historically, the presence of an infected peripancreatic fluid collection or pancreatic abscess has mandated operation. Primary surgical treatment is successful for most patients, but the death rate is reportedly 15% to 80%, and surgery is associated with reoperation and prolonged lengths of stay.1 It has been more than 20 years since the treatment of pancreatic abscess was reviewed at our institution.2 In that report, Holden et al identified a death rate of 50% among 28 patients treated operatively and a complication rate of 93%.The availability of percutaneous catheter drainage (PCD) under radiologic guidance has replaced surgical drainage as the primary treatment of intraabdominal and hepatic abscesses. 3 A natural progression of the use of PCD has been its application for peripancreatic fluid collections and abscess. To ascertain the relative merits of PCD and to guide patient selection, we performed a retrospective chart review of patients with peripancreatic fluid collections or pancreatic abscess who had computed tomography (CT)-guided aspiration.

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Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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“…Patients are usually severely ill, and pancreatic infection is a common complication, often responsible for the high mortality rate in these patients [2]. Early recognition of patients with pancreatic necrosis by using CT can be helpful in predicting the severity of pancreatitis and in identifying those patients likely to develop pancreatic infection [2,3].…”

Section: January 1991mentioning

confidence: 99%

“…The purpose of this study was to correlate enhancement of pancreatic parenchyma on contrast-enhanced CT with necrosis found surgically in patients with suspected necrotizing pancreatitis. [2,5,6]. Present clinical criteria [4] are useful but imperfect in separating patients with acute (self-limited) edematous pancreatitis from those with necrotizing pancreatitis.…”

Section: January 1991mentioning

confidence: 99%

CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis.

Johnson¹,

Stephens

Sarr³

1991

American Journal of Roentgenology

107

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This study was performed to determine if a correlation exists between pancreatic David H. Stephens1 parenchymal enhancement or lack thereof on contrast-enhanced CT and surgical cviMichael G. Sarr2 dence of pancreatic necrosis. Accurate CT assessment of pancreatic vascular perfusion would be helpful in preoperative planning before pancreatic debridement and necrosectomy. The CT scans and medical records were blindly and retrospectively reviewed in 13 patients with the operative diagnosis of pancreatic necrosis. In all cases, CT examinations preceded surgery within 72 hr. Surgical and pathologic findings served as the gold standards for the diagnosis of pancreatic necrosis. Seven (54%) of 13 patients had a region or regions of parenchymal necrosis within the head, body, and/or tail of the pancreas seen during surgery. All seven of these patients had no pancreatic enhancement on CT in at least one region of the pancreas (CT sensitivity = 100%). In four of the seven, two regions were found to be necrotic at surgery, but only one of the two segments did not enhance on CT scans. In three of the seven patients, lack of contrast enhancement on CT (no enhancement of the pancreatic head and body in two patients and throughout the gland in another) correlated with necrosis in the same regions at surgery. The remaining six (46%) patients, who had peripancreatic or small, focal, and/or superficial areas of pancreatic necrosis at surgery, had normal pancreatic enhancement on CT.Our results show that regions of pancreatic necrosis found surgically correlate with lack of enhancement of pancreatic parenchyma on CT. Peripancreatic necrosis and minor areas of focal or superficial parenchymal necrosis were not detected on CT.

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“…Fluid located in the posterior pararenal or perirenal space was graded higher because this is considered an uncommon finding (19). It is interesting that, although pancreatic glandular necrosis has long been considered a very important radiologic prognostic sign (5,20,21), this input did not improve the performance of the ANN. This is likely because substantial necrosis (ie, Ͼ30%) will be seen in only a small number of consecutive patients with acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Outcome Analysis of Patients with Acute Pancreatitis by Using an Artificial Neural Network

Keogan

Freed

et al. 2002

Academic Radiology

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Rationale and Objectives. The authors performed this study to evaluate the ability of an artificial neural network (ANN) that uses radiologic and laboratory data to predict the outcome in patients with acute pancreatitis. Materials andMethods. An ANN was constructed with data from 92 patients with acute pancreatitis who underwent computed tomography (CT). Input nodes included clinical, laboratory, and CT data. The ANN was trained and tested by using a round-robin technique, and the performance of the ANN was compared with that of linear discriminant analysis and Ranson and Balthazar grading systems by using receiver operating characteristic analysis. The length of hospital stay was used as an outcome measure.Results. Hospital stay ranged from 0 to 45 days, with a mean of 8.4 days. The hospital stay was shorter than the mean for 62 patients and longer than the mean for 30. The 23 input features were reduced by using stepwise linear discriminant analysis, and an ANN was developed with the six most statistically significant parameters (blood pressure, extent of inflammation, fluid aspiration, serum creatinine level, serum calcium level, and the presence of concurrent severe illness). With these features, the ANN successfully predicted whether the patient would exceed the mean length of stay (A z ϭ 0.83 Ϯ 0.05). Although the A z performance of the ANN was statistically significantly better than that of the Ranson (A z ϭ 0.68 Ϯ 0.06, P Ͻ .02) and Balthazar (A z ϭ 0.62 Ϯ 0.06, P Ͻ .003) grades, it was not significantly better than that of linear discriminant analysis (A z ϭ 0.82 Ϯ 0.05, P ϭ .53).Conclusion. An ANN may be useful for predicting outcome in patients with acute pancreatitis. Key Words. Computers, diagnostic aid; computers, ANN; pancreatitis. © AUR, 2002An episode of acute pancreatitis may run a variable and unpredictable course (1,2). Prediction of the likely severity of an episode in an individual patient is difficult but has implications for the institution of therapy and for patient information. For this reason, several predictive systems have been devised. Some of these systems are based on clinical criteria (eg, the Ranson and the acute physiology and chronic health evaluation [APACHE] scoring systems [2-4]), whereas others, such as the Balthazar system (5,6), are based on radiologic features at computed tomography (CT) (Fig 1). To our knowledge, no system has been devised in which both clinical and radiologic indicators are combined to predict severity or outcome. In this study, this task was investigated by using two multivariate decision model approaches: an artificial neural network (ANN) and linear discriminant analysis.ANNs are computer models composed of parallel, nonlinear computational elements arranged in layers with a

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Results of surgical treatment of necrotizing pancreatitis

Cited by 148 publications

References 30 publications

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis.

Outcome Analysis of Patients with Acute Pancreatitis by Using an Artificial Neural Network

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