Ultrasound-guided percutaneous drainage of infected pancreatic necrosis

Abstract

BackgroundThe role of percutaneous drainage in the management of infected pancreatic necrosis remains controversial, and ultrasound-guided technique is rarely used for this indication. The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous catheter drainage for infected pancreatic necrosis.MethodsThe patient group consisted of 16 men and 2 women. The mean age of the patients was 47 years. The median computed tomography severity index of acute pancreatitis was 10 points. Percutaneous catheter drainage was performed under sonographic guidance using preferably retroperitoneal approach, and transperitoneal access in selected cases. The medical records and imaging scans were reviewed retrospectively for each patient.ResultsPercutaneous catheter drainage resulted in a complete resolution of infected pancreatic necrosis in 6 of 18 patients (33 %). Twelve of 18 patients who were initially managed with PCD required eventually necrosectomy (67 %). The most common reason for crossover to surgical intervention was persistent sepsis (n = 7). Open necrosectomy was performed in 4 of these patients, and 3 patients underwent successful minimally invasive retroperitoneal necrosectomy. Five patients required conversion to open surgery because of procedure-related complications. In 3 cases, there was leakage of the necrotic material into the peritoneal cavity. Two other patients experienced hemorrhagic complications. Overall mortality rate was 17 %. The size of the largest necrotic collection in patients who were successfully treated with percutaneous drainage decreased by a median of 76 % shortly after the procedure, whereas it decreased only by a median of 16 % in cases of failure of percutaneous drainage.ConclusionsUltrasound-guided percutaneous catheter drainage used in infected pancreatic necrosis is a technique with acceptably low morbidity and mortality that may be the definitive treatment or a bridge management to necrosectomy. A negligible decrease in size of the necrotic collection predicts failure of percutaneous drainage.

Ultrasound-guided percutaneous drainage of infected pancreatic necrosis

“…Percutaneous drainage in our series was successful for 33 % of the patients [ 3 ], similar to the success rate reported in a recent prospective study by van Santvoort et al [ 4 ] (35 %). We think the lower success rate for PCD in our series was mainly due to a few technical complications that occurred early in our experience with this technique, and this issue is thoroughly explained in our article.…”

Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

“…However, in some cases, indications for drainage such as infection or pressure effects to the surrounding organ may occur earlier, warranting early intervention. Feasibility of percutaneous drainage within 4 weeks has been reported 12 13 14 but study regarding the feasible timing of endoscopic drainage for pancreatic fluid collection (PFC) has been limited. The aim of this study was to evaluate feasibility and safety of early (< 4 weeks) endoscopic drainage for PFC.…”

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

“…Percutaneous pigtail tube drainage became the first-line treatment for IPN because of simple operation, convenience, and small disturbance to the patient. However, it was reported that the success rate of percutaneous drainage therapy for IPN was only 33% [ 10 ].…”