Acute necrotising pancreatits: Current Concepts

Raul, Subrat Kumar
April 2005
Indian Journal of Surgery;Apr2005, Vol. 67 Issue 2, p78
Academic Journal
Pancreatic necrosis represents a severe form of acute pancreatitis. The morbidity and mortality associated with acute pancreatitis are substantially higher when necrosis is present especially when the area of necrosis is also infected. Despite a relative shortage of randomized clinical trials, there has been a significant change in the management of acute necrotising pancreatitis over the past 20 years. In recent years the treatment of acute necrotising pancreatitis has shifted away from early surgical debridement (necrosectomy) to aggressive intensive medical care of multiple organ systems with specific criteria for operative and nonoperative management. This review presents the current concepts with regards to diagnosis and management of acute necrotising pancreatitis including the controversial aspects. Some of the issues addressed include the management of these patients in an intensive care/ therapy unit, the role of prophylactic antibiotics, requirement of nutrition, either enteral and/or parenteral, the role of CT scan and FNAC in diagnosing infection and finally the role of surgery. An extensive review of the literature has been done for this purpose from the Ovid Medline search, pubmed and documented facts from standard text books has also been included along with certain landmark old articles.


Related Articles

  • Antibiotic prophylaxis in severe acute pancreatitis- what are the facts? Slavin, J.; Neoptolemos, J. P. // Langenbeck's Archives of Surgery;Apr2001, Vol. 386 Issue 2, p155 

    After acute pancreatitis, sepsis secondary to infected pancreatic necrosis is the main cause of late stage death. Routine prophylactic antibiotic use following a severe attack of pancreatitis has been proposed but remains contentious. Three recent randomised controlled studies compared routine...

  • Review: Antibiotic prophylaxis of pancreatic necrosis in acute pancreatitis reduces mortality and sepsis. Kinney, Timothy P.; Waxman, Irving // ACP Journal Club;Jul/Aug2004, Vol. 141 Issue 1, p11 

    The article presents the information that antibiotic prophylaxis of pancreatic necrosis in acute pancreatitis reduces mortality and sepsis. In patients with severe acute pancreatitis who have developed pancreatic necrosis, prophylactic antibiotic therapy reduces all-cause mortality and...

  • Akut nekrotizan pankreatitli hastalarda cerrahi tedavi sonuçları ve mortaliteye etkili faktörler. Aliosmanoğlu, İbrahim; Gül, Mesut; Tekeş, Fırat; Türkoğlu, Ahmet; Ülger, Burak Veli; Uslukaya, Ömer; Oğuz, Abdullah // Journal of Clinical & Experimental Investigations / Klinik ve De;2012, Vol. 3 Issue 4, p500 

    Acute necrotizing pancreatitis is a condition still with high morbidity and mortality which is associated with severe acute pancreatitis because parenchyma necrosis occurs during illness. Our aim in this study is to examine the factors affecting mortality in patients undergoing surgery because...

  • Endoscopic ultrasound-guided insertion of a large diameter fully covered self-expandable metallic stent as rescue therapy for recurrent infected walled off pancreatic necrosis after surgical necrosectomy. Ang, Tiing Leong; Eu Kwek, Andrew Boon; Fock, Kwong Ming; Teo, Eng Kiong // Endoscopic Ultrasound;Oct-Dec2014, Vol. 3 Issue 4, p245 

    No abstract available.

  • Predicting the Severity of Acute Pancreatitis: Is It Time to Concentrate on the Hematocrit? Baron, Todd H. // American Journal of Gastroenterology;Jul2001, Vol. 96 Issue 7, p1960 

    Focuses on a study that evaluates hemoconcentration upon hospital admission as a potential marker of clinically severe and necrotizing pancreatitis. Background on studies about hemoconcentration; Usefulness of hemoconcentration as a potential marker for severe pancreatitis; Absence of...

  • Relation of Serial Measurements of Plasma-Soluble Intercellular Adhesion Molecule-1 to Severity of Acute Pancreatitis. Kaufmann, P.; Smolle, K. H.; Brunner, G. A.; Demel, U.; Tilz, G. P.; Krejs, G. J. // American Journal of Gastroenterology;Sep1999, Vol. 94 Issue 9, p2412 

    OBJECTIVE: Acute pancreatitis remains a clinical challenge because it is difficult to predict whether, in a given patient, the disease will be mild or will run a severe course with a possibly fatal outcome. The aim of this study was to investigate whether circulating soluble intercellular...

  • Radiation dose from computed tomography in patients with necrotizing pancreatitis: how much is too much? Ball, Chad G.; Correa-Gallego, Camilo; Howard, Thomas J.; Zyromski, Nicholas J.; House, Michael G.; Pitt, Henry A.; Nakeeb, Atilla; Schmidt, Christian M.; Akisik, Fatih; Lillemoe, Keith D. // Journal of Gastrointestinal Surgery;Oct2010, Vol. 14 Issue 10, p1529 

    Objectives: Low-dose ionizing radiation from medical imaging has been indirectly linked with subsequent cancer. Computed tomography (CT) is the gold standard for defining pancreatic necrosis. The primary goal was to identify the frequency and effective radiation dose of CT imaging...

  • Combined minimally invasive management of infected pancreatic necrosis: a case report. Wysocki, Łukasz; Wroński, Marek; Cebulski, Włodzimierz; Krasnodębski, Ireneusz Wojciech // Videosurgery & Other Miniinvasive Techniques / Wideochirurgia i;Mar2014, Vol. 2014 Issue 1, p107 

    Infected necrosis is a potentially fatal complication of necrotizing pancreatitis. Open surgical debridement is the mainstay management of infected pancreatic necrosis. Over the last decade minimally invasive techniques have been increasingly used for the treatment of infected pancreatic...

  • Cutaneous Pseudo Abscesses: An Unusual Presentation of Severe Pancreatitis. Manji, Nasrullah; Hulyalkar, Atul R.; Keroack, Mark A.; Vekshtein, Vladimir I.; Kirshenbaum, James M.; Sugarman, Daniel I.; Chopra, Sanjiv // American Journal of Gastroenterology;Feb1988, Vol. 83 Issue 2, p177 

    In this report, we present a 53-yr-old man with extensive subcutaneous fat necrosis due to acute pancreatitis presenting as fluctuant collections resembling large multiple abscesses. The diagnosis was suggested by examination of the wound aspirate. Findings included absence of organisms on the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics