Outcome of Intensive Medical Treatments in Patients with Infected Severe Necrotizing Pancreatitis.
- Author:
Ju Hyung SONG
1
;
Dong Wan SEO
;
Seung Woon BYUN
;
Dong Hoe KOO
;
Jung Ho BAE
;
Sang Su LEE
;
Sung Koo LEE
;
Myung Hwan KIM
Author Information
1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. dwseoamc@amc.seoul.kr
- Publication Type:Original Article ; English Abstract
- Keywords:
Pancreatitis;
Pancreatic necrosis;
Infected necrosis;
Percutaneous drainage;
Intensive medical treatment
- MeSH:
Bacterial Infections/diagnosis/*prevention & control;
Humans;
Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy;
Retrospective Studies;
Treatment Outcome
- From:The Korean Journal of Gastroenterology
2006;48(5):337-343
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
