Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases
S W Ashley1, A Perez, E A Pierce
1Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St., Boston, MA 02115, USA. sashley@partners.org
Annals of Surgery
|September 27, 2001
Summary
A conservative management strategy for necrotizing pancreatitis is effective, reserving intervention for infected cases or organized necrosis complications. This approach minimizes mortality and avoids unnecessary surgeries in sterile pancreatic necrosis patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- The surgical management of sterile pancreatic necrosis is debated.
- Conservative approaches are gaining traction but require further evaluation across diverse necrotizing pancreatitis patient groups.
Purpose of the Study:
- To assess the impact of a conservative management strategy in necrotizing pancreatitis.
- To reserve interventions for patients with confirmed infection or late-stage organized necrosis.
Main Methods:
- Reviewed 1,110 acute pancreatitis patients, identifying 99 with necrotizing pancreatitis via contrast-enhanced CT.
- Utilized fine-needle aspiration and CT findings (extraintestinal gas) to diagnose infection.
- Compared outcomes between conservative management and intervention groups.
Main Results:
- Overall mortality for necrotizing pancreatitis was 14%.
- Patients without infection (n=62) managed conservatively had an 11% mortality rate, primarily from organ failure; 5 required later surgery for organized necrosis without mortality.
- Patients with infected necrosis (n=34) had a 12% mortality rate following surgery or percutaneous drainage.
Conclusions:
- Conservative management is successful for most necrotizing pancreatitis patients.
- Surgery may be necessary for symptomatic organized necrosis.
- Aggressive early surgical intervention offers limited benefit for most patients.
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