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Infected necrosis complicating acute pancreatitis: experience with 131 cases
Shirish K Bhansali1, Sharad C Shah, Shrinivas B Desai
1Department of Surgery, Jaslok Hospital and Research Center, Mumbai.
Summary
Infected pancreatic necrosis (IPN) has high mortality, with complications including organ dysfunction and fistulas. Early surgery, low albumin, and organ dysfunction predict worse outcomes for IPN patients.
Area of Science:
- Gastroenterology
- Surgical Critical Care
- Infectious Diseases
Background:
- Infected pancreatic necrosis (IPN) presents significant challenges in patient management.
- Despite advances, mortality rates for IPN remain high, necessitating further research into contributing factors and optimal treatment strategies.
Purpose of the Study:
- To analyze complications and treatment outcomes in patients with infected pancreatic necrosis.
- To identify prognostic factors associated with mortality in IPN.
Main Methods:
- A retrospective study of 131 patients diagnosed with IPN over a 20-year period.
- Diagnosis confirmed via CT scan evidence of extraluminal air or percutaneous aspiration with bacteriological analysis.
- Treatment involved organ support, nutritional support, antibiotics, pus evacuation, surgical necrosectomy, and feeding jejunostomy.
Main Results:
- Common complications included multiple organ dysfunction syndrome (MODS), pancreatic and gastrointestinal fistulas, and severe bleeding.
- Mortality was significantly higher in patients undergoing surgery within 15 days of onset (60% vs. 25%).
- Lower serum albumin (<2.5 g/dL) and the presence of MODS were associated with increased mortality (p=0.002 and p=0.001, respectively).
Conclusions:
- MODS, gastrointestinal and pancreatic fistulas, and extra-intestinal bleeding are significant complications of IPN.
- Low serum albumin, development of MODS, and the necessity for early surgical intervention are unfavorable prognostic indicators for IPN patients.