Endoscopic evaluation of infected pancreatic necrosis

The most severe form of acute pancreatitis is characterized by necrosis of the pancreatic parenchyma and/or peripancreatic tissue. Secondary infection of this necrotic tissue carries a high mortality because there is little limitation to the spread of this infection in the retroperitoneum. Improvements in the management of infected pancreatic necrosis have been achieved by techniques that allow complete removal of the infected debris. Problems still remain in identifying the extent of necrosis and removing all of it. Intraoperative endoscopy can be used to evaluate tracking of the infected process to other areas of the retroperitoneum. Direct visualization of the path that the necrotizing process has taken to areas of the retroperitoneum that are difficult to reach allows the dissection to be limited if there is no necrosis or expansion to remove all necrotic material completely. The endoscope can also be used to remove necrotic material either by irrigation or by direct debridement. The methodology of this technique is described.