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Bacteriologic status of necrotic tissue in necrotizing pancreatitis
P A Banks1, S G Gerzof, F K Chong
1Division of Gastroenterology, St. Elizabeth's Hospital, Boston, Massachusetts 02135.
Abstract:
To confirm the accuracy of guided percutaneous aspiration (GPA) in distinguishing sterile from infected pancreatic necrosis, we have performed Brown-Brenn tissue Gram stains on pancreatic and peripancreatic necrotic tissue removed operatively in 15 patients. In eight patients judged to have sterile necrosis on the basis of negative cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery was also free of bacteria. In seven patients judged to have infected necrosis on the basis of positive cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery harbored a considerable number of bacteria. We conclude that GPA targeted to areas of necrosis accurately distinguishes infected necrosis from sterile necrosis, and in infected necrosis, the solid necrotic tissue as well as the fluid component contains bacteria. We therefore believe that infected necrosis is not likely to be eradicated by catheter drainage and should be treated by surgical debridement.
Insights
Guided percutaneous aspiration (GPA) accurately differentiates infected from sterile pancreatic necrosis. Infected necrosis requires surgical debridement, not just catheter drainage, as bacteria are present in both fluid and solid necrotic tissue.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Infectious Diseases
Background:
- Pancreatic necrosis is a severe complication of pancreatitis.
- Distinguishing sterile from infected necrosis is crucial for appropriate treatment.
- Current diagnostic methods may have limitations.
Purpose of the Study:
- To evaluate the accuracy of guided percutaneous aspiration (GPA) in differentiating sterile from infected pancreatic necrosis.
- To correlate microbiological findings from GPA with intraoperative tissue analysis.
Main Methods:
- Fifteen patients with pancreatic necrosis underwent GPA for fluid and tissue sampling.
- Brown-Brenn Gram stains were performed on operative debridement tissue.
- Cultures from GPA and operative samples were compared.
Main Results:
- GPA correctly identified sterile necrosis in 8 patients (negative cultures pre- and intraoperatively).
- GPA correctly identified infected necrosis in 7 patients (positive cultures pre- and intraoperatively).
- In infected cases, bacteria were found in both fluid and solid necrotic tissue.
Conclusions:
- Guided percutaneous aspiration is an accurate method for distinguishing sterile from infected pancreatic necrosis.
- Infected pancreatic necrosis contains bacteria in both fluid and solid components.
- Surgical debridement is recommended for infected pancreatic necrosis, as catheter drainage alone is unlikely to be effective.