Alternative treatment modalities of infected pancreatic necrosis

Infected pancreatic necrosis diagnosed by fine needle aspiration (FNA) is generally considered an indication for surgery. Percutaneous drainage can postpone surgical intervention and in some cases can even have a therapeutic effect. Furthermore, targeted antibiotic therapy alone, based on bacterial cultures from FNA, can result in a full recovery. A retrospective analysis was carried out on the various treatment modalities of infected pancreatic necrosis.

Eighty patients with infected pancreatic necrosis were treated in the Department of Surgery, Teaching County Hospital, Györ, Hungary between 1998 and 2003. Seventy-four patients required surgical intervention, 12 of which underwent prior ultrasound or CT-guided drainage.

In patients with previous percutaneous drainage the average time to first surgical intervention was 30 days (n=12). However, in those patients who did not undergo percutaneous drainage the time to initial surgical intervention was 15.6 days. This was statistically significant (p = 0.001). There was a full recovery in 3 out of the 15 patients, who underwent percutaneous drainage. This figure of 20% corresponds with that in the published literature. Three of the total 80 patients studied made a complete recovery when treated with targeted antibiotic therapy alone and did not require further radiological or surgical intervention.

Our data indicate that percutaneous drainage can postpone surgical intervention. Furthermore, we demonstrate that percutaneous drainage alone can lead to full recovery in selected cases. In addition, targeted antibiotic therapy based on FNA may result in the complete recovery of a stable patient without requiring radiological or surgical intervention.