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acute necrotizing pancreatitis
Epidemiology:
- 10% of acute pancreatitis
Pathology:
- necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection
- walled off pancreatic necrosis develops after 4 weeks of disease
Special laboratory:
- ERCP if signs of biliary obstruction & or cholangitis
Radiology:
- CT of abdomen
- ultrasound screening for DVT to prevent symptomatic pulmonary embolism
Complications:
- see acute pancreatitis
Management:
- treat infected acute necrotizing pancreatitis with broad spectrum antibiotics. [3]
- a carbapenem alone
- metronidazole + 3rd generation cephalosporin or fluoroquinolone
- routine use of antifungal agent not recommended [3]
- aggressive intravenous fluid hydration to maintain intravascular volume
- providing adequate nutritional support with enteral nutrition beyond the ligament of Treitz
- an infected or symptomatic walled off pancreatic necrosis may require drainage
- delayed drainage non-inferior to immediate drainage [4]
- some patients never require drainage [4]
- open pancreatectomy is associated with high morbidity
see pancreatic necrosis
General
acute pancreatitis
pancreatic necrosis
References
- Boumitri C, Brown E, Kahaleh M.
Necrotizing Pancreatitis: Current Management and Therapies.
Clin Endosc. 2017 Jul;50(4):357-365.
PMID: 28516758 PMCID: PMC5565044 Free PMC article
- Larkin M
DVT Screening, Early Treatment, Prevent PE in Necrotizing Pancreatitis.
Medscape - Oct 21, 2020.
https://www.medscape.com/viewarticle/939556
- NEJM Knowledge+ Gastroenterology
- Van Veldhuisen CL, Sissingh NJ, Boxhoorn L et al.
Long-term outcome of immediate versus postponed intervention in patients with
infected necrotizing pancreatitis (POINTER): Multicenter randomized trial.
Ann Surg 2024 Apr; 279:671-678.
PMID: 37450701 PMCID: PMC10922655
https://journals.lww.com/annalsofsurgery/fulltext/2024/04000/long_term_outcome_of_immediate_versus_postponed.19.aspx