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pancreatic necrosis
Etiology:
- acute necrotizing 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
Radiology:
- CT of abdomen with contrast
- non-enhancing hypodense areas of the pancreas [1]
Differential diagnosis:
- pancreatic pseudocyst
- pancreatic necrosis may consist of more solid debris
Management:
- treat infected pancreatic necrosis with broad spectrum antibiotics. [3]
- enteral nutrition beyond the ligament of Treitz [1]
- step-up approach to surgical intervention
- most fluid collections resolve without intervention [1]
- asymptomatic patients with walled-off pancreatic necrosis require no further intervention [1]
- percutaneous drainage
- delayed drainage of infected pancreatic necrosis safe [2]
- endoscopic debridement
- value as a means to delay surgical intervention until it is safe.
- may have a role at times as a definitive treatment.
- delay open surgery 12-30 days
Notes:
- also see acute necrotizing pancreatitis
Related
pancreatitis
Specific
acute necrotizing pancreatitis
General
necrosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18.
American College of Physicians, Philadelphia 2015, 2018
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Boxhoorn L, van Dijk SM, van Grinsven J et al.
Immediate versus postponed intervention for infected necrotizing pancreatitis.
N Engl J Med 2021 Oct 7; 385:1372
PMID: 34614330
https://www.nejm.org/doi/10.1056/NEJMoa2100826
- NEJM Knowledge+ Gastroenterology