title: [Retrograde pancreatic duct imaging and surgical tactics in hemorrhagic necrotizing pancreatitis. Preliminary report].
abstract: In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past months. The results in, to date, ten patients revealed four different morphological findings of importance for the surgical tactic: 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. - 2. Contrast medium leaks via a ductal fistula: left resection including the removal of the fistulous area must be done. - 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. - 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesion resulting in drainage of the necrotic cavity into the bowel permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. - The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERP.
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000601:surgery*
vernacular_title: Retrograde Pankreasgangdarstellung und Operationstaktik bei der hämorrhagisch-nekrotisierenden Pankreatitis. Vorläufiger Bericht.