title: Infected pancreatic necrosis complicated by multiple organ failure.
abstract: OBJECTIVE
  Sixteen patients with bacteriologically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical treatment were studied prospectively.
  
  
  METHODS
  The severity of IPN was documented pre-operatively using the following scores: 1) degree of necrosis by CT scan [< 30% in three patients (19%); 30-50% in nine patients (56%); > 50% in four patients (25%)]; 2) Elebute and Stoner's sepsis score (16 +/- 4 points); 3) Goris' score of multiple organ failure (MOF) (5 +/- 2 points). Sequential surgical treatment was carried out by the same surgical team, as follows: 1) abdominal re-explorations through a zipper for the first 7-10 days; 2) open abdomen and repeated peritoneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infection (range: 15-85 days). No patient required further re-exploration.
  
  
  RESULTS
  Mortality occurred in 3/16 patients (19%), due to MOF in all 3 cases. The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73 +/- 33 days, without fistulae. These results indicate that by treating severe IPN with the technique of sequential abdominal re-explorations, open drainage and continuous closed lavage, a low 19% mortality can be achieved.
  
  
  CONCLUSIONS
  This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN: these data could facilitate future comparison of results obtained with other treatment modalities.
authors.affiliation: Department of Surgery, University of Pavia in Varese, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Dominioni
authors.forename: A
authors.initials: A
authors.lastname: Chiappa
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.forename: P F
authors.initials: PF
authors.lastname: Interdonato
authors.forename: L
authors.initials: L
authors.lastname: Festi
authors.forename: G
authors.initials: G
authors.lastname: Carcano
authors.forename: A
authors.initials: A
authors.lastname: Benevento
authors.forename: R
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications* / Q000401:mortality; D010180:Pancreatectomy; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome