[Treatment of pancreatic necrosis and secondary pancreatic infections].
Acute pancreatitis is a disease capable of the widest clinical expression, ranging from mild discomfort to multiorgan failure and death. Moreover, the process may remain localized in the pancreas, or spread to regional tissues, or even involve remote organs. Despite several efforts, the pathophysiology of acute pancreatitis and its complications remains obscure. In the absence of an understanding of the pathogenesis and the reasons for the variations in severity, the study and management of acute pancreatitis has necessarily been empirical. There is little doubt that the development of pancreatic necrosis in patients with acute pancreatitis results in an increase in clinical severity and an escalation of the mortality risk when compared to interstitial pancreatitis. Furthermore, the mortality risk of patients with sterile pancreatic necrosis is markedly different from that of patients developing secondary infections in pre-existing pancreatic necrosis. Infected pancreatic necrosis is uniformly fatal, if untreated. While most authorities agree that surgical debridement is required for survival in patients with secondary pancreatic infections, the precise form of the subsequent drainage has become a matter of some controversy. In this paper we discuss the most recent insights relating to the nosographical classification of pancreatic necrosis and secondary pancreatic infections, along with an analysis of the findings in the literature regarding the surgical treatment of these conditions.
Nigro
Casimiro
C
Dipartimento di Scienze Chirurgiche, Istituto di Clinica Chirurgica Unità Operativa di Chirurgia Generale III, Policlinico Universitario Agostino Gemelli, Roma, Italia.
Brisinda
Giuseppe
G
Matera
Daniele
D
Maria
Giorgio
G
Brandara
Francesco
F
Sganga
Gabriele
G
Civello
Ignazio Massimo
IM
D000038:Abscess / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy; D006801:Humans; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents