Conservative management of infected necrosis complicating severe acute pancreatitis.
OBJECTIVE
Patients with severe necrotizing pancreatitis are at risk for infection, a major cause of morbidity and mortality. Most patients with infected pancreatic tissue require surgical intervention (necrosectomy), which is associated with high morbidity and mortality. A subset of these patients can be managed successfully with conservative management combined with prolonged courses of antibiotics.


METHODS
Three cases of severe acute pancreatitis seen at our institution are described, in which the patients developed aspirate-proven pancreatic infections. The patients were nonetheless stable from a clinical standpoint and were treated with long courses of antibiotics known to penetrate the pancreas; emergent surgery was deferred.


RESULTS
In two patients, surgery was completely avoided, with good clinical outcome. In the third patient, elective surgery was undertaken 12 wk after the episode of acute pancreatitis, to perform necrosectomy on organized pancreatic necrosis and to evaluate the patient's biliary tree. There were no postoperative complications.


CONCLUSIONS
A subset of patients with severe acute pancreatitis complicated by infection can be successfully managed with long term antibiotics and other supportive measures. High risk necrosectomy can, in some instances, be delayed or avoided entirely.
Adler
Douglas G
DG
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55901, USA.
Chari
Suresh T
ST
Dahl
Tamela J
TJ
Farnell
Michael B
MB
Pearson
Randall K
RK
D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000628:therapy*; D012720:Severity of Illness Index