Contemporary management of infected necrosis complicating severe acute pancreatitis.
Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions.
Jamdar
Saurabh
S
Hepatobiliary Unit, Department of Surgery, Manchester Royal Infirmary, Manchester, UK.
Siriwardena
Ajith K
AK
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019468:Disease Management; D004322:Drainage / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*
D000900:Anti-Bacterial Agents