title: The efficacy of nonsurgical treatment of infected pancreatic necrosis.
abstract: OBJECTIVE
  We conducted this study to evaluate the efficacy of nonsurgical treatment for patients with infected pancreatic necrosis (IPN).
  
  
  METHODS
  Among 224 patients with acute pancreatitis from 2000 to 2004, there were 31 patients diagnosed as having IPN complication. The diagnostic criteria for IPN were either a positive culture or free gas in the pancreas of patients with acute pancreatic necrosis. Nonsurgical management including percutaneous drainage or endoscopic drainage (ED) followed by vigorous irrigation was initially attempted in all patients. Surgery was planned only when there was no clinical improvement after the initial nonsurgical treatment.
  
  
  RESULTS
  Percutaneous drainage or ED was performed in 18 and 5 patients, respectively. Eight patients received antibiotics only. Four patients (12.9%) (3 from percutaneous drainage group and 1 from ED group) required surgery. Sepsis or fistula developed in 32% and 6% of patients, respectively, and was managed successfully. One patient (3.2%) died as a result of rapidly progressing multiorgan failure. The mean duration of hospitalization was 37 days. During the follow-up period, 7 patients were readmitted because of fever; they were managed by reposition of the drainage tube.
  
  
  CONCLUSIONS
  Intensive nonsurgical treatment is very effective and safe and should be considered as an initial treatment modality for patients with IPN.
authors: Department of Internal Medicine, Dongguk University International Hospital, Dongguk University College of Medicine, Goyang, Korea.
authors: Jun Kyu
authors: JK
authors: Lee
authors: Kyeong Keun
authors: KK
authors: Kwak
authors: Joo Kyung
authors: JK
authors: Park
authors: Won Jae
authors: WJ
authors: Yoon
authors: Sang Hyub
authors: SH
authors: Lee
authors: Ji Kon
authors: JK
authors: Ryu
authors: Yong-Tae
authors: YT
authors: Kim
authors: Yong Bum
authors: YB
authors: Yoon
mesh_terms: D000150:Acinetobacter / Q000302:isolation & purification; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011549:Pseudomonas / Q000302:isolation & purification; D012008:Recurrence; D013211:Staphylococcus aureus / Q000302:isolation & purification; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D007507:Therapeutic Irrigation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents