The efficacy of nonsurgical treatment of infected pancreatic necrosis.
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.
Lee
Jun Kyu
JK
Department of Internal Medicine, Dongguk University International Hospital, Dongguk University College of Medicine, Goyang, Korea.
Kwak
Kyeong Keun
KK
Park
Joo Kyung
JK
Yoon
Won Jae
WJ
Lee
Sang Hyub
SH
Ryu
Ji Kon
JK
Kim
Yong-Tae
YT
Yoon
Yong Bum
YB
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
D000900:Anti-Bacterial Agents