Management of infected pancreatic necrosis.
The past two decades have seen major advances in the understanding and clinical management of acute pancreatitis, yet it still lacks a specific treatment, and management is largely supportive and reactive. Surgery is seeing a diminishing role in the early phase of acute pancreatitis but still predominates in the management of infected pancreatic necrosis--the most lethal complication. This review focuses on recent literature but begins with an account of the evolution of infected necrosis management, which serves to place current treatment into context. Although surgeons initially emphasized less invasive approaches to pancreatic necrosis, they now compete with new techniques developed by pioneering physicians, radiologists, and interventional endoscopists. Clinicians adopting the new techniques will need to emulate the dedication and commitment that the current pioneers demonstrate. Although new techniques are still evolving, they should be evaluated against existing standards of treatment.
Larvin
Mike
M
Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham at Derby, Derby City General Hospital, Derby, DE22 3DT, UK. mike.larvin@nottingham.ac.uk
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008826:Microbial Sensitivity Tests; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents