Percutaneous "stepped" drainage technique for infected pancreatic necrosis.
BACKGROUND
Aggressive surgical pancreatic debridement remains the standard of care, may require multiple abdominal explorations and is associated with high mortality. We have introduced the stepped technique of percutaneous treatment of infected peripancreatic fluid collections.


METHODS
We performed a retrospective review of patients with severe infected necrotizing pancreatitis who were managed percutaneously. Culture results, number of radiological interventions, length of stay, and complications were recorded.


RESULTS
There were 8 patients with a median number of Ranson's criteria of 4.5. Sixty invasive procedures were performed. A median number of two separate catheter sites per patient were necessary for the removal of necrotic material. Median duration of percutaneous intervention was 71.5 days with complete removal of necrotic material and resolution of infected collections in all patients.


CONCLUSIONS
Surgeons and interventional radiologists should be familiar with this evolving technique which is less invasive then surgery, but may prolong the time necessary for complete resolution.
Bala
Miklosh
M
Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. mikloshbala@gmail.com
Almogy
Gidon
G
Klimov
Alex
A
Rivkind
Avraham I
AI
Verstandig
Anthony
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019283:Pancreatitis, Acute Necrotizing / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation