title: Ultrasound-guided percutaneous drainage of infected pancreatic necrosis.
abstract: BACKGROUND
  The role of percutaneous drainage in the management of infected pancreatic necrosis remains controversial, and ultrasound-guided technique is rarely used for this indication. The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous catheter drainage for infected pancreatic necrosis.
  
  
  METHODS
  The patient group consisted of 16 men and 2 women. The mean age of the patients was 47 years. The median computed tomography severity index of acute pancreatitis was 10 points. Percutaneous catheter drainage was performed under sonographic guidance using preferably retroperitoneal approach, and transperitoneal access in selected cases. The medical records and imaging scans were reviewed retrospectively for each patient.
  
  
  RESULTS
  Percutaneous catheter drainage resulted in a complete resolution of infected pancreatic necrosis in 6 of 18 patients (33 %). Twelve of 18 patients who were initially managed with PCD required eventually necrosectomy (67 %). The most common reason for crossover to surgical intervention was persistent sepsis (n = 7). Open necrosectomy was performed in 4 of these patients, and 3 patients underwent successful minimally invasive retroperitoneal necrosectomy. Five patients required conversion to open surgery because of procedure-related complications. In 3 cases, there was leakage of the necrotic material into the peritoneal cavity. Two other patients experienced hemorrhagic complications. Overall mortality rate was 17 %. The size of the largest necrotic collection in patients who were successfully treated with percutaneous drainage decreased by a median of 76 % shortly after the procedure, whereas it decreased only by a median of 16 % in cases of failure of percutaneous drainage.
  
  
  CONCLUSIONS
  Ultrasound-guided percutaneous catheter drainage used in infected pancreatic necrosis is a technique with acceptably low morbidity and mortality that may be the definitive treatment or a bridge management to necrosectomy. A negligible decrease in size of the necrotic collection predicts failure of percutaneous drainage.
authors: Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warsaw, Poland. mwronski@vp.pl
authors: Marek
authors: M
authors: Wroński
authors: Włodzimierz
authors: W
authors: Cebulski
authors: Dominika
authors: D
authors: Karkocha
authors: Maciej
authors: M
authors: Słodkowski
authors: Lukasz
authors: L
authors: Wysocki
authors: Mieczysław
authors: M
authors: Jankowski
authors: Ireneusz W
authors: IW
authors: Krasnodębski
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
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