title: Medical versus surgical management for emphysematous pancreatic necrosis: is gas within pancreatic necrosis an absolute indication for surgery?
abstract: OBJECTIVE
  The aim of this study was to evaluate whether pancreatic necrosis with presence of gas is an absolute indication for surgery or if there is a possibility for the medical management of this pathology.
  
  
  METHODS
  This study is a retrospective study including 56 patients with diagnosis of pancreatic necrosis and gas on computed tomography from April 2003 to March 2011. We recorded all the factors related to each group of treatment, including APACHE II score, C-reactive protein level, Tomographic Severity Index, organ and multiorgan failure, and infected necrosis after fine-needle puncture, to evaluate the differences between surgical and medical treatment.
  
  
  RESULTS
  Thirty-six (64%) of these patients were submitted to surgery, whereas 20 (36%) were managed conservatively. Twenty-eight patients (78%) who underwent surgery had infected necrosis. Thirty-five percent of the patients (7 patients) in the medical group had organ failure versus 83% of the patients in the surgical group.
  
  
  CONCLUSIONS
  Pancreatic necrosis with gas on computed tomography is a relative indication for surgery. Medical management is a feasible and safe possibility for this pathology in selected cases. The presence of organ failure and infected necrosis often precludes a surgical treatment.
authors.affiliation: From the Departments of *Pancreatic Surgery and †Critical Care Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Barreda
authors.forename: Javier
authors.initials: J
authors.lastname: Targarona
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pando
authors.forename: Miguel
authors.initials: M
authors.lastname: Reynel
authors.forename: Jose
authors.initials: J
authors.lastname: Portugal
authors.forename: Claudia
authors.initials: C
authors.lastname: Barreda
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D044963:Biopsy, Fine-Needle; D002097:C-Reactive Protein / Q000032:analysis; D004646:Emphysema / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005740:Gases; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology / Q000628:therapy; D010180:Pancreatectomy / Q000009:adverse effects; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005740:Gases; D002097:C-Reactive Protein