CT Guided Percutaneous Drainage of Infected Acute
Necrotizing Pancreatitis*
Patrick C. Freeny, MD
It has generally been accepted that the only effective treatment for infected acute
necrotizing pancreatitis (ANP) is surgical debridement and drainage. However, recent
reports have suggested that radiogically-guided percutaneous drainage (PD) may also
be effective in some patients. This presentation will describe the current techniques
and results of percutaneous drainage in a series of patients with ANP. In our series,
PD was successful in 41% of patients with infected ANP. In these cases, average drainage
time was 88 days, required an average of 3.8 catheter changes per patient, and an
average of 2.8 catheters per patient. Large bore catheters and multiple treatment
sessions with vigorous irrigation and suction were required for success. No significant
complications occurred and no mortality resulted. Pancreatic surgery (necrosectomy
and drainage or partial pancreatic section) was required in 50% of cases for control
of sepsis or a pancreatic duct fistula. In these patients, mortality rate was 23.5%
The presence of infected central necrosis was the main indicator that a patient would
require eventual pancreatic surgery. Central necrosis was present in 41% of patients
and only 29% of these were cured with PD. The remaining patients required pancreatic
surgery.
Summary:
PD can be expected to cure about 40% of patients with ANP. However, if the necrosis
is central, most of these patients (71%) will require eventual pancreatic surgery,
usually for control of infection or pancreatic duct fistula. |
Abstracts
"Dome
Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Endoscopic
Drainage of Pancreatic Pseudocyst
Gary C. Vitale, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
CT Guided Percutaneous
Drainage of Infected Acute Necrotizing Pancreatitis
Patrick C. Freeny, MD
Management
of Metastatic Carcinoma
T. S. Ravikumar, MD
Management
of Liver Trauma
Juan C. Asensio, MD
Management
of Benign Liver Tumors
Leslie H. Blumgart, MD, FRCS
Role
and Techniques of "Dome-Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
Current
ConceptsæAdequate Pain Management
Young K. Choi, MD
Prevention
and Management of Infection Complicating Acute Pancreatitis
Henry L. Laws, MD
Indication
for and Timing of ERCP in Biliary Pancreatitis
John Baillie, MB, ChB, FRCP
Timing
of Laparoscopic Cholecystectomy After Biliary Pancreatitis
Gary C. Vitale
Magnetic
Resonance Angiography
Martin R. Prince, MD, PhD
Pancreatic
Imaging
Patrick C. Freeny, MD
Endoscopic
Ultrasonography
Charles Noyer, MD
Limited
Gastric Resection
Jo Buyske, MD
Current
ConceptsæManagement of Pancreatic Carcinoma
Henry A. Pitt, MD
Watchful
Waiting in the Management of Inguinal Hernia
Robert J. Fitzgibbons, MD
Treatment
of Incisional (Ventral) Hernias: Open Repair
Maximo Deysine, MD, FACP
Treatment
of Incisional (Ventral) Hernias: Laparoscopic Repair
Adrian E. Park, MD
Indications
for Converting to Open Operation
John G. Hunter, MD
Medicolegal
Implications of Common Bile Duct Injury During Laparoscopic Cholecystectomy
Kenneth A. Kern, MD, FACS
Role
and Technique of Pylorus Preserving Pacreatectomy
Henry A. Pitt, MD |
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