An Acute Necrotising Pancreatitis -A Medical Emergency (original) (raw)
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IOSR Journals , 2019
Necrotizing pancreatitis is one of the important causes of mortality in acute pancreatitis especially when it is infected. Intervention is very rarely indicated in patients with sterile necrosis but may be required in those who continue to deteriorate despite maximal supportive care. In contrast, patients with infected pancreatic or peri-pancreatic necrosis almost always require intervention. Although infected pancreatic necrosis has been considered an absolute indication for surgical intervention, cases successfully managed non-surgically have been reported. This study assessed the course of necrotizing pancreatitis with and without surgical intervention. This observational study was conducted in NilRatan Sircar medical college & hospital, on patients admitted with Acute Pancreatitis and latter diagnosed to have Acute Necrotizing Pancreatitis (on the basis of Contrast Enhanced CT Scan of Whole Abdomen) during January 2015 to September 2016.Thirty patients who fulfilled the inclusion criteria were enrolled for the study .There was a male preponderance. 50% of cases occurred in the age group of 30 to 49 years. Gall stone was the most common etiological agent followed by alcoholism and also gall stone was most common cause of infected necrotizing pancreatitis being present in 67% cases. Esch.coli was the most common organism found in infected necrotizing pancreatitis. CRP >= 150mg/L was 82% sensitive and 56% specific in diagnosing severe pancreatitis with CTSI > 6 73% of patients with acute necrotizing pancreatitis had less than 50% necrosis .64% of the patients (n=22) were managed conservatively. Rest 8 patients with >50 % necrosis had to undergo necrosectomy. One patient out of the 22 patients managed conservatively and 3 patients out of the 8 managed surgically died of various complications.
Acute necrotising pancreatits : Current Concepts
2005
Pancreatic necrosis represents a severe form of acute pancreatitis. The morbidity and mortality associated with acute pancreatitis are substantially higher when necrosis is present especially when the area of necrosis is also infected. Despite a relative shortage of randomized clinical trials, there has been a significant change in the management of acute necrotising pancreatitis over the past 20 years. In recent years the treatment of acute necrotising pancreatitis has shifted away from early surgical debridement (necrosectomy) to aggressive intensive medical care of multiple organ systems with specific criteria for operative and nonoperative management. This review presents the current concepts with regards to diagnosis and management of acute necrotising pancreatitis including the controversial aspects. Some of the issues addressed include the management of these patients in an intensive care/ therapy unit, the role of prophylactic antibiotics, requirement of nutrition, either en...
A Case Report on Acute Necrotizing Pancreatitis and Nursing Management
Journal of Pharmaceutical Research International, 2021
Introduction: Necrotizing pancreatitis (NP) is a health problem in which part of pancreas dies. This is because of inflammation or injury. If the dead tissue gets infected, it can cause serious issues. Pancreatitis is inflammation of the pancreas. During recurring attacks of pancreatitis, tissues within pancreas may die and later become infected. This condition is called as acute necrotizing pancreatitis. Case Presentation: A 48 yr old male visited in AVBRH with the chief complaints of pain in epigastric region, recurrent vomiting, and abdominal distention since 7 days. Otherwise client was alright. After undergoing investigations such as complete blood count, liver function test, kidney function test, CT Scan (Computed tomography) and sonography etc. He was diagnosed with Acute Necrotizing Pancreatitis and was admitted to male medi- cine ward No.29. He had past medical history of pain in epigastric region, fever, abdominal distention, since 5days. For these complaints his family memb...
Il Giornale di chirurgia
Severe acute pancreatitis (SAP) management has changed over the last fifteen years, and from too aggressive behaviour, we moved to a cautious one. In every case, we can appreciate defect of extremist conceptual position. We reviewed our strategy on disease treatment, and we analyzed treatment of single cases. We collected 4 SAP cases from January 2009 to January 2010. All patients were septic, and we adopted the same approach for all of them, avoiding surgery without peritoneal infection. In all patients we placed jejumostomy and, after cleaning of septic site, we started immediate enteral nutrition (EN). Antibiotic therapy against Gram+, Gram- and antifugal drug had been started. No one died and all patients were back to an active life even if social costs are considerably high especially due to very long hospital stay.
Diagnosis and Management of Pancreatic Necrosis Infection
Acta Scientific Gastrointestinal Disorders, 2020
Acute pancreatitis (AP) is defined, according to the consensus of Atlanta in 1992 [1], as an acute inflammatory process affecting the pancreas with participation of peri-pancreatic tissues or remote organs. In practice, there are two distinct varieties: edematous pancreatitis and necrotizing pancreatitis. The edematous form usually results in spontaneous recovery; however necrotizing form is the severe form of acute pancreatitis (15% to 20% of cases) whose natural evolution can be divided into two phases [2]. The first 14 days characterized by the presence of systemic inflammatory response syndrome (SIRS) secondary to the release of inflammatory mediators that are responsible for the failure of multiple organs (lung, kidneys, and heart, etc....). The second phase occurs after two weeks of evolution and is dominated by septic complications associated with infection of the pancreatic necrosis, which is seen in
Treatment of Acute Necrotising Pancreatitis and Its Complications: The Surgeon's Perspective
2021
Acute necrotising pancreatitis (ANP) is associated with high complication and mortality rates. It is still difficult for the surgeon to choose and schedule the most appropriate treatment. Compared to the past, the current minimally invasive “step-up” approach enables better outcomes in terms of morbidity/mortality, notwithstanding long periods of hospitalisation, and above all ensures better levels of residual pancreatic function. We hereby report the case of a patient hospitalised in our division for approximately 4 months with a diagnosis of ANP complicated by infection and late bleeding, handled with a sequential approach.
Management of necrotizing pancreatitis
World journal of gastroenterology : WJG, 2001
Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undertaken. Treatment of sterile necrosis should initially be nonoperative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB, and the role of enteral feeding.