Review
Copyright ©The Author(s) 2001. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 15, 2001; 7(4): 476-481
Published online Aug 15, 2001. doi: 10.3748/wjg.v7.i4.476
Management of necrotizing pancreatitis
John Slavin, Paula Ghaneh, Robert Sutton, Mark Hartley, Peter Rowlands, Conall Garvey, Mark Hughes, John Neoptolemos
John Slavin, Paula Ghaneh, Robert Sutton, Mark Hartley, John Neoptolemos, Departments of Surgery, Royal Liverpool University Hospital
Peter Rowlands, Conall Garvey, Mark Hughes, Radiology, Royal Liverpool University Hospital
Author contributions: All authors contributed equally to the work.
Correspondence to: Mr. J. Slavin, Senior Lecturer, Department of Surgery, Royal Liverpool University Hospital 5th floor UCD Building, Daulby Street, Liverpool, L69 3GA, United Kingdom, UK. jpss@liverpool.ac.uk
Telephone: 0044-151-706-4177 Fax: 0044-151-706-5826
Received: May 15, 2001
Revised: June 8, 2001
Accepted: June 15, 2001
Published online: August 15, 2001
Abstract

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 non-operative. 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.

Keywords: pancreatitis, acute necrotizing/drug therapy; pancreatitis, acute necrotizing/surgery; biopsy, needle; tomography, x-ray computered; enteral nutrition; human