Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.482
Peer-review started: October 24, 2022
First decision: December 19, 2022
Revised: December 21, 2022
Accepted: January 5, 2023
Article in press: January 5, 2023
Published online: January 16, 2023
Processing time: 79 Days and 12.8 Hours
Necrotizing or severe pancreatitis represents approximately 10%-20% of acute pancreatitis. 30%-40% of patients with acute necrotizing pancreatitis (ANP) will develop debris infection through translocation of intestinal microbial flora. Infected ANP constitutes a serious clinical condition and is complicated by severe sepsis with high mortality rates of up to 40% despite progress in current intensive care. The timely detection of sepsis is crucial. The Quick Sequential Organ Failure Assessment score, procalcitonin levels > 1.8 ng/mL and increased lactates > 2 mmol/L (> 18 mg/dL), indicate the need for urgent management. The escalated step-by-step management protocol starts with broad-spectrum antibiotics, percutaneous drainage or endoscopic management, and ends with surgical management if needed. The latter includes necrosectomy (either laparoscopic or traditional open surgery), peritoneal lavage and extensive drainage. This management protocol increases the chance of survival to approximately 60% in patients with otherwise fatal cases. Any treatment choice must be individualized, and the timing is critical.
Core Tip: Infected acute necrotizing pancreatitis requires multidisciplinary management and multiple interventions that must be individualized. Early recognition of sepsis and prompt step-by-step individualized management for timely debridement and intensive care are imperative to improve outcomes.