| Early surgical débridement of symptomatic pancreatic necrosis is beneficial irrespective of infection. | |
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MedLine Citation:
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PMID: 1733356 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In order to assess the recent trend of nonoperative management of pancreatic necrosis, we reviewed 82 variables in 73 consecutive patients with symptomatic necrotizing pancreatitis. The mortality rate for the series was 25% (18 of 73). The only preintervention variables that correlated with mortality were APACHE II score greater than 15 (p = 0.01), preintervention blood transfusion (p less than 0.001), respiratory failure (p less than 0.001), and shock (p less than 0.01). Patients who developed recurrent sepsis following the initial intervention had a significantly higher mortality rate (17 of 34) than those who did not (1 of 39) (p less than 0.001). The rate of recurrent sepsis varied widely among individual surgeons and correlated with APACHE II score. The presence of infected versus noninfected necrosis did not correlate significantly with outcome. When percutaneous radiologically guided drainage was the initial therapeutic modality (n = 6), recurrent sepsis requiring surgical drainage inevitably occurred. Patients treated with percutaneous drainage (often in combination with surgical drainage) had a longer hospital stay (82 versus 42 days, p less than 0.001), spent more days in the intensive care unit (31 versus 6 days, p less than 0.001), and required more days of total parenteral nutrition (57 versus 27 days, p less than 0.001) than those treated solely by surgical means. We conclude that aggressive initial surgical débridement should be the first step in managing symptomatic pancreatic necrosis and that the presence of infection should not be the sole determinant of intervention. |
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Authors:
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D W Rattner; D A Legermate; M J Lee; P R Mueller; A L Warshaw |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of surgery Volume: 163 ISSN: 0002-9610 ISO Abbreviation: Am. J. Surg. Publication Date: 1992 Jan |
Date Detail:
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Created Date: 1992-02-25 Completed Date: 1992-02-25 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0370473 Medline TA: Am J Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 105-9; discussion 109-10 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Massachusetts General Hospital, Boston 02114. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Bacterial Infections
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complications*,
mortality Debridement* Drainage Female Humans Length of Stay Male Middle Aged Necrosis Pancreas / pathology Pancreatitis / microbiology, mortality, surgery* Severity of Illness Index Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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