Document Detail

The evolving management of infected pancreatic necrosis.
MedLine Citation:
PMID:  23025961     Owner:  NLM     Status:  MEDLINE    
Management of infected pancreatic necrosis (IPN) has for decades been based on early operative débridement. This approach is associated with mortality rates as high as 58 per cent. Recently, the care of these patients has evolved and emphasizes delayed operation and early intervention with percutaneous drainage. In 2002, we began to incorporate these new principles for the treatment of IPN and herein characterize the recent UCLA experience with management of IPN. A retrospective review of patients with IPN treated at UCLA between 2002 and 2011 was conducted. Mean patient age was 53.4 years. Mean Ranson's score was 3.3±2.3 and average number of concurrent comorbidities 3.2±2.5. All patients were treated with intravenous antibiotics. Thirteen of 18 patients (72.2%) had percutaneous drainage catheters placed (mean 1.1 drains per patient). Two patients were treated with percutaneous drainage alone. Sixteen of 18 (88.9%) eventually underwent surgical débridement. Of the operative patients, mean time from diagnosis to surgery was 28.4 days. The mortality in this group was 16.7 per cent. In conclusion, antibiotics and percutaneous drainage is an acceptable and possibly preferable initial therapeutic strategy for patients with IPN. Delayed operation and early intervention with percutaneous drainage appears to improve mortality for these patients.
Graham Donald; Timothy Donahue; Howard A Reber; O Joe Hines
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American surgeon     Volume:  78     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  2012-12-03     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1151-5     Citation Subset:  IM    
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
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MeSH Terms
Middle Aged
Pancreatic Diseases / microbiology*,  pathology,  therapy*
Retrospective Studies
Grant Support
P01AT003960/AT/NCCAM NIH HHS; T32 07180-37//PHS HHS; T32 DK007180/DK/NIDDK NIH HHS

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