Combination of percutaneous catheter drainage with negative pressure irrigation and endoscopic drainage for severe acute pancreatitis patients with infected pancreatic necrosis

Abstract

Objective To investigate the effectiveness of combining percutaneous catheter drainage (PCD),negative pressure irrigation (NPI) with endoscopic drainage (ED) for severe acute pancreatitis (SAP) patients with infected pancreatic necrosis (IPN).Methods The clinical data of 17 patients with IPN admitted from July 2011 to July 2012 were reviewed and the clinical course and outcome were analyzed.All the patients were treated with PCD + NPI + ED.ResuIis The time interval from onset of the disease to IPN diagnosis was (26.9 ±7.9) days.Thirteen cases were infected with gram-negative bacterium,3 cases with gram-positive bacterium and 1 case with invasive fungal.The time interval from onset to first PCD + NPI was (34.8 ± 11.6) days.Eight cases were treated with CT guidance,1 case with ultrasound guidance and 8 cases with both.The mean number of double catheterization cannulas in every patient was 3.5 ± 1.2.The time interval from first PCD + NPI to first ED was (26.7 ± 9.6) days and the mean ED treatment of every patient was (2.1 ±0.9) times.Among all patients,two were converted to open surgery and the time intervals from disease onset to operation in these two patients were 24 days and 56 days respectively.No catheterization related complication occurred in these 17 cases.Bleeding occurred in the first patient during the procedure of ED.After ED,duodenal fistula occurred in 2 patients,jejunal fistula occurred in 1 patient,descending colon fistula occurred in 1 patient,abdominal cavity bleeding occurred in 2 patients.No new cases of organ dysfunction and sepsis occurred.One patient developed multiple organ dysfunction and sepsis before PCD +NPI + ED treatment,though this patient underwent laparotomy,sepsis was not controlled and this patient died eventually.Conclusions Combination of PCD + NPI + ED can effectively avoid operation for most patients with IPN,and decrease complication rates and improve the prognosis of patients. Key words: Pancreatitis, acute necrotizing; Percutaneous catheter drainage; Endoscopic drainage; Operation