Multidisciplinary Approach in Treatment of Necrotizing Pancreatitis in a Community Hospital Setting: A Case Series

Abstract

Introduction: Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis. Severity of acute pancreatitis is linked to presence of systemic organ dysfunctions and/or necrotizing pancreatitis. The optimal management of necrotizing pancreatitis continues to evolve. Severe necrotic pancreatitis (SNP) with proven infected necrosis as well as septic complications directly caused by the pancreatic infection is strong indication for surgical management. At the same time, recent advances in radiological imaging, new developments in interventional radiology and other minimal access interventions have revolutionized the management of SNP. We are presenting our experience with multidisciplinary approach in treatment of severe necrotizing pancreatitis in community hospital setting. We performed a retrospective chart review of 7 patients who underwent either one or more of the following: endoscopic intervention, radiologic intervention and surgical intervention for acute severe necrotizing pancreatitis between 2010 to present. Out of seven patients, there were four males and three females aged between 32-74 years. Four patients underwent endoscopic drainage and necrosectomy, of those three patients had multiple interventions. Two patients underwent both surgical and endoscopic procedures and both needed repeated interventions. One patient underwent endoscopic and radiologic intervention that also needed repeated interventions. No deaths were reported. All patients improved symptomatically and radiographically in 4-6 weeks. Conclusion: Our experience highlights the safety and feasibility of performing complex endoscopic interventions in community hospital setting with acceptable success rates and no mortality in patients with severe necrotizing pancreatitis.