Pancreatic Necrosis: A Single Center Epidemiologic Description

Abstract

Introduction: Pancreatic necrosis is a complication of acute pancreatitis which results in the formation of walled-off collections that may contain both solid debris and liquid elements. Necrotic collections have a tendency to get infected and can cause other major complications including abdominal pain, mass effect resulting in gastric outlet or biliary obstruction, pseudo aneurysms or septic shock. This study analyzes the epidemiology of patients suffering from pancreatic necrosis and the characteristics of the necrotic cavity.Figure 1Figure 2Methods: This study was a retrospective review of 85 patients who were treated for pancreatic necrosis at our institution over a five year period (December 2010 - October 2015). We collected epidemiologic data pertaining to these patients, the severity of their episode of acute pancreatitis, clinical features as well as details regarding the necrotic cavity. Results: The mean age of patients treated for pancreatic necrosis at our institution was 53.7 ± 15 years. 72% of them were males and 84% were Caucasians. Median scores for the Charlson comorbidity index and the Bedside Severity of Index in Acute Pancreatitis (BISAP) was 2 for both. Most common cause of acute pancreatitis preceding pancreatic necrosis was gallstone disease (33%) followed by alcoholinduced pancreatitis (30%). (Table 1) Mean dimensions of the necrotic cavity were 79.4mm × 67.5mm × 91.3mm. Most necrotic collections were observed to involve the majority of the pancreas (45%), however the pancreatic body was the most commonly affected if the necrosis was localized (33%). Around 50% of necrotic collections were infected, however only 27% of patients were found to be bacteremic. (Table 2). Conclusion: Pancreatic necrosis is a known and serious complication of acute pancreatitis. Amongst all causes of acute pancreatitis, gallstone pancreatitis was associated with a higher rate of complicating into pancreatic necrosis. Although infected pancreatic necrosis is an indication for debridement, not all infected cysts result in peripheral bacterial seeding and sepsis. Hence, not all infected cysts may need debridement and further studies are needed to establish which patients may benefit from any kind of intervention versus just conservative management.