Pigtail catheter drainage and surgery in severe acute pancreatitis.

Manish Kumar,Vishnu Prasad Nelamangala Ramakrishnaiah,Anandhi Amaranathan,Mangala Goneppanavar,Sakthivel Chinnakkulam Kandhasamy,Ashok Kumar Sahoo

doi:10.1002/jgh3.12182

Abstract

Background and AimSevere acute pancreatitis is initially managed with conservative treatment. Patients who failed conservative management were effectively treated with pigtail drainage. Factors predicting surgery remain uncertain.MethodsA total of 58 patients with severe acute pancreatitis presenting to JIPMER Hospital were studied and managed with a step‐up approach. In this prospective observational study, patients were divided into three groups based on the final mode of treatment received: conservative, pigtail alone, and surgery groups.ResultsOf 58 patients, 30 patients were managed with conservative treatment, 20 patients with pigtail alone, and 8 patients underwent surgical treatment after pigtail failure. Overall sepsis reversal was achieved in 22 of 28 (78.5%) patients: 18 were in the pigtail alone group, and 4 were in surgery group, which was statistically significant (P = 0.03). Respiratory failure was the most common organ failure, 68.9%, and overall mortality was 8.62 in this study. On univariate analysis, absence of sepsis reversal within 2 weeks of pigtail insertion is a predictor of need of surgery. Other significant findings were higher catheter‐related complications in the surgery group (P = 0.01) and a 100% unimicrobial infection in the surgery group (P = 0.02). Overall mortality was 8.6%, which did not differ significantly between the groups.ConclusionThe step‐up approach avoided unnecessary intervention, and 52% patients recovered by conservative treatment alone. Sepsis reversal within 2 weeks of pigtail insertion can be used as a predictor of surgery in the early course of severe acute pancreatitis managed by the step‐up approach.

Highlights

Acute pancreatitis is one of the most common gastrointestinal (GI) emergencies presenting to a tertiary care hospital.[1]
Of 58 patients, 30 patients were included in Group 1 and 20 patients in Group 2, and the remaining 8 patients were assigned to Group 3
Alcohol Gall stones Others Clinical and severity scores Bedside Index of Severity in Acute Pancreatitis (BISAP) Modified computed tomography severity index (CTSI) APACHE II at admission APACHE II at first pigtail APACHE II at surgery Length of hospital stay Necrosis, n (%) No necrosis Less than 30% 30–50% More than 50% Organ failure No organ failure, n (%) Single organ failure, n (%) Multiorgan failure, n (%) Renal failure, n (%) Respiratory failure, n (%) CVS failure, n (%) Mortality, n (%)

Summary

Introduction

Acute pancreatitis is one of the most common gastrointestinal (GI) emergencies presenting to a tertiary care hospital.[1]. Patients with acute necrotizing pancreatitis were traditionally managed by open necrosectomy It is associated with a high rate of complications in 52–88% of patients and with mortality in 18–36%, with a risk of long-term pancreatic insufficiency.[4]. Methods: A total of 58 patients with severe acute pancreatitis presenting to JIPMER Hospital were studied and managed with a step-up approach. In this prospective observational study, patients were divided into three groups based on the final mode of treatment received: conservative, pigtail alone, and surgery groups. Sepsis reversal within 2 weeks of pigtail insertion can be used as a predictor of surgery in the early course of severe acute pancreatitis managed by the step-up approach

Methods

Results

Conclusion