Role of Early Intervention in Improving the Clinical Outcome of Acute Pancreatitis by Image Guided Percutaneous Catheter Drainage of Pancreatic Collections

Chittoor Ramya Sudha,Amitha K S Vikrama Amitha K S Vikrama,Gurudutt P Varty Gurudutt P Varty,Ankita Sanjeev Dhawan,Yugandhar Samireddypalle,Sagar Dembla,Umamaheswara V Reddy

doi:10.47009/ajmrr.2020.8.1.24

Abstract

Background: To assess the role of image guided percutaneous drainage of acute pancreatic collections in influencing the clinical outcome of patients. Subjects and Methods: This is a prospective study done in the department of intervention radiology, Narayana medical college. About 20 cases have been performed in our institution from January 2019 to December 2019. All these drainage procedures have been done under CT guidance. All these cases were strictly followed during their hospital course. Clinical success has been defined as control of sepsis and prevention of MODS without the requirement of surgical debridement. Results: Out of twenty cases, which we intervened, there was an improvement in clinical outcome in fourteen cases with the prevention of septic shock and multiorgan failure. Three cases were critically ill at the time of admission and succumbed to MODS (Multiple organ dysfunction syndrome). The other three cases required additional surgical intervention-debridement. In which, there was increased morbidity with delayed recovery in two cases, and one case developed MODS and expired. Conclusion: Image guided Percutaneous catheter drainage is a safe and effective technique to drain pancreatic collections. Adequate knowledge regarding the interpretation of imaging findings, time to intervene, adequate expertise for performing the procedure, close follow up with regular clinical assessment is vital in the management of patients in acute pancreatitis. Early and aggressive intervention helps reduce the morbidity and mortality by preventing the evolution of MODS.

Highlights

Acute necrotizing pancreatitis corresponds to 10–15% of all cases of acute pancreatitis. [1] It was frequently complicated by a systemic inflammatory response syndrome and multisystem organ failure and infections
Infectious pancreatic necrosis (IPN) is the most dreaded and severe complication causing 80% of the deaths associated with AP. [1,2,3,4,5]
Such aggressive treatment is associated with significant complications and mortality in 11–39 % of patients. This high rate has been primarily attributed by the presence of comorbid medical conditions and multisystem organ failure which is derived from a systemic response to pancreatitis. [6,7,8,9,10,11]

Summary

Introduction

Acute necrotizing pancreatitis corresponds to 10–15% of all cases of acute pancreatitis. [1] It was frequently complicated by a systemic inflammatory response syndrome and multisystem organ failure and infections. The surgical debridement has been the mainstay of treatment of patients with acute necrotizing pancreatitis traditionally Such aggressive treatment is associated with significant complications and mortality in 11–39 % of patients. This high rate has been primarily attributed by the presence of comorbid medical conditions and multisystem organ failure which is derived from a systemic response to pancreatitis. To assess the role of image guided percutaneous drainage of acute pancreatic collections in influencing the clinical outcome of patients. Adequate knowledge regarding the interpretation of imaging findings, time to intervene, adequate expertise for performing the procedure, close follow up with regular clinical assessment is vital in the management of patients in acute pancreatitis. And aggressive intervention helps reduce the morbidity and mortality by preventing the evolution of MODS

Methods

Results

Discussion

Conclusion