Complication Of Necrotizing Pancreatitis Research Articles

91 Colon Involvement in Necrotizing Pancreatitis—Incidence, Predictors and Outcomes From a Single Tertiary Care Center

INTRODUCTION: Colonic involvement significantly impacts the clinical course of necrotizing pancreatitis (NP) and reported in 6–40%. The spectrum of colonic complications includes fistula, strictures and ischemic colitis. The study aimed to determine the incidence, risk factors and clinical outcomes of colonic involvement of NP managed in our institution. METHODS: A retrospective analysis of all NP patients managed at our institution between 2010–2019 was performed from a prospectively maintained database for the occurrence of colonic complications. Baseline demographic characteristics, clinical presentation, management and outcomes were extracted. RESULTS: Colonic involvement occurred in 20 (3.9%) of the 515 NP patients managed during the study period, with colon fistulation detected in 12 (2.3%), strictures in 6 (1.2%) and ischemic colitis in 2 (0.4%). Males were predominantly involved [16 (80%)]. The median (range) age was 56 (23–84) years and alcohol was the main etiology of pancreatitis [10 (50%)]. All patients had extensive pancreatic and extra-pancreatic necrosis, with average BISAP score of 3 and modified Marshall score of 5. Infected necrosis noted in 18 (90%) patients. Subsequently, all underwent endoscopic and/or percutaneous drainage. Fistulae involved the left colon (mainly splenic flexure) in 9 (69.2%) and the right colon in 4 (30.8%) patients. While spontaneous closure occurred in 7 (53.8%); 4 (30.8%) were managed with over the scope clips and 2 (15.4%) surgically. Clinical outcomes were successful in 11 (92%) and all-cause mortality was 2 (17%). Colonic strictures and ischemia were managed conservatively in 3 (37.5%) subjects; 3 (37.5%) had stent placement, 1 (12.5%) underwent balloon dilation, and 1 (12.5%) underwent right sided hemicolectomy. Outcome was successful in all 8 (100%) patients. CONCLUSION: Male gender, obesity, alcohol etiology, infected necrosis, extensive pancreatic and extra-pancreatic involvement, and need for adjuvant percutaneous drainage may be predictors for development of colon complications in NP. Majority resolved conservatively after complete debridement of necrotic collection, some needed endoscopic management and very few needed surgical interventions.

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

BACKGROUNDAcute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.AIMTo investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.METHODSThe clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.RESULTSIn this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.CONCLUSIONIn this study, we identified the timing, the common species, and site of infection in patients with NP.

Clinically Acceptable Optimized Dose Reduction in Computed Tomographic Imaging of Necrotizing Pancreatitis Using a Noise Addition Software Tool.

This study aimed to determine potential radiation dose reduction of contrast-enhanced computed tomography (CECT) for imaging necrotizing pancreatitis (NP) using a noise addition tool. Eighty-four patients were identified with at least 1 abdominopelvic CECT for NP within a 2-year period. Sixty consecutive scans were selected as reference radiation dose data sets. A noise addition software was used to simulate 4 data sets of increased noise. Readers rated confidence for identifying (i) anatomic structures, (ii) complications of NP, and (iii) diagnostic acceptability. Noise and dose levels were identified at acceptability threshold where observer scores were statistically indistinguishable from full-dose computed tomographies. Observers' perception of image tasks decreased progressively with increasing noise (P < 0.05). Acceptability and statistical analysis indicated that noise can be increased from 10 to 25 HU corresponding to an 84% reduction in dose without change in observer perception (P < 0.05). Higher image noise levels may be tolerated in CECT in patients with NP.

Application of retroperitoneal pancreatic necrosectomy using percutaneous nephroscope

Objective Infected pancreatic necrosis is a serious complication of necrotizing pancreatitis. A method of minimally-invasive retroperitoneal infected pancreatic necrosectomy using percutaneous nephroscope was evaluated. Methods 21 patients with acute pancreatitis were treated in our hospital from June 2008 to August 2009. Among 13 patients who developed infected pancreatic necrosis, 6 underwent percutaneous catheter drainage by CT guidance. Then retroperitoneal infected pancreatic necrostectomy using percutaneous nephroscope along the sinus tract were performed after drainage for 5-36 d. Results In these 6 patients, 3 received percutaneous nephroscopic treatment one time, 2 two times and 1 three times. There were no operative mortality and morbidity except that 1 patient developed pseudocyst 6 months after operation. Conclusion Retroperitoneal pancreatic necrosectomy by percutaneous nephroscope is a safe, feasible, minimally-invasive and efficient method for treating infected pancreatic necrosis when the indication and occasion are suitable. This method would be a valid therapeutic option for treating necrotizing pancreatitis. However, further evaluation is necessary. Key words: Infected pancreatic necrosis; Percutaneous nephroscope; Retroperitoneal pancreatic necrosectomy