A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis

Article Abstract:

A consistent factor seen in fatal cases of acute pancreatitis (inflammation of the pancreas usually due to damage of the biliary system from trauma, alcohol, infectious disease, or certain drugs) is pancreatic necrosis (death of pancreatic tissue). When pancreatic necrosis is accompanied by infection, surgery is absolutely indicated. However, indications for surgery have not been established for patients with noninfected pancreatic necrosis. It has been suggested that the removal of the noninfected necrotic portion of the pancreas would prevent the systemic effects of pancreatic necrosis. A study was undertaken to determine how frequently pancreatic necrosis develops; how often it becomes infected; and if noninfected necrosis can be safely treated without surgery. Acute pancreatitis was diagnosed in 194 patients. All patients were treated initially by only supportive measures (fluid replacement and monitoring). Patients with severe acute pancreatitis underwent dynamic computed tomographic scanning of the pancreas. Pancreatic necrosis was identified in 38 patients (20 percent) and confirmed by surgery in 28 patients. Patients with necrosis who continued to have fever underwent needle aspiration to obtain a specimen for bacterial culture. Of the 38 patients with necrosis, 27 (31 percent) had infection; this complication was treated with open drainage and the mortality was 15 percent. The 11 patients with non-infected necrosis were successfully treated without surgery. These findings suggest that not all patients with pancreatic necrosis require surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Complications and side effects, Prognosis

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Antibiotics in acute pancreatitis: current status and future directions

Article Abstract:

Acute pancreatitis, inflammation of the pancreas, is generally due to damage to the biliary system caused by trauma, alcohol, infectious disease or certain drugs. From 10 to 15 percent of patients with acute pancreatitis die; this rate has remained stable for the past 40 years in spite of advances in diagnosis and treatment. For patients with acute pancreatitis, development of secondary infection is responsible for about 80 percent of all deaths. Inadequate attention has been paid to the role of antibiotics in preventing and treating these infections. A study was undertaken to review what is known about antibiotic penetration into the pancreas; to determine which antibiotics are effective and when to use them; and to suggest areas for future research. It is not known if use of antibiotics to prevent secondary infection is helpful; there are no randomized clinical studies available. The choice of antibiotic when secondary infection is present can only be made on the basis of indirect evidence. Information on the penetration of the pancreas by antibiotics is scarce; most information that does exist is based on the presence of antibiotic in pancreatic juice. Only recently have the most common pancreatic pathogens (disease-causing organisms) been identified. Theoretically the best antibiotic choice appears to be ceftazidime and clindamycin; however, this combination does not cover enterococcus, one of the common pathogens. The lack of knowledge should stimulate more research on the use of antibiotics in treating acute pancreatitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Antibiotics, Drug therapy

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Pancreaticogastrostomy for chronic pancreatitis

Article Abstract:

This paper chronicled the authors' experience with 45 patients who had painful infections of the pancreas. All patients had their diagnosis confirmed by studies of the pancreatic and bile ducts, findings of decreased pancreas liver production, and microscopic examination (following surgery). All patients underwent a simultaneous removal of the stomach and pancreas. Alcohol was found to be the main cause (alcoholic abuse in 84 percent). Follow-up at four years showed the following results: good (56 percent), fair (23 percent), and poor (21 percent). The operative mortality rate was less than five percent. Poor results of the surgical procedure were related to the use of tranquilizers and postoperative alcohol consumption. Eighty-three percent survived the operation by at least eight years.

Patient outcomes, Mortality, Gastrostomy

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