The Role of Surgery in the Management of Acute Pancreatitis
The clinical course of an episode of acute pancreatitis varies from a mild, transitory form to a severe necrotizing form characterized by multisystem organ failure and mortality in 20% to 40% of cases. Mild pancreatitis does not need specialized treatment, and surgery is necessary only to treat unde...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2000-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/2000/710910 |
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| Summary: | The clinical course of an episode
of acute pancreatitis varies from a mild, transitory form to a
severe necrotizing form characterized by multisystem organ failure
and mortality in 20% to 40% of cases. Mild pancreatitis does
not need specialized treatment, and surgery is necessary only to
treat underlying mechanical factors such as gallstones or tumours
at the papilla of Vater. On the other hand, patients with severe
necrotizing pancreatitis need to be identified as early as possible
after the onset of symptoms to start intensive care treatment. In
this subgroup of patients, approximately 15% to 20% of all patients
with acute pancreatitis, stratification according to infection
status is crucial. Patients with infected necrosis must
undergo surgical intervention, which consists of an organpreserving
necrosectomy followed by postoperative lavage
and/or drainage to evacuate necrotic debris, which appears during
the further course of the condition. Primary intensive care
treatment, including antibiotic treatment, delays the need for
surgery in most patients until the third or fourth week after the
onset of symptoms. At that time, necrosectomy is technically
easier to perform and the bleeding risk is reduced, compared with
necrosectomy earlier in the disease course. In patients with sterile
necrosis, the available data strongly support a conservative
approach (ie, intensive care unit treatment). Surgery is rarely
necessary in these patients. |
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| ISSN: | 0835-7900 |