Management of infected pancreatic necrosis: state of the art

Detalhes bibliográficos
Autor(a) principal: Rasslan,Roberto
Data de Publicação: 2017
Outros Autores: Novo,Fernando da Costa Ferreira, Bitran,Alberto, Utiyama,Edivaldo Massazo, Rasslan,Samir
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista do Colégio Brasileiro de Cirurgiões
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912017000500521
Resumo: ABSTRACT Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.
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spelling Management of infected pancreatic necrosis: state of the artPancreatitisPancreatitis, Acute NecrotizingInfectionDrainageABSTRACT Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.Colégio Brasileiro de Cirurgiões2017-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912017000500521Revista do Colégio Brasileiro de Cirurgiões v.44 n.5 2017reponame:Revista do Colégio Brasileiro de Cirurgiõesinstname:Colégio Brasileiro de Cirurgiões (CBC)instacron:CBC10.1590/0100-69912017005015info:eu-repo/semantics/openAccessRasslan,RobertoNovo,Fernando da Costa FerreiraBitran,AlbertoUtiyama,Edivaldo MassazoRasslan,Samireng2018-03-08T00:00:00Zoai:scielo:S0100-69912017000500521Revistahttp://www.scielo.br/rcbcONGhttps://old.scielo.br/oai/scielo-oai.php||revistacbc@cbc.org.br1809-45460100-6991opendoar:2018-03-08T00:00Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC)false
dc.title.none.fl_str_mv Management of infected pancreatic necrosis: state of the art
title Management of infected pancreatic necrosis: state of the art
spellingShingle Management of infected pancreatic necrosis: state of the art
Rasslan,Roberto
Pancreatitis
Pancreatitis, Acute Necrotizing
Infection
Drainage
title_short Management of infected pancreatic necrosis: state of the art
title_full Management of infected pancreatic necrosis: state of the art
title_fullStr Management of infected pancreatic necrosis: state of the art
title_full_unstemmed Management of infected pancreatic necrosis: state of the art
title_sort Management of infected pancreatic necrosis: state of the art
author Rasslan,Roberto
author_facet Rasslan,Roberto
Novo,Fernando da Costa Ferreira
Bitran,Alberto
Utiyama,Edivaldo Massazo
Rasslan,Samir
author_role author
author2 Novo,Fernando da Costa Ferreira
Bitran,Alberto
Utiyama,Edivaldo Massazo
Rasslan,Samir
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Rasslan,Roberto
Novo,Fernando da Costa Ferreira
Bitran,Alberto
Utiyama,Edivaldo Massazo
Rasslan,Samir
dc.subject.por.fl_str_mv Pancreatitis
Pancreatitis, Acute Necrotizing
Infection
Drainage
topic Pancreatitis
Pancreatitis, Acute Necrotizing
Infection
Drainage
description ABSTRACT Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.
publishDate 2017
dc.date.none.fl_str_mv 2017-10-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912017000500521
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/0100-69912017005015
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dc.publisher.none.fl_str_mv Colégio Brasileiro de Cirurgiões
publisher.none.fl_str_mv Colégio Brasileiro de Cirurgiões
dc.source.none.fl_str_mv Revista do Colégio Brasileiro de Cirurgiões v.44 n.5 2017
reponame:Revista do Colégio Brasileiro de Cirurgiões
instname:Colégio Brasileiro de Cirurgiões (CBC)
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instname_str Colégio Brasileiro de Cirurgiões (CBC)
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reponame_str Revista do Colégio Brasileiro de Cirurgiões
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repository.name.fl_str_mv Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC)
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