Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Clinics |
Texto Completo: | https://www.revistas.usp.br/clinics/article/view/128302 |
Resumo: | OBJECTIVE: To present our experience in the management of patients with infected pancreatic necrosis without drainage. METHODS: The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. RESULTS: We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >;8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >;9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. CONCLUSIONS: In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration. |
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Clinics |
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Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone OBJECTIVE: To present our experience in the management of patients with infected pancreatic necrosis without drainage. METHODS: The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. RESULTS: We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >;8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >;9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. CONCLUSIONS: In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2017-02-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/12830210.6061/clinics/2017(02)04Clinics; Vol. 72 No. 2 (2017); 87-94Clinics; v. 72 n. 2 (2017); 87-94Clinics; Vol. 72 Núm. 2 (2017); 87-941980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/128302/125195Copyright (c) 2017 Clinicsinfo:eu-repo/semantics/openAccessRasslan, Robertoda Costa Ferreira Novo, FernandoRocha, Marcelo CristianoBitran, Albertode Souza Rocha, Manoelde Oliveira Bernini, CelsoRasslan, SamirUtiyama, Edivaldo Massazo2017-03-16T11:39:13Zoai:revistas.usp.br:article/128302Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2017-03-16T11:39:13Clinics - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
title |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
spellingShingle |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone Rasslan, Roberto |
title_short |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
title_full |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
title_fullStr |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
title_full_unstemmed |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
title_sort |
Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone |
author |
Rasslan, Roberto |
author_facet |
Rasslan, Roberto da Costa Ferreira Novo, Fernando Rocha, Marcelo Cristiano Bitran, Alberto de Souza Rocha, Manoel de Oliveira Bernini, Celso Rasslan, Samir Utiyama, Edivaldo Massazo |
author_role |
author |
author2 |
da Costa Ferreira Novo, Fernando Rocha, Marcelo Cristiano Bitran, Alberto de Souza Rocha, Manoel de Oliveira Bernini, Celso Rasslan, Samir Utiyama, Edivaldo Massazo |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Rasslan, Roberto da Costa Ferreira Novo, Fernando Rocha, Marcelo Cristiano Bitran, Alberto de Souza Rocha, Manoel de Oliveira Bernini, Celso Rasslan, Samir Utiyama, Edivaldo Massazo |
description |
OBJECTIVE: To present our experience in the management of patients with infected pancreatic necrosis without drainage. METHODS: The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. RESULTS: We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >;8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >;9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. CONCLUSIONS: In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-02-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/128302 10.6061/clinics/2017(02)04 |
url |
https://www.revistas.usp.br/clinics/article/view/128302 |
identifier_str_mv |
10.6061/clinics/2017(02)04 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/128302/125195 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Clinics info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Clinics |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
dc.source.none.fl_str_mv |
Clinics; Vol. 72 No. 2 (2017); 87-94 Clinics; v. 72 n. 2 (2017); 87-94 Clinics; Vol. 72 Núm. 2 (2017); 87-94 1980-5322 1807-5932 reponame:Clinics instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Clinics |
collection |
Clinics |
repository.name.fl_str_mv |
Clinics - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
||clinics@hc.fm.usp.br |
_version_ |
1800222763117445120 |