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At least 19 recordsLinked to original sources
PubMed1977

Survival of patients with duodenal fistulas from necrotizing pancreatitis.

Acute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X-ray findings of an intra-abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X-rays to locate new intra-abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.

Acute Disease↗
PubMed1979

Observations during treatment of acute necrotizing pancreatitis with surgical ablation.

Seven patients with acute necrotizing pancreatitis were treated by surgical ablation. Immediate improvement was seen in six patients. Two patients died during the course of postoperative complications requiring reoperations. At operation, strikingly conforming lesions were found in the shape of a sharply limited necrotic portion of the gland. The body and tail of the pancreas constituted this necrotic portion in all patients. In a certain group of patients, the vascular anatomy infers a total infarction of the body and tail of the pancreas if a thrombosis of the transverse pancreatic artery occurs. In view of these observations, more interest should be directed toward the possibility of a vascular occlusion as a cause of pancreatic necrosis.

Acute Disease↗
PubMed2026

Potential of plasma metagenomic next-generation sequencing to guide antibiotic therapy in acute necrotizing pancreatitis with early fever: a prospective multicenter cohort study.

BACKGROUND: Indiscriminate antibiotic use remains common in febrile patients with acute necrotizing pancreatitis (ANP), particularly during the early phase. Metagenomic next‑generation sequencing (mNGS) has shown diagnostic utility for infected pancreatic necrosis (IPN) and may offer a means to guide antimicrobial therapy. We aimed to explore whether mNGS could potentially improve the appropriateness of antibiotic use in ANP patients presenting with early fever. METHODS: This prospective multicenter cohort study was conducted at five hospitals in China, enrolling ANP patients who developed fever within two weeks of symptom onset. Antibiotic susceptibility was defined per local microbiology laboratory reports. The hypothetical impact of mNGS on reducing inappropriate antibiotic use was evaluated through a retrospective simulation using predefined criteria from the BGI China antimicrobial drug usage card, as mNGS results were not disclosed to the treating teams during the actual clinical course. RESULTS: Between May 2023 and December 2024, 125 ANP patients with early fever were enrolled. Antibiotics were administered to 91.2% (114/125) of patients, whereas only 23.2% (29/125)were eventually confirmed to have IPN, and the rate of appropriate antibiotic use was 14.5% (17/117) based on conventional culture. In our simulated model, if therapy had been guided by plasma mNGS results, the estimated rate of appropriate antibiotic use could have increased to 71.8%. CONCLUSIONS: Plasma mNGS facilitates rapid pathogen identification and shows potential for improving antibiotic appropriateness in ANP patients with early fever.

Adult↗
PubMed1979

[Acute necrotizing pancreatitis and post-operative irrigation-lavage].

A series of 62 operated cases of acute necroto-hemorrhagic pancreatitis is presented along with discussion of the four principle objectives of surgical treatment: exposure, evaluation and selective resection of the lesions followed by close observation. Based on peroperative determination of anatomic site and macroscopic character, a double codification for each lesion is proposed. This codification provides the surgeon an objective basis for his choice of the type of procedure to be done. The surgery itself has a dual purpose: to eradicate frank necrosis and to protect the remaining tissue from autodigestion by installing one or more drains for irrigation and lavage of the lesion site. In the case of stage 3 necrosis, the procedure must include a left pancreatectomy of varying extent.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Early factors of necrosis in acute hemorrhagic necrotic pancreatitis].

In 60 cases of acute pancreatitis it was noted that 10 developed towards the haemorrhagic necrotic form. All these cases were surgically verified. Stress is laid on the factors that appear earliest in the change-over from an oedematous to a necrotico-haemorrhagic form. These factors (shock, fever, leukocytosis, hypocalcaemia, hyperglycaemia, pain, etc.) are assessed in relation to the frequency of their appearance and of their importance and reliability. These parameters point to the change-over from a pancreatopathy of medical significance to one of surgical interest and also suggest the most suitable moment for carrying out the operation.

Acute Disease↗
PubMed1979

[Indication of delayed surgery in the postacute phase of hemorrhagic necrotizing pancreatitis].

In acute hemorrhagic-necrotizing pancreatitis partial necrosis with good response to conservative therapy can be differentiated from extensive necrosis with no response to conservative therapy. In case of surviving the acute phase sequester and abscess are often to be seen in the "postacute phase", after 10-14 days. The indications for the "delayed operation" in this postacute phase are development of a palpable mass together with clinical deterioration and other complications. The surgical procedure consists of digital removal of necrotic tissue (sequestrotomy), abscess incision and resection. Since 1971 84 of 93 patients with a postacute pancreatitis were operated, two third survived.

Acute Disease↗
PubMed1979

Resection of the pancreas for acute hemorrhagic and necrotizing pancreatitis.

The role of surgery in the treatment of acute hemorrhagic or necrotizing pancreatitis is discussed on the basis of a series of 996 patients with all types of acute pancreatitis who were treated in the years 1967--1976. Pancreatic resection was performed in 29 patients with hemorrhagic or necrotizing pancreatitis during the past 3 years. The extent of resection ranged from 60 to 100% of the pancreas. Eight patients died, for a mortality rate of 28%. Eight of 21 surviving patients developed diabetes requiring substitution therapy. During a follow-up period of 6 to 36 months, 17 patients were able to resume work, 3 are still convalescing, and 1 has retired.

Acute Disease↗