In acute pancreatitis, infection of necrosis is associated with a substantial mortality of 15% to more than 50% even if immediate necrosectomy, the recommended standard treatment, is performed.
This is mainly because of the patients' critical systemic and unstable local conditions at the time of manifestation of infection.
Dr Runzi and colleagues investigated whether this dreaded complication can be managed conservatively.
The investigative team evaluated 88 consecutive patients with severe acute necrotizing pancreatitis who received intensive care treatment including early antibiotic prophylaxis.
|Nonsurgical therapy was continued after adapting the antibiotic regimen to bacteriology|
The team included 28 patients who developed infection of necroses, verified by fine needle aspiration, about 19 after admission and no patient received urgent surgery.
In all patients nonsurgical therapy was continued after adapting the antibiotic regimen to bacteriology.
In the further course, the researchers excluded 12 patients due to refractory local complications eventually requiring surgical treatment about 36 days after diagnosis of infection.
The team found that 16 patients were managed with medical treatment alone.
The investigators also noted that 6 patients recovered without further complications; 10 patients developed single or multiple organ failure, and 2 died.
Dr Runzi concludes, “These data suggest that in patients with acute necrotizing pancreatitis and infected necroses, surgery can be avoided without compromising prognosis and outcome.”