acute necrotizing pancreatitis

Epidemiology

• 10% of acute pancreatitis

Pathology

• necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection
• walled off pancreatic necrosis develops after 4 weeks of disease

Diagnostic procedures

• ERCP if signs of biliary obstruction & or cholangitis

Radiology

• CT of abdomen
• ultrasound screening for DVT to prevent symptomatic pulmonary embolism

Complications

• see acute pancreatitis

Management

• treat infected acute necrotizing pancreatitis with broad spectrum antibiotics.
  • a carbapenem alone
  • metronidazole + 3rd generation cephalosporin or fluoroquinolone
  • routine use of antifungal agent not recommended
• aggressive intravenous fluid hydration to maintain intravascular volume
• providing adequate nutritional support with enteral nutrition beyond the ligament of Treitz
• an infected or symptomatic walled off pancreatic necrosis may require drainage
  • delayed drainage non-inferior to immediate drainage
  • some patients never require drainage
• open pancreatectomy is associated with high morbidity

see pancreatic necrosis

More general terms

• acute pancreatitis
• pancreatic necrosis