pancreatic necrosis
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Etiology
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
Radiology
- CT of abdomen with contrast
Differential diagnosis
- pancreatic pseudocyst
- pancreatic necrosis may consist of more solid debris
Management
- treat infected pancreatic necrosis with broad spectrum antibiotics.[3]
- enteral nutrition beyond the ligament of Treitz[1]
- step-up approach to surgical intervention
- most fluid collections resolve without intervention[1]
- asymptomatic patients with walled-off pancreatic necrosis require no further intervention[1]
- percutaneous drainage
- delayed drainage of infected pancreatic necrosis safe[2]
- endoscopic debridement
- value as a means to delay surgical intervention until it is safe.
- may have a role at times as a definitive treatment.
- delay open surgery 12-30 days
Notes
- also see acute necrotizing pancreatitis
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 2.0 2.1 Boxhoorn L, van Dijk SM, van Grinsven J et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med 2021 Oct 7; 385:1372 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34614330 https://www.nejm.org/doi/10.1056/NEJMoa2100826
- ↑ 3.0 3.1 NEJM Knowledge+ Gastroenterology