Pancreatic Necrosis and Pancreatic Abscess Follow-up
- Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD more...
Further Outpatient Care
See Patient Education.
Transfer
Patients usually should be in an ICU setting because they may decompensate quickly and require aggressive treatment, including mechanical ventilation.
Complications
- Fistula formation
- Enterocutaneous following surgery
- Entero-entero
- Enterovascular
- Recurrent pancreatitis
- Bowel obstruction
- Death
Patient Education
- Inform patients about the common causes of pancreatitis.
- Offer cholecystectomy to patients with gallstone pancreatitis if they are surgical candidates.
- Provide counseling for patients to abstain from alcohol use.
- Monitor patients for steatorrhea, and inform them about the potential for pancreatic insufficiency and the potential need for pancreatic enzyme and fat-soluble vitamin supplementation.
- For excellent patient education resources, visit eMedicine's Liver, Gallbladder, and Pancreas Center. Also, see eMedicine's patient education article Pancreatitis.
Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol. Oct 14 2007;13(38):5043-51. [Medline].
Dugernier T, Dewaele J, Laterre PF. Current surgical management of acute pancreatitis. Acta Chir Belg. Mar-Apr 2006;106(2):165-71. [Medline].
Ciesek S, Manns MP, Krüger M. [Retroperitoneal abscess in a man with severe necrotizing pancreatitis]. Dtsch Med Wochenschr. Sep 8 2006;131(36):1937-40. [Medline].
Mathew A, Biswas A, Meitz KP. Endoscopic necrosectomy as primary treatment for infected peripancreatic fluid collections (with video). Gastrointest Endosc. Oct 2008;68(4):776-82. [Medline].
Loveday BP, Mittal A, Phillips A, Windsor JA. Minimally invasive management of pancreatic abscess, pseudocyst, and necrosis: a systematic review of current guidelines. World J Surg. Nov 2008;32(11):2383-94. [Medline].
Bucher P, Pugin F, Morel P. Minimally invasive necrosectomy for infected necrotizing pancreatitis. Pancreas. Mar 2008;36(2):113-9. [Medline].
Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg. Jun 2007;245(6):943-51. [Medline].
Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. Apr 2006;63(4):635-43. [Medline].
Sikora SS, Khare R, Srikanth G, Kumar A, Saxena R, Kapoor VK. External pancreatic fistula as a sequel to management of acute severe necrotizing pancreatitis. Dig Surg. 2005;22(6):446-51; discussion 452. [Medline].
Pitchumoni CS, Patel NM, Shah P. Factors influencing mortality in acute pancreatitis: can we alter them?. J Clin Gastroenterol. Oct 2005;39(9):798-814. [Medline].
[Guideline] Isaji S, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: surgical management. J Hepatobiliary Pancreat Surg. 2006;13(1):48-55. [Medline]. [Full Text].
Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg. 2006;23(5-6):336-44; discussion 344-5. [Medline].
Beger HG, Bittner R, Block S, Büchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. Aug 1986;91(2):433-8. [Medline].
Büchler M, Malfertheiner P, Friess H, Isenmann R, Vanek E, Grimm H, et al. Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology. Dec 1992;103(6):1902-8. [Medline].
D'Egidio A, Schein M. Surgical strategies in the treatment of pancreatic necrosis and infection. Br J Surg. Feb 1991;78(2):133-7. [Medline].
Dragonetti GC, Licht H, Rubin W. Pancreatitis. Evaluation and treatment. Prim Care. Sep 1996;23(3):525-34. [Medline].
Dubner H, Steinberg W, Hill M, Bassi C, Chardavoyne R, Bank S. Infected pancreatic necrosis and peripancreatic fluid collections: serendipitous response to antibiotics and medical therapy in three patients. Pancreas. Apr 1996;12(3):298-302. [Medline].
Gerzof SG, Banks PA, Robbins AH, Johnson WC, Spechler SJ, Wetzner SM, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology. Dec 1987;93(6):1315-20. [Medline].
Gorbach SL, Bartlett JG, Blacklow NR. Infectious Diseases. 2nd ed. 1998:891-892.
Karimgani I, Porter KA, Langevin RE, Banks PA. Prognostic factors in sterile pancreatic necrosis. Gastroenterology. Nov 1992;103(5):1636-40. [Medline].
Kramer KM, Levy H. Prophylactic antibiotics for severe acute pancreatitis: the beginning of an era. Pharmacotherapy. May 1999;19(5):592-602. [Medline].
Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 1. 5th ed. 2000:839-840.
Norman J. The role of cytokines in the pathogenesis of acute pancreatitis. Am J Surg. Jan 1998;175(1):76-83. [Medline].
Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet. May 1993;176(5):480-3. [Medline].
Powell JJ, Campbell E, Johnson CD, Siriwardena AK. Survey of antibiotic prophylaxis in acute pancreatitis in the UK and Ireland. Br J Surg. Mar 1999;86(3):320-2. [Medline].
Robertson KW, Stewart IS, Imrie CW. Severe acute pancreatitis and pregnancy. Pancreatology. 2006;6(4):309-15. [Medline].
Rünzi M, Layer P. Nonsurgical management of acute pancreatitis. Use of antibiotics. Surg Clin North Am. Aug 1999;79(4):759-65, ix. [Medline].
Seewald S, Groth S, Omar S, Imazu H, Seitz U, de Weerth A, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. Jul 2005;62(1):92-100. [Medline].
Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc. Dec 2007;66(6):1107-19. [Medline].
Witt H, Apte MV, Keim V, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. Apr 2007;132(4):1557-73. [Medline].
Wyncoll DL. The management of severe acute necrotising pancreatitis: an evidence-based review of the literature. Intensive Care Med. Feb 1999;25(2):146-56. [Medline].
Yasuda T, Ueda T, Takeyama Y, Shinzeki M, Sawa H, Nakajima T, et al. Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis. J Gastroenterol. Aug 2007;42(8):681-9. [Medline].

