Planned repeated necrosectomy for the management of acute necrotizing pancreatitis

ABSTRACT

The aim of this work was to study the outcome of planned repeated necrosectomy for cases proved to be acute necrotizing pancreatitis in multiple centers over four years. One hundred and fifteen patients with acute pancreatitis were revised and diagnosed depending on clinical grounds, laboratory and radiological investigations. From this group, 21 patients [12 males and nine females with an age ranging between 30-72 years and a mean of 56] with proven acute necrotizing pancreatitis were included in this study and managed by planned repeated operative necrosectomy. Contrast enhanced CT was done to the whole group and it was indicative for necrotizing pancreatitis in ten patients with the pathognomonic presence of extraluminal gas. Also, CT guided aspiration was done in 12 patients as it was positive culture [mixed aerobic and anaerobic organisms] in five patients who were considered necrotizing pancreatitis and managed accordingly by repetitive operative necrosectomy. The remaining six patients were diagnosed depending on the deterioration of their clinical picture with no response to medical conservative treatment which was started in the whole group