Necrotizing Pancreatitis: A comprehensive review of the presentation, management, and complications
Main Article Content
Abstract
Necrotizing pancreatitis (NP) is a life-threatening complication of acute pancreatitis. It requires an extended hospital stay, aggressive management, and has a higher risk of mortality. Risk factors such as comorbidities in the patient’s history including history of coronary artery disease and cerebrovascular disease can increase the risk of developing necrotizing pancreatitis. The presentation of necrotizing pancreatitis is similar to acute pancreatitis, but specific labs such as hematocrit level can be monitored to anticipate the development of necrotizing pancreatitis. In addition, diagnostic imaging must be obtained to classify necrotizing pancreatitis and aid in management choice. Fluid hydration, adequate pain management, and nutritional support are the principles of treating necrotizing pancreatitis. Deciding whether to drain the necrotic collection or not is usually determined based on the type of necrosis present and whether it is infected. Infected necrotizing pancreatitis can also occur, and patients usually need to be monitored closely with appropriate antibiotics for a long duration. Patients affected by necrotizing pancreatitis can potentially develop complications that can lead to devastating outcomes. Necrotizing pancreatitis complications can occur due to an inflammatory reaction on the adjacent structure such as splanchnic vein thrombosis, gastrointestinal fistula or inflammatory reaction within the pancreas leading to an exocrine and an endocrine pancreatic insufficiency. We present here a literature review of necrotizing pancreatitis and the complications that can arise from it.
Keywords:
Necrotizing Pancreatitis, Pancreatitis
Article Details
How to Cite
TRAD, George et al.
Necrotizing Pancreatitis: A comprehensive review of the presentation, management, and complications.
Medical Research Archives, [S.l.], v. 11, n. 5, may 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3992>. Date accessed: 27 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i5.3992.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Alvi AR, Sheikh GM, Kazim SF. Delayed surgical therapy reduces mortality in patients with acute necrotizing pancreatitis. J Pak Med Assoc. 2011;61(10):973-7.
3. Johnstone C. Pathophysiology and nursing management of acute pancreatitis. Nurs Stand. 2018.
4. Boumitri C, Brown E, Kahaleh M. Necrotizing Pancreatitis: Current Management and Therapies. Clin Endosc. 2017;50(4):357-65.
5. Chen HZ, Ji L, Li L, Wang G, Bai XW, Cheng CD, et al. Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis. Medicine (Baltimore). 2017; 96(30):e7487.
6. Wang GJ, Gao CF, Wei D, Wang C, Ding SQ. Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol. 2009; 15(12):1427-30.
7. Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016; 375(20):1972-81.
8. Das S, Mahakkanukrauh P, Ho CC. The Burden of Gastrointestinal, Liver, and Pancreatic Diseases: The Global Scenario. Gastroenterology. 2016;150(4):1045-6.
9. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012; 143(5):1179-87.e3.
10. Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015;149(7):1731-41.e3.
11. Roch AM, Maatman T, Carr RA, Easler JJ, Schmidt CM, House MG, et al. Evolving treatment of necrotizing pancreatitis. Am J Surg. 2018;215(3):526-9.
12. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
13. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491-502.
14. Phogat D, Bajpai M, Agrawal P, Ganguli P. Acute necrotizing pancreatitis. Autops Case Rep. 2020;10(4):e2020215.
15. Baron TH, Morgan DE. Acute necrotizing pancreatitis. N Engl J Med. 1999; 340(18):1412-7.
16. Chao CT, Chao JY. Case report: furosemide and pancreatitis: Importance of dose and latency period before reaction. Can Fam Physician. 2013;59(1):43-5.
17. Baillargeon JD, Orav J, Ramagopal V, Tenner SM, Banks PA. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998;93(11):2130-4.
18. Tenner S, Baillie J, DeWitt J, Vege SS, Gastroenterology ACo. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-15; 16.
19. Zeng YB, Zhan XB, Guo XR, Zhang HG, Chen Y, Cai QC, et al. Risk factors for pancreatic infection in patients with severe acute pancreatitis: an analysis of 163 cases. J Dig Dis. 2014;15(7):377-85.
20. Ji L, Lv JC, Song ZF, Jiang MT, Li L, Sun B. Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2016;15(4):428-33.
21. Talukdar R, Nechutova H, Clemens M, Vege SS. Could rising BUN predict the future development of infected pancreatic necrosis? Pancreatology. 2013;13(4):355-9.
22. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-703.
23. Harris HW, Barcia A, Schell MT, Thoeni RF, Schecter WP. Necrotizing pancreatitis: a surgical approach independent of documented infection. HPB (Oxford). 2004;6(3):161-8.
24. Tran A, Fernando SM, Rochwerg B, Inaba K, Bertens KA, Engels PT, et al. Prognostic factors associated with development of infected necrosis in patients with acute necrotizing or severe pancreatitis-A systematic review and meta-analysis. J Trauma Acute Care Surg. 2022;92(5):940-8.
25. Chung KM, Chuang SS. Cullen and Grey Turner signs in idiopathic perirenal hemorrhage. CMAJ. 2011;183(16):E1221.
26. Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, et al. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics. 2014;34(5):1218-39.
27. Manfredi R, Brizi MG, Canadè A, Vecchioli A, Marano P. Imaging of acute pancreatitis. Rays. 2001;26(2):135-42.
28. Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751-64.
29. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, Committee AGAICG. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology. 2018; 154(4):1096-101.
30. Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994;330(17):1198-210.
31. Banks PA, Freeman ML, Gastroenterology PPCotACo. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379-400.
32. Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9(8):710-7.e1.
33. Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol. 2008;6(10):1070-6.
34. Hjortrup PB, Haase N, Bundgaard H, Thomsen SL, Winding R, Pettilä V, et al. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med. 2016;42(11):1695-705.
35. Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015;19(1):251.
36. Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014; 46(5):361-80.
37. de-Madaria E, Buxbaum JL, Maisonneuve P, García García de Paredes A, Zapater P, Guilabert L, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022;387(11):989-1000.
38. Goodgame JT, Fischer JE. Parenteral nutrition in the treatment of acute pancreatitis: effect on complications and mortality. Ann Surg. 1977;186(5):651-8.
39. Pickens RC, Sulzer JK, Cochran A, Vrochides D, Martinie JB, Baker EH, et al. Retrospective Validation of an Algorithmic Treatment Pathway for Necrotizing Pancreatitis. Am Surg. 2019;85(8):840-7.
40. Driedger M, Zyromski NJ, Visser BC, Jester A, Sutherland FR, Nakeeb A, et al. Surgical Transgastric Necrosectomy for Necrotizing Pancreatitis: A Single-stage Procedure for Walled-off Pancreatic Necrosis. Ann Surg. 2020;271(1):163-8.
41. Haney CM, Kowalewski KF, Schmidt MW, Koschny R, Felinska EA, Kalkum E, et al. Endoscopic versus surgical treatment for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2020; 34(6):2429-44.
42. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol. 1998; 170(4):969-75.
43. Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145(3):583-90.e1.
44. Kirks RC, Sola R, Iannitti DA, Martinie JB, Vrochides D. Robotic transgastric cystgastrostomy and pancreatic debridement in the management of pancreatic fluid collections following acute pancreatitis. J Vis Surg. 2016;2:127.
45. Simo KA, Niemeyer DJ, Swan RZ, Sindram D, Martinie JB, Iannitti DA. Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement. Surg Endosc. 2014;28(5):1465-72.
46. Maatman TK, Zyromski NJ. Open Pancreatic Debridement in Necrotizing Pancreatitis. J Gastrointest Surg. 2021; 25(1):331-2.
47. Garret C, Canet E, Corvec S, Boutoille D, Péron M, Archambeaud I, et al. Impact of prior antibiotics on infected pancreatic necrosis microbiology in ICU patients: a retrospective cohort study. Ann Intensive Care. 2020;10(1):82.
48. Bai Y, Gao J, Zou DW, Li ZS. Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol. 2008;103(1):104-10.
49. Isenmann R, Rünzi M, Kron M, Kahl S, Kraus D, Jung N, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004; 126(4):997-1004.
50. Dellinger EP, Tellado JM, Soto NE, Ashley SW, Barie PS, Dugernier T, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg. 2007;245(5):674-83.
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