| Theme | Serve Acute Pancreatitis -- Prediction of Deterioration and Therapeutic Strategy | |
|---|---|---|
| Title | Timing and Indications of Necrosectomy for Necrotizing Pancreatitis | |
| Publish Date | 2001/07 | |
| Author | Yoshikura Haraguchi | National Hospital Tokyo Disaster Medical Center |
| Author | Junichi Inoue | National Hospital Tokyo Disaster Medical Center |
| Author | Syunji Hasegawa | Tokyo Metropolitan Police Hospital |
| [ Summary ] | This report deals with the timing and significance of invasive therapy, including surgery and interventional therapy for necrotizing pancreatitis. It has been reported that high mortality rates are closely related to the extent of intrapancreatic and retroperitoneal necrosis. The principle for treating necrotizing pancreatitis is as follows Initial treatment is basically the same as that applied to all cases of severe pancreatitis, whether necrosis exists or not. In addition, it is often necessary to relieve the severity of extended necrosis cases and their complications. For that purpose, surgery and/or interventional therapy should be chosen. In this paper, the characteristics, merits and weak points of the above therapy modalities are also discussed. Four cases are presented: One is a case in which emergency operation was necessary in an early stage, the second is a case in which an emergency operation became necessary because of widespread infected necrosis, the third is a case in which secondary perforation of the transverse colon occured and an operation was performed, the fourth is a case who died because of massive necrosis in the head. In addition, a specimen was obtained in a postmortem study, in which necrosis extened deeply in to the head. Presently it is thought to be difficult to help such patients without total necrosectomy. The results obtained by the survery conducted by the Research Committee of Acute Severe Pancreatitis, supported by the Japan Welfare and Ministry were also reported. They revealed that cases with a severe degree of acute pancreatitis, lasting more than 2 weeks had higher mortality rates and most postmortem examinations confirmed a severe degree of necrosis. |
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