OBJECTIVE: To present our experience in the management of
patients with infected
pancreatic necrosis without
drainage .
METHODS: The
records of
patients with
pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed.
RESULTS: We identified 61
patients with
pancreatic necrosis . Six
patients with
pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of
drainage . Only 2
patients had an
APACHE II score >8. The first computed
tomography scan revealed the presence of gas in 5
patients . The Balthazar computed
tomography severity index score was >9 in 5 of the 6
patients . All
patients were treated with
antibiotics for at least 3 weeks.
Blood cultures were positive in only 2
patients .
Parenteral nutrition was not used in these
patients . The length of
hospital stay exceeded three weeks for 5
patients ; 3
patients had to be readmitted. A
cholecystectomy was performed after
necrosis was completely resolved;
pancreatitis recurred in 2
patients before the operation. No
patients died.
CONCLUSIONS: In selected
patients , infected
pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous
drainage or any additional surgical intervention. Intervention
procedures should be performed for
patients who exhibit clinical and
laboratory deterioration.