Infected pancreatic necrosis complicated by multiple organ failure
Dominioni, L.; Chiappa, A.; Bianchi, V.; Interdonato, P.F.; Festi, L.; Carcano, G.; Benevento, A.; Dionigi, R.
Hepato-Gastroenterology 44(16): 968-974
1997
ISSN/ISBN: 0172-6390 PMID: 9261584 Document Number: 478851
Background/Aims: Sixteen patients with bacterio- logically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical treatment were studied prospectively. Methodology: The severity of IPN was documented pre-operatively using the following scores: 1) degree of necrosis by CT scan ( lt 30% in three patients (19%); 3050% in nine patients (56%); gt 50% in four patients (25%)); 2) Elebute and Stoner's sepsis score (16+-4 points), 3) Goris' score of multiple organ failure (MOF) (5+-2 points). Sequential surgical treatment was carried out by the same surgical team, as follows: 1) abdominal re-explorations through a zipper for the first 7-10 days; 2) open abdomen and repeated peritoneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infection (range: 15-85 days). No patient required further re-exploration. Results: Mortality occurred in 3116 patients (19%), due to MOF in all 3 cases. The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73+-33 days, without fistulae. These results indicate that by treating severe IPN with the technique of sequential abdominal re-explorations, open drainage and continuous closed lavage, a low 19% mortality can be achieved. Conclusion: This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN: these data could facilitate future comparison of results obtained with other treatment modalities.