Surgical treatment of necrotizing pancreatitis by marsupialization. 1984

J A Knol, and F E Eckhauser, and W E Strodel

The ideal surgical treatment for necrotizing pancreatitis remains a matter of debate. To provide adequate drainage and egress for large fragments of devitalized pancreas as well as access for interval debridement, three patients with significant pancreatic necrosis underwent debridement of devitalized pancreas and open packing (marsupialization) of the lesser space. The etiologies of pancreatic necrosis included trauma in one patient, an infected pancreatic pseudocyst in another patient, and acute alcoholic pancreatitis in the third patient. After the initial operative procedure, patients were returned to the operating room at intervals of 2 to 5 days for further debridement and dressing changes. Clinical improvement was observed almost immediately after the initial procedure, although the rate of recovery varied from patient to patient. No deaths occurred. Two procedure-related complications occurred: development of a loculated fluid collection in the left paracolic gutter that required surgical drainage and an injury to the splenic artery requiring arteriorrhaphy . Late complications included a ventral hernia and a persistent duodenocutaneous fistula. Marsupialization along with limited debridement is recommended as an alternative to closed drainage of the peripancreatic space in patients with significant pancreatic necrosis.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009336 Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
D010195 Pancreatitis INFLAMMATION of the PANCREAS. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of CHRONIC PANCREATITIS (International Symposium on Acute Pancreatitis, Atlanta, 1992). The two most common forms of acute pancreatitis are ALCOHOLIC PANCREATITIS and gallstone pancreatitis. Acute Edematous Pancreatitis,Acute Pancreatitis,Pancreatic Parenchyma with Edema,Pancreatic Parenchymal Edema,Pancreatitis, Acute,Pancreatitis, Acute Edematous,Peripancreatic Fat Necrosis,Acute Edematous Pancreatitides,Acute Pancreatitides,Edema, Pancreatic Parenchymal,Edematous Pancreatitides, Acute,Edematous Pancreatitis, Acute,Fat Necrosis, Peripancreatic,Necrosis, Peripancreatic Fat,Pancreatic Parenchymal Edemas,Pancreatitides, Acute,Pancreatitides, Acute Edematous,Parenchymal Edema, Pancreatic,Peripancreatic Fat Necroses
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D003646 Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed) Debridements
D004322 Drainage The removal of fluids or discharges from the body, such as from a wound, sore, or cavity.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001458 Bandages Material used for wrapping or binding any part of the body. Dressings,Bandage,Dressing

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