Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
Department of Emergency and Trauma Surgery, Parma University Hospital, Viale Antonio Gramsci, 14, 43126, Parma, Italy.
World J Emerg Surg. 2020 Jul 29;15(1):44. doi: 10.1186/s13017-020-00326-z.
Acute pancreatitis is a common inflammatory pancreatic disorder, often caused by gallstone disease and frequently requiring hospitalization. In 80% of cases, a rapid and favourable outcome is described, while a necrosis of pancreatic parenchyma or extra-pancreatic tissues is reported in 10-20% of patients. The onset of pancreatic necrosis determines a significant increase of early organ failure rate and death that has higher incidence if infection of pancreatic necrosis (IPN) or extra-pancreatic collections occur. IPN always requires an invasive intervention, and, in the last decade, the advent of minimally invasive techniques has gradually replaced the employment of the open traditional approach. We report a series of three severe cases of IPN managed with primary open necrosectomy (ON) and a systematic review of the literature, in order to understand if emergency surgery still has a role in the current clinical practice.
From January 2010 to January 2020, 3 cases of IPN were treated in our Academic Department of General and Emergency Surgery. We performed a PubMed MEDLINE search on the ON of IPN, selecting 20 from 654 articles for review.
The 3 cases were male patients with a mean age of 61.3 years. All patients referred to our service complaining an evolving severe clinical condition evocating a sepsis due to IPN. CT scan was the main diagnostic tool. Patients were initially conservatively managed. In consideration of clinical worsening conditions, and at the failure of conservative and minimal invasive treatment, they were, finally, managed with emergency ON. Patients reported no complications nor procedure-related sequelae in the follow-up period.
The ON is confirmed to be the last resort, useful in selected severe cases, with a defined timing and in case of proven non-feasibility and no advantage of other minimally invasive approaches.
急性胰腺炎是一种常见的胰腺炎症性疾病，常由胆石病引起，常需住院治疗。在 80%的病例中，描述了快速和有利的结果，而在 10-20%的患者中报告了胰腺实质或胰腺外组织的坏死。胰腺坏死的发生决定了早期器官衰竭率和死亡率的显著增加，如果发生胰腺坏死感染（IPN）或胰腺外积液，其发生率更高。IPN 总是需要侵入性干预，在过去十年中，微创技术的出现逐渐取代了传统的开放性方法。我们报告了三例严重 IPN 的病例，采用了原发性开放性坏死切除术（ON），并对文献进行了系统回顾，以了解在当前的临床实践中，紧急手术是否仍有作用。
从 2010 年 1 月至 2020 年 1 月，我们在普通和急诊外科的学术部门治疗了 3 例 IPN 病例。我们在 PubMed MEDLINE 上对 IPN 的 ON 进行了搜索，从 654 篇文章中选择了 20 篇进行回顾。
这 3 例患者均为男性，平均年龄 61.3 岁。所有患者均因 IPN 导致的严重临床病情恶化而转诊至我院。CT 扫描是主要的诊断工具。患者最初采用保守治疗。由于临床病情恶化，并且保守和微创治疗失败，最终采用紧急 ON 治疗。在随访期间，患者未报告并发症或与手术相关的后遗症。
ON 被证实是一种最后的手段，在选择的严重病例中有用，具有明确的时机，并且在其他微创方法不可行或没有优势的情况下。
