Storm F K, Wilson S E
World J Surg. 1977 Jan;1(1):105-11. doi: 10.1007/BF01654745.
Acute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X-ray findings of an intra-abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X-rays to locate new intra-abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.
3例患者在出血性胰腺炎初步成功治疗2至4周后，出现了与隐匿性十二指肠坏死和穿孔相关的急性坏死性胰腺炎。因发热、腹部肿块或腹内脓肿的X线表现而需要进行探查。手术时，所有胰腺和腹膜后脓肿均用引流管引流，十二指肠瘘予以闭合。经胃造口置入腔内管用于十二指肠减压。术后处理包括全胃肠外营养、针对需氧菌和厌氧菌的抗生素，以及频繁进行X线检查以定位新的腹内脓肿。由于每位患者持续存在胰腺坏死和脓肿形成，均需进行1至4次再次手术。坏死性胰腺炎伴有持续的腹膜后脓毒症和瘘管形成会导致严重的发病率、数月的住院时间，且目前是胰腺炎患者的主要死亡原因。所有3例患者均存活，这得益于对不断发展的腹膜后脓肿的引流以及我们处理大型十二指肠瘘技术的改进。
