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Pancreatic debridement

Thomas E Clancy, MD
Section Editors
Stanley W Ashley, MD
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Wenliang Chen, MD, PhD


Pancreatic debridement is indicated for patients with pancreatic necrosis and progressive clinical sepsis as a complication of severe acute pancreatitis [1,2]. Pancreatic and peripancreatic necrosis occur in approximately 20 percent of patients with pancreatitis, as a result of inflammation and vascular compromise [3,4].

The indications and techniques for pancreatic debridement will be reviewed here. The etiology, diagnosis, and the general approach to the treatment of acute pancreatitis are discussed elsewhere. (See "Etiology of acute pancreatitis" and "Clinical manifestations and diagnosis of acute pancreatitis" and "Predicting the severity of acute pancreatitis" and "Management of acute pancreatitis".)


Pancreatic necrosis can lead to secondary infection or symptomatic sterile necrosis, which is characterized by chronic low-grade fever, nausea, lethargy, and inability to eat [5-8]. Both infected pancreatic necrosis and symptomatic sterile necrosis are accepted indications for debridement [5,8,9].

The goal of pancreatic debridement is to excise all dead and devitalized pancreatic and peripancreatic tissue while preserving viable functioning pancreas, controlling resultant pancreatic fistulas, and limiting extraneous organ damage [1,7]. For patients with biliary pancreatitis, cholecystectomy with intraoperative cholangiography is an important secondary objective of the surgery because it will prevent recurrent disease [10].

Infected pancreatic necrosis — Secondary infection of the necrotic pancreatic or peripancreatic tissue with either bacteria or fungus occurs soon after the initial inflammatory reaction subsides and is heralded by tachycardia, hypotension, fevers, and/or deteriorating organ function [11]. Bacterial or fungal infections occur either by bacterial translocation from the gastrointestinal tract or via seeding through transient bacteremia that can occur in the setting of invasive intravenous lines, endotracheal intubation, or prolonged bladder catheterization. The risk of secondary bacterial infections can be minimized with early enteral feeding, central line catheter maintenance programs, ventilator protocols, and early urinary catheter removal [12-14].

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Literature review current through: Nov 2017. | This topic last updated: Nov 09, 2017.
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