Review

Necrotizing pancreatitis: Diagnose, treat, consult

Tiffany Y. Chua, MD, R. Matthew Walsh, MD, FACS, Mark E. Baker, MD and Tyler Stevens, MD
Cleveland Clinic Journal of Medicine August 2017, 84 (8) 639-648; DOI: https://doi.org/10.3949/ccjm.84a.16052

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    Acute edematous interstitial pancreatitis. Contrast-enhanced computed tomography through the pancreatic tail (A) and uncinate process (B) shows mild peripancreatic changes (arrows) that blur the interface between the pancreatic parenchyma and the peripancreatic fat.

  • FIGURE 2
    FIGURE 2
  • FIGURE 3
    FIGURE 3

    Infected walled-off necrosis. Unenhanced computed tomography through the head and body of the pancreas (A) and pelvis (B) 4 months after the onset of symptoms shows walled-off necrosis with gas (arrows).

  • FIGURE 4
    FIGURE 4

    Treatment of infected walled-off necrosis in the patient shown in Figure 3. Under computed tomographic guidance, 3 large-bore catheters were placed in the left flank (arrows).

  • FIGURE 5
    FIGURE 5

    Further treatment of infected walled-off necrosis in the patient shown in Figures 3 and 4. At 10 weeks after symptom onset and 6 weeks after catheter placement, laparoscopic-assisted debridement was done via the catheter sites. Computed tomography without contrast enhancement shows the results of debridement. Large drains (arrows) were placed after debridement.

Tables

  • TABLE 1

    Severity of early acute pancreatitis

    Mild
    Symptoms resolve without local or systemic
    complications
    Moderate
    Necrosis with or without transient organ failure (organ dysfunction ≤ 48 hours)
    Local complications (with or without infection) or exacerbation of comorbid conditions
    Severe pancreatitis
    Necrosis and persistent organ dysfunction (> 48 hours) of 1 or more organ systems

    • Based on information in reference 4.

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