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{"work":{"id":24228374,"created_at":"2016-04-08T23:41:54.417-07:00","from_world_paper_id":151715577,"updated_at":"2025-01-11T00:57:15.719-08:00","_data":{"ai_abstract":"Acute pancreatitis (AP) is a prevalent gastrointestinal condition, with severe acute pancreatitis (SAP) accounting for about 20% of cases and a mortality exceeding 30%. Risk factors primarily include gallstone disease and alcohol consumption. SAP is characterized by necrosis of the pancreas and possible organ failure. Modern treatment strategies focus on management without immediate surgery, emphasizing the role of antibiotics and critical care support. Severity scoring systems such as the Ranson score and APACHE II aid in predicting outcomes and necessary interventions.","publication_date":"2011,,","publication_name":"European Journal of Gastroenterology \u0026 Hepatology"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Severe acute pancreatitis","broadcastable":true,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [46691274,46746485]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "full_page_mobile_sutd_modal"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":44560054,"attachmentType":"pdf"}"><img alt="First page of “Severe acute pancreatitis”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/44560054/mini_magick20190214-16634-nebubr.png?1550155995" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Severe acute pancreatitis</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="46691274" href="https://independent.academia.edu/FrancescoSantullo"><img alt="Profile image of Francesco Santullo" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />Francesco Santullo</a><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="46746485" href="https://independent.academia.edu/AnnaCrocco"><img alt="Profile image of Anna Crocco" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />Anna Crocco</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2011, European Journal of Gastroenterology & Hepatology</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">11 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 24228374; const worksViewsPath = "/v0/works/views?subdomain_param=api&work_ids%5B%5D=24228374"; const getWorkViews = async (workId) => { const response = await fetch(worksViewsPath); if (!response.ok) { throw new Error('Failed to load work views'); } const data = await response.json(); return data.views[workId]; }; // Get the view count for the work - we send this immediately rather than waiting for // the DOM to load, so it can be available as soon as possible (but without holding up // the backend or other resource requests, because it's a bit expensive and not critical). const viewCount = await getWorkViews(workId); const updateViewCount = (viewCount) => { try { const viewCountNumber = parseInt(viewCount, 10); if (viewCountNumber === 0) { // Remove the whole views element if there are zero views. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); return; } const commaizedViewCount = viewCountNumber.toLocaleString(); const viewCountBody = document.getElementById('work-metadata-view-count'); if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--detail ds2-5-body-md">AI-generated Abstract</p><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">Acute pancreatitis (AP) is a prevalent gastrointestinal condition, with severe acute pancreatitis (SAP) accounting for about 20% of cases and a mortality exceeding 30%. Risk factors primarily include gallstone disease and alcohol consumption. SAP is characterized by necrosis of the pancreas and possible organ failure. Modern treatment strategies focus on management without immediate surgery, emphasizing the role of antibiotics and critical care support. Severity scoring systems such as the Ranson score and APACHE II aid in predicting outcomes and necessary interventions.</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":44560054,"attachmentType":"pdf","workUrl":"https://www.academia.edu/24228374/Severe_acute_pancreatitis"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":44560054,"attachmentType":"pdf","workUrl":"https://www.academia.edu/24228374/Severe_acute_pancreatitis"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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The goal of this consensus statement is to provide recommendations regarding the management of the critically ill patient with severe acute pancreatitis (SAP). Data Sources and Methods: An international consensus conference was held in April 2004 to develop recommendations for the management of the critically ill patient with SAP. Evidencebased recommendations were developed by a jury of ten persons representing surgery, internal medicine, and critical care after conferring with experts and reviewing the pertinent literature to address specific questions concerning the management of patients with severe acute pancreatitis. Data Synthesis: There were a total of 23 recommendations developed to provide guidance to critical care clinicians caring for the patient with SAP. Topics addressed were as follows. 1) When should the patient admitted with acute pancreatitis be monitored in an ICU or stepdown unit? 2) Should patients with severe acute pancreatitis receive prophylactic antibiotics? 3) What is the optimal mode and timing of nutritional support for the patient with SAP? 4) What are the indications for surgery in acute pancreatitis, what is the optimal timing for intervention, and what are the roles for less invasive approaches including percutaneous drainage and laparoscopy? 5) Under what circumstances should patients with gallstone pancreatitis undergo interventions for clearance of the bile duct? 6) Is there a role for therapy targeting the inflammatory response in the patient with SAP? Some of the recommendations included a recommendation against the routine use of prophylactic systemic antibacterial or antifungal agents in patients with necrotizing pancreatitis. The jury also recommended against pancreatic debridement or drainage for sterile necrosis, limiting debridement or drainage to those with infected pancreatic necrosis and/or abscess confirmed by radiologic evidence of gas or results or fine needle aspirate. Furthermore, the jury recommended that whenever possible, operative necrosectomy and/or drainage be delayed at least 2-3 wk to allow for demarcation of the necrotic pancreas. Conclusions: This consensus statement provides 23 different recommendations concerning the management of patients with SAP. These recommendations differ in several ways from previous recommendations because of the release of recent data concerning the management of these patients and also because of the focus on the critically ill patient. There are a number of important questions that could not be answered using an evidence-based approach, and areas in need of further research were identified.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Management of the critically ill patient with severe acute pancreatitis","attachmentId":71944838,"attachmentType":"pdf","work_url":"https://www.academia.edu/56676145/Management_of_the_critically_ill_patient_with_severe_acute_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/56676145/Management_of_the_critically_ill_patient_with_severe_acute_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="56676186" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/56676186/Executive_summary_management_of_the_critically_ill_patient_with_severe_acute_pancreatitis">Executive summary: management of the critically ill patient with severe acute pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="39339247" href="https://unl-pt.academia.edu/RuiMoreno">Rui Moreno</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Proceedings of the American Thoracic Society, 2004</p><p class="ds-related-work--abstract ds2-5-body-sm">Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course requiring only brief hospitalization to a rapidly progressive, fulminant illness resulting in the multiple organ dysfunction syndrome (MODS), with or without accompanying sepsis. The goal of this consensus statement is to provide recommendations regarding the management of the critically ill patient with severe acute pancreatitis (SAP). Data Sources and Methods: An international consensus conference was held in April 2004 to develop recommendations for the management of the critically ill patient with SAP. Evidencebased recommendations were developed by a jury of ten persons representing surgery, internal medicine, and critical care after conferring with experts and reviewing the pertinent literature to address specific questions concerning the management of patients with severe acute pancreatitis. Data Synthesis: There were a total of 23 recommendations developed to provide guidance to critical care clinicians caring for the patient with SAP. Topics addressed were as follows. 1) When should the patient admitted with acute pancreatitis be monitored in an ICU or stepdown unit? 2) Should patients with severe acute pancreatitis receive prophylactic antibiotics? 3) What is the optimal mode and timing of nutritional support for the patient with SAP? 4) What are the indications for surgery in acute pancreatitis, what is the optimal timing for intervention, and what are the roles for less invasive approaches including percutaneous drainage and laparoscopy? 5) Under what circumstances should patients with gallstone pancreatitis undergo interventions for clearance of the bile duct? 6) Is there a role for therapy targeting the inflammatory response in the patient with SAP? Some of the recommendations included a recommendation against the routine use of prophylactic systemic antibacterial or antifungal agents in patients with necrotizing pancreatitis. The jury also recommended against pancreatic debridement or drainage for sterile necrosis, limiting debridement or drainage to those with infected pancreatic necrosis and/or abscess confirmed by radiologic evidence of gas or results or fine needle aspirate. Furthermore, the jury recommended that whenever possible, operative necrosectomy and/or drainage be delayed at least 2-3 wk to allow for demarcation of the necrotic pancreas. Conclusions: This consensus statement provides 23 different recommendations concerning the management of patients with SAP. These recommendations differ in several ways from previous recommendations because of the release of recent data concerning the management of these patients and also because of the focus on the critically ill patient. There are a number of important questions that could not be answered using an evidence-based approach, and areas in need of further research were identified.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Executive summary: management of the critically ill patient with severe acute pancreatitis","attachmentId":71944764,"attachmentType":"pdf","work_url":"https://www.academia.edu/56676186/Executive_summary_management_of_the_critically_ill_patient_with_severe_acute_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/56676186/Executive_summary_management_of_the_critically_ill_patient_with_severe_acute_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="19494181" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/19494181/Contemporary_management_of_infected_necrosis_complicating_severe_acute_pancreatitis">Contemporary management of infected necrosis complicating severe acute pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="39768253" href="https://independent.academia.edu/SaurabhJamdar">Saurabh Jamdar</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Critical care (London, England), 2006</p><p class="ds-related-work--abstract ds2-5-body-sm">Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward &#39;less drastic&#39; surgical interventions.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Contemporary management of infected necrosis complicating severe acute pancreatitis","attachmentId":40651261,"attachmentType":"pdf","work_url":"https://www.academia.edu/19494181/Contemporary_management_of_infected_necrosis_complicating_severe_acute_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/19494181/Contemporary_management_of_infected_necrosis_complicating_severe_acute_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="16124130" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/16124130/Early_antibiotic_treatment_in_acute_necrotising_pancreatitis">Early antibiotic treatment in acute necrotising pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="35238606" href="https://independent.academia.edu/TomSchroder">Tom Schroder</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The Lancet, 1995</p><p class="ds-related-work--abstract ds2-5-body-sm">Despite improvements in surgical treatment and intensive care, mortality from severe acute pancreatitis remains high. We have carried out a randomised study of 60 consecutive patients with alcohol-induced necrotising pancreatitis to find out whether early antibiotic treatment can improve outcome. 30 patients were assigned cefuroxime (4&middot;5 g/day intravenously) from admission. In the second group, no antibiotic treatment was given until clinical or microbiologically verified infection or after a secondary rise in C-reactive protein. The inclusion criteria were C-reactive protein concentration above 120 mg/L within 48 h of admission and low enhancement (<30 Hounsfield units) on contrast-enhanced computed tomography. There were more infectious complications in the non-antibiotic than in the antibiotic group (mean per patient 1&middot;8 vs 1&middot;0, p=0&middot;01). The most common cause of sepsis was Staphylococcus epidermidis; positive cultures were obtained from pancreatic necrosis or the central venous line in 14 of 18 patients with suspected but blood-culture-negative sepsis. Mortality was higher in the non-antibiotic group (seven vs one in the antibiotic group; p=0&middot;03). Four of the eight patients who died had cultures from pancreatic necrosis positive for Staph epidermidis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Early antibiotic treatment in acute necrotising pancreatitis","attachmentId":42741414,"attachmentType":"pdf","work_url":"https://www.academia.edu/16124130/Early_antibiotic_treatment_in_acute_necrotising_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/16124130/Early_antibiotic_treatment_in_acute_necrotising_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="47995588" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/47995588/Diagnosis_and_Management_of_Pancreatic_Necrosis_Infection">Diagnosis and Management of Pancreatic Necrosis Infection</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="107889345" href="https://independent.academia.edu/waadfarhat">waad farhat</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Acta Scientific Gastrointestinal Disorders</p><p class="ds-related-work--abstract ds2-5-body-sm">Acute pancreatitis (AP) is defined, according to the consensus of Atlanta in 1992 [1], as an acute inflammatory process affecting the pancreas with participation of peri-pancreatic tissues or remote organs. In practice, there are two distinct varieties: edematous pancreatitis and necrotizing pancreatitis. The edematous form usually results in spontaneous recovery; however necrotizing form is the severe form of acute pancreatitis (15% to 20% of cases) whose natural evolution can be divided into two phases . The first 14 days characterized by the presence of systemic inflammatory response syndrome (SIRS) secondary to the release of inflammatory mediators that are responsible for the failure of multiple organs (lung, kidneys, and heart, etc....). The second phase occurs after two weeks of evolution and is dominated by septic complications associated with infection of the pancreatic necrosis, which is seen in</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Diagnosis and Management of Pancreatic Necrosis Infection","attachmentId":66837283,"attachmentType":"pdf","work_url":"https://www.academia.edu/47995588/Diagnosis_and_Management_of_Pancreatic_Necrosis_Infection","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/47995588/Diagnosis_and_Management_of_Pancreatic_Necrosis_Infection"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="117037721" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/117037721/Prophylactic_antibiotic_use_in_severe_acute_pancreatitis_hemlock_help_or_hype">Prophylactic antibiotic use in severe acute pancreatitis: hemlock, help, or hype?</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="206332713" href="https://independent.academia.edu/AlphonsoBrown2">Alphonso Brown</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gastroenterology, 2004</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Prophylactic antibiotic use in severe acute pancreatitis: hemlock, help, or hype?","attachmentId":113003514,"attachmentType":"pdf","work_url":"https://www.academia.edu/117037721/Prophylactic_antibiotic_use_in_severe_acute_pancreatitis_hemlock_help_or_hype","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/117037721/Prophylactic_antibiotic_use_in_severe_acute_pancreatitis_hemlock_help_or_hype"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="85273506" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/85273506/Management_of_Severe_Acute_Pancreatitis">Management of Severe Acute Pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="232572740" href="https://independent.academia.edu/NileshDoctor">Nilesh Doctor</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Annals of Surgery, 2010</p><p class="ds-related-work--abstract ds2-5-body-sm">Throughout much of history, surgery of the pancreas was restricted to drainage of abscesses and treatment of traumatic wounds. At the turn of the 20th century under the impetus of anesthesia, such surgical stalwarts as Mayo Robson, Mickulicz, and Moynihan began to deploy laparotomy and gauze drainage in an effort to salvage patients afflicted with severe acute pancreatitis (SAP). Over the next thirty years, surgical intervention in SAP became the therapy for choice, despite surgical mortality rates that often exceeded 50%. When the discovery of the serum test for amylase revealed that clinically milder forms of acute pancreatitis existed that could respond to nonoperative therapy, a wave of conservatism emerged, and, for the next quarter century, surgical intervention for SAP was rarely practiced. However, by the 1960s, conservative mortality rates for SAP were reported to be as high as 60% to 80%, leading surgeons to not only refine the indications for surgery in SAP, but also to consider new approaches. Extensive pancreatic resections for SAP became the vogue in continental surgical centers in the 1960s and 1970s, but often resulted in high mortality rates and inadvertent removal of viable tissue. Accurate diagnosis of pancreatic necrosis by dynamic CT led to new approaches for management. Some surgeons recommended restricting intervention to those with documented infected necrosis, and proposed delayed exploration employing sequestrectomy and open-packing. Others advocated debridement early in the course of the disease for all patients with necrotizing pancreatitis, regardless of the status of infection. In the 1990s, however, a series of prospective studies emerged proving that nonoperative management of patients with sterile pancreatic necrosis was superior to surgical intervention, and that delayed intervention provided improved surgical mortality rates. The surgical odyssey in managing the necrotizing form of SAP, from simple drainage, to resection, to debridement, to sequestrectomy, although somewhat tortuous, is nevertheless an notable example of how evidence-based knowledge leads to improvement in patient care. Today's 10% to 20% surgical mortality rates reflect not only considerable advances in surgical management, but also highlight concomitant improvements in fluid therapy, antibiotics, and intensive care. Although history documents the important contributions that surgical practitioners have made to acute pancreatitis and its complications, surgeons are rarely complacent, and the recent emergence of minimally invasive techniques holds future promise for patients afflicted with this ".. . most formidable of catastrophes."</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Management of Severe Acute Pancreatitis","attachmentId":90021984,"attachmentType":"pdf","work_url":"https://www.academia.edu/85273506/Management_of_Severe_Acute_Pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/85273506/Management_of_Severe_Acute_Pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="90019787" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/90019787/Early_Antibiotic_Treatment_for_Severe_Acute_Necrotizing_Pancreatitis">Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="64350319" href="https://independent.academia.edu/S%C3%A1nchezGarc%C3%ADaMiguel">Miguel Sánchez García</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Annals of Surgery, 2007</p><p class="ds-related-work--abstract ds2-5-body-sm">Background & Aims: In patients with severe, necrotizing pancreatitis, it is common to administer early, broad-spectrum antibiotics, often a carbapenem, in the hope of reducing the incidence of pancreatic and peripancreatic infections, although the benefits of doing so have not been proved. Methods: A multicenter, prospective, double-blind, placebo-controlled randomized study set in 32 centers within North America and Europe. Participants: One hundred patients with clinically severe, confirmed necrotizing pancreatitis: 50 received meropenem and 50 received placebo. Interventions: Meropenem (1 g intravenously every 8 hours) or placebo within 5 days of the onset of symptoms for 7 to 21 days. Main Outcome Measures: Primary endpoint: development of pancreatic or peripancreatic infection within 42 days following randomization. Other endpoints: time between onset of pancreatitis and the development of pancreatic or peripancreatic infection; all-cause mortality; requirement for surgical intervention; development of nonpancreatic infections within 42 days following randomization. Results: Pancreatic or peripancreatic infections developed in 18% (9 of 50) of patients in the meropenem group compared with 12% (6 of 50) in the placebo group (P ϭ 0.401). Overall mortality rate was 20% (10 of 50) in the meropenem group and 18% (9 of 50) in the placebo group (P ϭ 0.799). Surgical intervention was required in 26% (13 of 50) and 20% (10 of 50) of the meropenem and placebo groups, respectively (P ϭ 0.476). Conclusions: This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality, or requirement for surgical intervention, and did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis","attachmentId":93699413,"attachmentType":"pdf","work_url":"https://www.academia.edu/90019787/Early_Antibiotic_Treatment_for_Severe_Acute_Necrotizing_Pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/90019787/Early_Antibiotic_Treatment_for_Severe_Acute_Necrotizing_Pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="56237773" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/56237773/Occurrence_and_Risk_Factors_of_Infected_Pancreatic_Necrosis_in_Intensive_Care_Unit_Treated_Patients_with_Necrotizing_Severe_Acute_Pancreatitis">Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit–Treated Patients with Necrotizing Severe Acute Pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="34304285" href="https://independent.academia.edu/AriLeppaniemi">Ari Leppaniemi</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Gastrointestinal Surgery</p><p class="ds-related-work--abstract ds2-5-body-sm">Background In patients with severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) is associated with a worsened outcome. We studied risk factors and consequences of IPN in patients with necrotizing SAP. Methods The study consisted of a retrospective cohort of 163 consecutive patients treated for necrotizing SAP at a university hospital intensive care unit (ICU) between 2010 and 2018. Results All patients had experienced at least one persistent organ failure and approximately 60% had multiple organ failure within the first 24 h from admission to the ICU. Forty-seven (28.8%) patients had IPN within 90 days. Independent risk factors for IPN were more extensive anatomical spread of necrotic collections (unilateral paracolic or retromesenteric (OR 5.7, 95% CI 1.5–21.1) and widespread (OR 21.8, 95% CI 6.1–77.8)) compared to local collections around the pancreas, postinterventional pancreatitis (OR 13.5, 95% CI 2.4–76.5), preceding bacteremia (OR 4.8, 95% CI 1.3–17.6), and pr...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit–Treated Patients with Necrotizing Severe Acute Pancreatitis","attachmentId":71721980,"attachmentType":"pdf","work_url":"https://www.academia.edu/56237773/Occurrence_and_Risk_Factors_of_Infected_Pancreatic_Necrosis_in_Intensive_Care_Unit_Treated_Patients_with_Necrotizing_Severe_Acute_Pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/56237773/Occurrence_and_Risk_Factors_of_Infected_Pancreatic_Necrosis_in_Intensive_Care_Unit_Treated_Patients_with_Necrotizing_Severe_Acute_Pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":44560054,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":44560054,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_44560054" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. 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