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Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.","publication_name":"World Journal of Emergency Surgery","grobid_abstract_attachment_id":"71721975"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"2019 WSES guidelines for the management of severe acute pancreatitis","broadcastable":true,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [34304285]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; 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":71721975,"attachmentType":"pdf"}"><img alt="First page of “2019 WSES guidelines for the management of severe acute pancreatitis”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/71721975/mini_magick20211007-24658-8214dn.png?1633651123" /><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">2019 WSES guidelines for the management of 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="34304285" href="https://independent.academia.edu/AriLeppaniemi"><img alt="Profile image of Ari Leppaniemi" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />Ari Leppaniemi</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">World Journal of Emergency Surgery</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">20 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 = 56237766; 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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--work-abstract ds-work-card--detail ds2-5-body-md">Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.</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":71721975,"attachmentType":"pdf","workUrl":"https://www.academia.edu/56237766/2019_WSES_guidelines_for_the_management_of_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":71721975,"attachmentType":"pdf","workUrl":"https://www.academia.edu/56237766/2019_WSES_guidelines_for_the_management_of_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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It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. ...</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":"Improving the Outcome of Acute Pancreatitis","attachmentId":102492983,"attachmentType":"pdf","work_url":"https://www.academia.edu/102153447/Improving_the_Outcome_of_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/102153447/Improving_the_Outcome_of_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="1" data-entity-id="27393967" 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/27393967/MANAGEMENT_OF_SEVERE_ACUTE_PANCREATITIS_Standards_and_Future_Perspectives">MANAGEMENT OF SEVERE ACUTE PANCREATITIS : Standards and Future Perspectives</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="15954409" href="https://dypatil-in.academia.edu/KetanVagholkar">Ketan Vagholkar</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The Bombay Hospital journal</p><p class="ds-related-work--abstract ds2-5-body-sm">Severe acute pancreatitis is an inflammatory disease that often takes a complicated and life-threatening course. There is still much controversial debate over treatment of severe acute pancreatitis. Conservative management comprises early diagnosis, prompt and aggressive fluid replenishment, adequate nutritional support, management of pain, and optimal antibiotic therapy. Administration of such extensive conservative treatment is best undertaken in an intensive care unit (ICU), where the response of the patient to the treatment can be closely monitored and judged. Surgical intervention is warranted when there is supervening infection of the necrotic pancreas. Among all the surgical approaches, necrosectomy and continuous local lavage allow debridement of devitalized and infected tissue with preservation of vital pancreatic tissue, and yield good results if performed at the right time. Clinical and experimental studies aim to target the maintenance of the integrity of the intestinal barrier and function, to preserve pancreatic microcirculation, and to balanced and modulate the inflammatory response. However, whether these new approaches will be of major clinical benefit has to be evaluated in randomized clinical trials in the future.</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 : Standards and Future Perspectives","attachmentId":47648619,"attachmentType":"pdf","work_url":"https://www.academia.edu/27393967/MANAGEMENT_OF_SEVERE_ACUTE_PANCREATITIS_Standards_and_Future_Perspectives","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/27393967/MANAGEMENT_OF_SEVERE_ACUTE_PANCREATITIS_Standards_and_Future_Perspectives"><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="97146292" 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/97146292/Management_of_acute_pancreatitis_from_surgery_to_interventional_intensive_care">Management of acute pancreatitis: from surgery to interventional intensive care</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="50674277" href="https://independent.academia.edu/MarkusBuechler">Markus Buechler</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gut, 2005</p><p class="ds-related-work--abstract ds2-5-body-sm">I n recent years, treatment of severe acute pancreatitis has shifted away from early surgical treatment to aggressive intensive care. While the treatment is conservative in the early phase, surgery might be considered in the later phase of the disease. Surgical debridement is still the ''gold standard'' for treatment of infected pancreatic and peripancreatic necrosis. Advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of many surgical conditions over the past decades. Several interventional therapy regimens, including endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, fine needle aspiration for bacteriology (FNAB), percutaneous or endoscopic drainage of peripancreatic fluid collections, pseudocysts, and late abscesses, as well as selective angiography and catheter directed embolisation of acute pancreatitis associated bleeding complications have been well established as diagnostic and therapeutic standards in the management of acute pancreatitis. Secondary to recent technical improvements in interventional therapy and minimally invasive surgery, even infected pancreatic necrosis has successfully been treated in selected patients. However, technical feasibility does not obviate sound clinical judgement. We must be cautious in the application of new technologies in the absence of well designed clinical trials. Thus minimally invasive surgery and interventional therapy for infected necrosis should be limited to clinical trials and specific indications in patients who are critically ill and otherwise unfit for conventional surgery.</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 acute pancreatitis: from surgery to interventional intensive care","attachmentId":98848871,"attachmentType":"pdf","work_url":"https://www.academia.edu/97146292/Management_of_acute_pancreatitis_from_surgery_to_interventional_intensive_care","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/97146292/Management_of_acute_pancreatitis_from_surgery_to_interventional_intensive_care"><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="31649235" 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/31649235/Treatment_of_severe_acute_pancreatitis_and_its_complications">Treatment of severe acute pancreatitis and its complications</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="33090573" href="https://independent.academia.edu/EnverZerem">Enver Zerem</a></div><p class="ds-related-work--metadata ds2-5-body-xs">World Journal of Gastroenterology, 2014</p><p class="ds-related-work--abstract ds2-5-body-sm">Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.</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":"Treatment of severe acute pancreatitis and its complications","attachmentId":51974678,"attachmentType":"pdf","work_url":"https://www.academia.edu/31649235/Treatment_of_severe_acute_pancreatitis_and_its_complications","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/31649235/Treatment_of_severe_acute_pancreatitis_and_its_complications"><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="47339427" 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/47339427/Changes_in_the_Management_of_Treatment_in_Acute_Pancreatitis_Patients">Changes in the Management of Treatment in Acute Pancreatitis Patients</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="145823094" href="https://usfca.academia.edu/JanaKatuchova">Jana Katuchova</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Acute Pancreatitis, 2012</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":"Changes in the Management of Treatment in Acute Pancreatitis Patients","attachmentId":66483406,"attachmentType":"pdf","work_url":"https://www.academia.edu/47339427/Changes_in_the_Management_of_Treatment_in_Acute_Pancreatitis_Patients","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/47339427/Changes_in_the_Management_of_Treatment_in_Acute_Pancreatitis_Patients"><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="72305399" 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/72305399/Changing_concepts_in_the_surgical_management_of_acute_pancreatitis">Changing concepts in the surgical management of 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="36057155" href="https://independent.academia.edu/WaldemarUhl">Waldemar Uhl</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Best Practice & Research Clinical Gastroenterology, 1999</p><p class="ds-related-work--abstract ds2-5-body-sm">Most episodes of acute pancreatitis are mild and self-limiting, but severe disease complicated by multiple system organ failure develops in up to 20% of cases. Early detection of those patients who subsequently develop necrotizing pancreatitis allows the start of supportive treatment in the intensive care unit before organ failure occurs. Conservative treatment in the intensive care unit, including the administration of intravenous antibiotics, is the gold standard. Surgery is indicated in patients with infected pancreatic necrosis but not in patients with sterile necrosis in the absence of deteriorating multi-organ failure despite maximal intensive care unit treatment, or other specific surgical complications. At our institution, out of 44 patients with necrotizing pancreatitis 29 (66%) had sterile necrosis and were managed conservatively while 15 (34%) had infected pancreatic necrosis and were treated by necrosectomy and continuous closed retroperitoneal lavage. There were two deaths resulting in an overall mortality of 5% in patients with severe acute 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":"Changing concepts in the surgical management of acute pancreatitis","attachmentId":81285416,"attachmentType":"pdf","work_url":"https://www.academia.edu/72305399/Changing_concepts_in_the_surgical_management_of_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/72305399/Changing_concepts_in_the_surgical_management_of_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="6" 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="7" data-entity-id="58480090" 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/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art">Management of infected pancreatic necrosis: state of the art</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="40845374" href="https://usp-br.academia.edu/FernandoDaCostaFerreiraNovo">Fernando Da Costa Ferreira Novo</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Revista do Colégio Brasileiro de Cirurgiões</p><p class="ds-related-work--abstract ds2-5-body-sm">Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after...</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 infected pancreatic necrosis: state of the art","attachmentId":72870393,"attachmentType":"pdf","work_url":"https://www.academia.edu/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art","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/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art"><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="55553962" 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/55553962/Management_of_Severe_Acute_Pancreatitis_A_Surgical_Odyssey">Management of Severe Acute Pancreatitis: A Surgical Odyssey</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="111105460" href="https://bzu.academia.edu/MuhammadRehmanYousaf">Muhammad Rehman Yousaf</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">Purpose of review There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tubefeeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.</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: A Surgical Odyssey","attachmentId":71371978,"attachmentType":"pdf","work_url":"https://www.academia.edu/55553962/Management_of_Severe_Acute_Pancreatitis_A_Surgical_Odyssey","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/55553962/Management_of_Severe_Acute_Pancreatitis_A_Surgical_Odyssey"><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="117401642" 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/117401642/Sa1496_Two_Decade_Overview_of_the_Nationwide_Trend_of_Acute_Pancreatitis_Hospitalization_in_Hospital_Mortality_Rate_and_Predictive_Factors_of_in_Hospital_Mortality">Sa1496 Two Decade Overview of the Nationwide Trend of Acute Pancreatitis Hospitalization, in-Hospital Mortality Rate and Predictive Factors of in-Hospital Mortality</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="306753184" href="https://independent.academia.edu/mazenjamal2">mazen jamal</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gastroenterology, 2012</p><p class="ds-related-work--abstract ds2-5-body-sm">(17%), trauma (4%) and others (5%). Eighty patients (72%) had acute necrotizing pancreatitis, 17 (15%) patients had only PPN and 14 (13%) patients had no pancreatic or peripancreatic necrosis. Ninety three (84%) patients had PPN and of these 19 (20%) patients had extensive PPN, 17 (15%) patients had only PPN with no pancreatic necrosis and 18 (16%) patients had no PPN. Twenty three of 111 (20%) patients died whereas surgery or radiological/ endoscopic intervention was needed in 11 (10%) and 43 (39%) patients respectively. Forty (43%) of patients with PPN required radiological or endoscopic intervention whereas 3 /18 (16.6%) of patients without PPN required radiological or endoscopic intervention (p=0.03). Eleven (12%) of patients with PPN required surgery whereas none of the patients without PPN required surgery (p>0.05). Twenty (22%) patients with PPN succumbed to the illness whereas 3 /18 (16%) patients without PPN expired (p>0.05). Extensive PPN had significant association with the need for surgery (p=0.009). On comparison of patients with PPN only with the patients having no pancreatic or peripancreatic necrosis, there was no significant difference in the mortality and need for surgery between the two groups (p=0.39 and 0.37 respectively). However, 6/17 (35%) patients with PPN only required radiological/endoscopic intervention whereas 1/14 (7%) patients with no necrosis required intervention (p=0.06). Conclusion: In acute pancreatitis, presence of PPN may predict the need for intervention, with patients having extensive PPN more likely to undergo surgery.</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":"Sa1496 Two Decade Overview of the Nationwide Trend of Acute Pancreatitis Hospitalization, in-Hospital Mortality Rate and Predictive Factors of in-Hospital Mortality","attachmentId":113268101,"attachmentType":"pdf","work_url":"https://www.academia.edu/117401642/Sa1496_Two_Decade_Overview_of_the_Nationwide_Trend_of_Acute_Pancreatitis_Hospitalization_in_Hospital_Mortality_Rate_and_Predictive_Factors_of_in_Hospital_Mortality","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/117401642/Sa1496_Two_Decade_Overview_of_the_Nationwide_Trend_of_Acute_Pancreatitis_Hospitalization_in_Hospital_Mortality_Rate_and_Predictive_Factors_of_in_Hospital_Mortality"><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":71721975,"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":71721975,"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_71721975" 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. You can download the paper by clicking the button above.</p></div></div></div></div><div class="ds-sidebar--container js-work-sidebar"><div class="ds-related-content--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="0" data-entity-id="4045433" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/4045433/Management_of_severe_acute_pancreatitis">Management of severe acute pancreatitis</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="4864961" href="https://independent.academia.edu/MuhammadYousaf2">Muhammad Yousaf</a></div><p class="ds-related-work--metadata ds2-5-body-xs">British Journal of Surgery, 2003</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline 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conservatively?","attachmentId":111939875,"attachmentType":"pdf","work_url":"https://www.academia.edu/115571335/Can_infected_pancreatic_necrosis_really_be_managed_conservatively","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-related-work-grid-card-view-pdf" href="https://www.academia.edu/115571335/Can_infected_pancreatic_necrosis_really_be_managed_conservatively"><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-related-work-sidebar-card" data-collection-position="2" data-entity-id="47995588" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" 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