CLINICS

Clinics (Sao Paulo). 2017 February; 72(2): 87-94.
doi:10.6061/clinics/2017(02)04

Copyright © 2017 CLINICS

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

Roberto Rasslan I * , Fernando da Costa Ferreira Novo I , Marcelo Cristiano Rocha I , Alberto Bitran I , Manoel de Souza Rocha II , Celso de Oliveira Bernini I , Samir Rasslan I , Edivaldo Massazo Utiyama I

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil.

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Radiologia e Oncologia, São Paulo/SP, Brazil

*Corresponding author. E-mail: robertorasslan@uol.com.br

received September 15, 2016; revised November 18, 2016; accepted November 18, 2016.

Abstract

OBJECTIVE:

To present our experience in the management of patients with infected pancreatic necrosis without drainage.

METHODS:

The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed.

RESULTS:

We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died.

CONCLUSIONS:

In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

Keywords: Acute Pancreatitis, Necrotizing Pancreatitis, Infected Pancreatic Necrosis, Treatment


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