SURGICAL STRATEGY AND MANAGEMENT OF INFECTED PANCREATIC NECROSIS

Infected pancreatic necrosis and sepsis are the leading causes of deat h in patients viith necrotizing pancreatitis. Between 1986 and 1993, 1 23 patients with infected pancreatic necrosis were treated; in all cas es the infected necrosis extended to the retroperitoneal area. Surgica l treatment was performed a mean of 18.5 days after the onset of acute pancreatitis, Operative management consisted of wide-ranging necrosec tomy through all the affected area, combined with continuous widesprea d lavage and suction drainage applied for a mean of 39.5 days, with a median or 6.5 litres of normal saline per day, In 56 cases (46 per cen t), another surgical intervention (distal pancreatic resection, splene ctomy, cholecystectomy, sphincteroplasty or colonic resection) was als o performed. Bacteriological findings revealed mainly enteric bacteria , but Candida infection was detected in 21 per cent of patients, The o verall hospital mortality rate was 7 per cent (nine patients died), In fected pancreatic necrosis responds well to aggressive surgical treatm ent, continuous, longstanding lavage and suction drainage, together wi th supportive therapy combined with adequate antibiotic and antifungal medication.