November 12, 2014
ISSN: 0975-0711 (Electronic)
Accession Number: 23580124
Anti-Bacterial Agents/*therapeutic use
Pancreatitis, Acute Necrotizing/diagnosis/mortality/*therapy
Tomography, X-Ray Computed
Abstract: OBJECTIVES: Surgery is the mainstay treatment of emphysematous pancreatitis (EP). The aim of the present study was to assess the outcomes of patients with EP managed nonsurgically. METHODS: The patients with EP without organ dysfunction were managed nonsurgically with antibiotic therapy, nutritional support, and if required radiological drainage. The main outcome measure was survival. RESULTS: Nine patients were diagnosed with EP. They had computed tomographic severity index of 10, APACHE score of 11 (+/-3.4), and Ranson’s score of 4.2 (+/-1.2) in the first 24-48 h. All had monomicrobial infection of the pancreatic necrosis (Escherichia coli in 4/9, Pseudomonas aeruginosa in 3/9, and Klebsiella pneumoniae in 2/9 patients). All these patients were managed with antibiotics as per sensitivity reports (piperacillin-tazobactum in 5/9, imipenem in 3/9, and ciprofloxacin-metronidazole in 1/9 patients) and nutritional support. Seven of nine patients improved within 1 week of starting antibiotics. Two patients required percutaneous catheter drainage in addition. One of the patients had progressive organ dysfunction and was subjected for surgery. All 8/9 patients who were managed conservatively survived (89 % survival). The only patient who underwent surgery expired (11 % mortality). CONCLUSION: In EP without organ dysfunction, a trial of conservative management may be successful.
Notes: Nadkarni, Nikhil