Necrotizing pancreatitis

Changed by Bruno Di Muzio, 12 Dec 2016

Updates to Article Attributes

Body was changed:

Necrotising pancreatitis (NP) represents the severe form of pancreatitis. It is generally considered a subtype of acute pancreatitis as necrosis usually tends to occurs early, (withinwithin the first 24-48 hours), but can also rarely occur with subacute forms.

A key feature is a significant amount of pancreatic and/or peripancreatic tissue necrosis associated with pancreatitis.

Epidemiology

Around 5-10% of patients with interstitial oedematous pancreatitis (i.e. uncomplicated acute pancreatitis) will develop necrosis 5

Pathology

Necrotising pancreatitis can become infected, more commonly after the first week. 

Radiographic features

NP presents most commonlyoften as necrosis affecting both the pancreas and peripancreatic tissues. Rarely it will affect only the peripancreatic tissues or pancreas in isolation 5.

CT

Areas of necrosis are seen as non-enhancing low attenuating regions within the pancreas, but observed if a dual phase pancreatic study is performed.

Foci of gas may also be present in more extreme cases; extra-luminalextraluminal gas is highly suggestive of superimposed infection. 

Treatment and prognosis

The presence of necrosis implies a poorer prognosis with mortality rates reported up to 14% 3, if sterile. Mortality rates reach 20-30% in infected cases that are drained, either surgically or percutaneously, and about 100% in infected cases without drainage 5.  

Practical points

  • gas is the hallmark of infection 
  • acute necrotic collection ( less than 4 weeks): sterile or infected
  • walled-off necrosis (more than 4 weeks): sterile or infected
  • -<p><strong>Necrotising pancreatitis (NP)</strong> represents the severe form of <a href="/articles/pancreatitis">pancreatitis</a>. It is generally considered a subtype of acute pancreatitis as necrosis usually tends to occurs early, (within the first 24-48 hours) but can also rarely occur with subacute forms.</p><p>A key feature is a significant amount of pancreatic and/or peripancreatic tissue necrosis associated with pancreatitis.</p><h4>Epidemiology</h4><p>Around 5-10% of patients with interstitial oedematous pancreatitis (i.e. uncomplicated acute pancreatitis) will develop necrosis <sup>5</sup>. </p><h4>Pathology</h4><p>Necrotising pancreatitis can become infected, more commonly after the first week. </p><h4>Radiographic features</h4><p>NP presents most commonly as necrosis affecting both the pancreas and peripancreatic tissues. Rarely it will affect only the peripancreatic tissues or pancreas in isolation <sup>5</sup>.</p><h5>CT</h5><p>Areas of necrosis are seen as non-enhancing low attenuating regions within the pancreas, but observed if a dual phase pancreatic study is performed.</p><p>Foci of gas may also be present in more extreme cases; extra-luminal gas is highly suggestive of superimposed infection. </p><h4>Treatment and prognosis</h4><p>The presence of necrosis implies a poorer prognosis with mortality rates reported up to 14% <sup>3</sup>.</p>
  • +<p><strong>Necrotising pancreatitis (NP)</strong> represents the severe form of <a href="/articles/pancreatitis">pancreatitis</a>. It is considered a subtype of acute pancreatitis as necrosis usually tends to occurs early, within the first 24-48 hours, but can also rarely occur with subacute forms.</p><p>A key feature is a significant amount of pancreatic and peripancreatic tissue necrosis associated with pancreatitis.</p><h4>Epidemiology</h4><p>Around 5-10% of patients with interstitial oedematous pancreatitis (i.e. uncomplicated acute pancreatitis) will develop necrosis <sup>5</sup>. </p><h4>Pathology</h4><p>Necrotising pancreatitis can become infected, more commonly after the first week. </p><h4>Radiographic features</h4><p>NP presents most often as necrosis affecting both the pancreas and peripancreatic tissues. Rarely it will affect only the peripancreatic tissues or pancreas in isolation <sup>5</sup>.</p><h5>CT</h5><p>Areas of necrosis are seen as non-enhancing low attenuating regions within the pancreas but observed if a dual phase pancreatic study is performed.</p><p>Foci of gas may also be present in more extreme cases; extraluminal gas is highly suggestive of superimposed infection. </p><h4>Treatment and prognosis</h4><p>The presence of necrosis implies a poorer prognosis with mortality rates reported up to 14% <sup>3</sup>, if sterile. Mortality rates reach 20-30% in infected cases that are drained, either surgically or percutaneously, and about 100% in infected cases without drainage <sup>5</sup>.  </p><h4>Practical points</h4><ul>
  • +<li>gas is the hallmark of infection </li>
  • +<li>acute necrotic collection ( less than 4 weeks): sterile or infected</li>
  • +<li>walled-off necrosis (more than 4 weeks): sterile or infected</li>
  • +</ul>

References changed:

  • 5. Baron TH, Morgan DE. Acute necrotizing pancreatitis. The New England journal of medicine. 340 (18): 1412-7. <a href="https://doi.org/10.1056/NEJM199905063401807">doi:10.1056/NEJM199905063401807</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10228193">Pubmed</a> <span class="ref_v4"></span>

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