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Bacterial Infection and the Role of Fine Needle Aspiration

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Standards in Pancreatic Surgery

Abstract

There is general agreement among clinicians and pancreatologists that pancreatic infection is the most important causal factor of lethal outcome in human acute pancreatitis today [1–3]. Bacterial contamination of pancreatic necrosis has been demonstrated in 40%–70% of patients suffering from necrotizing pancreatitis [4–8], and it has been shown that the frequency of positive cultures increases directly with the duration and extent of necrosis. The necroses in 24% of patients with necrotizing pancreatitis operated on during the first week after hospitalization showed bacterial contamination. This percentage increased to 36% in the second week and to 72% in the third week; thereafter a decrease was found to 32% [9]. Bacterial contamination of pancreatic necrosis occurs early and frequently, as verified by Bassi in a similar study and by Gerzof with the aid of computed tomography (CT)-guided fine needle aspiration and Gram staining [5, 6].

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References

  1. Buggy BP, Nostrant TT (1983) Lethal pancreatitis. Am J Gastroenterol 78:810–814

    PubMed  CAS  Google Scholar 

  2. Allardyce DB (1987) Incidence of necrotizing pancreatitis and factors related to mortality. Am J Surg 154:295–299

    Article  PubMed  CAS  Google Scholar 

  3. Beger HG, Biichler M (1986) Decision-making in surgical treatment of acute pancreatitis: operative or conservative management of necrotizing pancreatitis? Theor Surg 1:61–68

    Google Scholar 

  4. Beger HG, Krautzberger W, Bittner R, Biichler M, Block S (1986) Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 91:433–438

    PubMed  CAS  Google Scholar 

  5. Gerzof SG, Banks PA, Robbins AH, Johnson WC, Spechler SJ, Wetzner SM, Snider JM, Langevin RE, Jay ME (1987) Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology 93:1315–1320

    PubMed  CAS  Google Scholar 

  6. Bassi C, Falconi M, Girelli R, Nifosi F, Elio A, Martini N, Pederzoli P (1989) Microbiological findings in severe pancreatitis. Surg Res Comm 5:1–4

    Google Scholar 

  7. Jones CE, Polk HC, Fulton RL (1975) Pancreatic abscess. Am J Surg 129:44–47

    Article  PubMed  CAS  Google Scholar 

  8. Becker JM, Pemberton JH, DiMagno EP, Ilstrup DM, Mcllrath DC, Dozois RR (1984) Prognostic factors in pancreatic abscess. Surgery 96:455–460

    PubMed  CAS  Google Scholar 

  9. Beger HG, Biichler M, Bittner R, Block S, Nevalainen T, Roscher R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212

    Article  PubMed  CAS  Google Scholar 

  10. Malangoni MA, Richardson JD, Shallcross JC, Sciler JG, Polk HC (1986) Factors contributing to fatal outcome after treatment of pancreatic abscess. Ann Surg 203:605–613

    Article  PubMed  CAS  Google Scholar 

  11. Evans FC (1969) Pancreatic abscess. Am J Surg 117:537–540

    Article  PubMed  CAS  Google Scholar 

  12. Cramer SI, Tan EGC, Warren KW, Braasch JW (1975) Pancreatic abscess: a critically analysis of 113 cases. Am J Surg 129:426–431

    Article  Google Scholar 

  13. Bradley EL, Fulenwider JT (1984) Open treatment of pancreatic abscess. Surg Gynecol Obstet 159:509–513

    PubMed  Google Scholar 

  14. Gerzof SG, Robbins AJ, Johnson WC, Birkett DH, Nabseth DC (1981) Percutaneous catheter drainage of abdominal abscess: a five year experience. N Engl J Med 305:653–657

    Article  PubMed  CAS  Google Scholar 

  15. van Sonnenberg E, Wing VW, Casola G, Nakamoto SK, Mueller PR, Ferrucci JT, Halasz NA, Simeone JF (1984) Temporizing effect of percutaneous drainage of complicated abscesses in critically ill patients. AJR 142:821–826

    Google Scholar 

  16. Warshaw AL (1974) Inflammatory masses following acute pancreatitis. Surg Gynecol Obstet 139:69–81

    Google Scholar 

  17. Wells CL, Rotstein OD, Pruett TL, Simmons RL (1986) Intestinal bacteria translocate into experimental intra-abdominal abscesses. Arch Surg 121:102–106

    PubMed  CAS  Google Scholar 

  18. Lange JF, van Gool J, Tytgat GNJ (1985) The protective effect of a reduction in intestinal flora on mortality of acute haemorrhagic pancreatitis in the rat. Hepatogastroenterology 34:28–30

    Google Scholar 

  19. Büchler M, Malfertheiner P, Schoetensack C, Uhl W, Beger HG (1986) Sensitivity of antiproteases, complement factors and C-reactive protein in detecting pancreatic necrosis. Results of a prospective clinical study. Int J Pancreatol 1:227–235

    PubMed  Google Scholar 

  20. Büchler M (1991) Objectivation of the severity of acute pancreatitis. Hepato- Gastroenterol 38:101–108

    Google Scholar 

  21. Mc Mahon MJ, Bowen M, Mayer AD, Cooper EH (1984) Relationship of α2-macroglobulin and other antiproteases to the clinical features of acute pancreatitis. Am J Surg 147:164–169

    Article  PubMed  CAS  Google Scholar 

  22. Uhl W, Büchler M, Malfertheiner P, Martini M, Beger HG (1991) PMN- Elastase in comparison with CRP, antiproteases and LDH as indicators of necrosis in human acute pancreatitis. Pancreas 6:253–259

    Article  PubMed  CAS  Google Scholar 

  23. Gross V, Schölmerich J, Leser HG (1989) Wertigkeit von Leukozytenelastase, C-reaktiven Protein und Proteaseninhibitoren für die Prognose der akuten Pankreatitis. Klin Wochenschr 67:237 (abstract)

    Google Scholar 

  24. Schröder T, Kivilaakso E, Lempinen M (1984) A new method for the diagnosis of acute hemorrhagic necrotising pancreatitis using contrast-enhanced CT. Gastrointest Radiol 9:27–30

    Article  PubMed  Google Scholar 

  25. Block S, Maier W, Clausen C, Bittner R, Büchler M, Malfertheiner P, Beger HG (1986) Identification of pancreas necrosis in severe acute pancreatitis. Gut 27:1035–42

    Article  PubMed  CAS  Google Scholar 

  26. Balhazar EJ (1989) CT diagnosis and staging of acute pancreatitis. Rad Clin North Am 27:19–37

    Google Scholar 

  27. Bradley EL, Murphy F, Ferguson C (1989) Prediction of pancreatic necrosis by dynamic pancreatography. Ann Surg 210:495–504

    Article  PubMed  Google Scholar 

  28. Gerzof SG, Banks PA, Robbins AH (1984) Role of guided percutaneous aspiration in early diagnosis of pancreatic sepsis. Dig Dis Sci 29:950 (abstract)

    Google Scholar 

  29. Büchler M, Malfertheiner P, Uhl W, Beger HG (1988) Conservative treatment of necrotizing pancreatitis in patients with minor pancreatic necrosis. Pancreas 3:592 (abstract)

    Article  Google Scholar 

  30. Beger HG, Uhl W (1990) Severe acute pancreatitis. II: The surgical approach. Clin Int Care 1:223–227

    CAS  Google Scholar 

  31. Büchler M, Malfertheiner P, Frieß H, Bittner R, Vanek E, Schlegel P, Beger HG (1989) The penetration of antibiotics into human pancreas. Infection 17: 20–25

    Article  PubMed  Google Scholar 

  32. Craig RM, Dordal E, Myles L (1975) The use of ampicillin in acute pancreatitis. Ann Int Med 83:831–832

    PubMed  CAS  Google Scholar 

  33. Howes R, Zuidema GD, Cameron JL (1975) Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res 18:197–200

    Article  PubMed  CAS  Google Scholar 

  34. Finch WT, Sawyers JL, Schenkers S (1976) A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann Surg 183:667–671

    Article  PubMed  CAS  Google Scholar 

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© 1993 Springer-Verlag Berlin Heidelberg

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Uhl, W., Büchler, M., Rau, B., Beger, H.G. (1993). Bacterial Infection and the Role of Fine Needle Aspiration. In: Beger, H.G., Büchler, M., Malfertheiner, P. (eds) Standards in Pancreatic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77437-9_12

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  • DOI: https://doi.org/10.1007/978-3-642-77437-9_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-77439-3

  • Online ISBN: 978-3-642-77437-9

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