Necrotizing Pancreatitis: Necrosectomy and Closed Continuous Lavage of the Lesser Sac. The Ulm Experience

Abstract

Acute pancreatitis ranges from a mild, self-limiting disease to a severe illness with sometimes fatal outcome. In about 80% of patients, acute pancreatitis takes the cause of an edematous—interstitial inflammation mainly caused by gallstones (30%) or overindulgence in alcohol (50%). A necrotizing form of acute pancreatitis develops in up to 20% of patients [1–3]. This type of acute pancreatitis, even if with slight or moderate morphologic alterations, often proceeds to local or systemic complications and may become life threatening. From a morphologic point of view, necrotizing pancreatitis shows an interstitial—edematous inflammation combined with more or less extensive necrosis of the pancreatic exocrine and endocrine parechyma, and sometimes even extensive fatty tissue necrosis in the peripancreatic and retroperitoneal tissue compartments [4]. The fluid collection around the pancreatic area in necrotizing pancreatitis contains vasoactive and toxic substances such as phospholipase A₂, endotoxin, prostacyclin, activated trypsin, complement break-down products, thromboxane, elastase, and many other undefined harmful substances [5]. The crucial risk in necrotizing pancreatitis is a bacterial infection of pancreatic necrosis [6–8].