REVIEW ARTICLES   

Panminerva Medica 2000 December;42(4):279-86

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Subacute pancreatic necrosis

Petrakis I., Vrachassotakis N., Kogerakis N., Koutsoumpas V., Chalkiadakis G.

From the Department of General Surgery University Hospital of Herakleion University of Crete, Greece

­Acute nec­rot­is­ing pan­crea­titis is the ­most seri­ous ­form of ­acute pan­crea­titis and ­accounts for the major­ity of com­pli­ca­tions. Treat­ment of ­patients ­with pan­creat­ic necro­sis is ­still con­tro­ver­sial. ­There is a ­well-estab­lished def­i­ni­tion for ­acute pan­crea­titis and con­se­quent pan­creat­ic ­fluid col­lec­tions. How­ev­er, it has ­been iden­ti­fied a ­group of ­patients who rep­re­sent a sep­ar­ate ­entity and ­whose col­lec­tions may ­prompt addi­tion­al ­change ­from the def­i­ni­tion of ­acute pan­crea­titis. Imag­ing inves­ti­ga­tions in ­these ­patients ­have ­well ­defined sub­acute col­lec­tions ­that ­evolve ­from ­severe ­acute nec­rot­is­ing pan­crea­titis involv­ing great­er ­than 30% of the ­gland. ­Although ­these col­lec­tions are not com­plete­ly liq­ue­fied, ­they do not ­meet cri­te­ria for pseu­do­cysts, how­ev­er, at the ­same ­time, ­they are mor­pho­log­i­cal­ly dif­fer­ent ­from ­acute pan­creat­ic necro­sis ­seen dur­ing ­initial pres­en­ta­tion of ­acute pan­crea­titis. It has ­been ­used to ­call “sub­acute” ­these col­lec­tions of necrot­ic pan­creat­ic tis­sue or “sub­acute pan­creat­ic necro­sis”. The pur­pose of ­this ­review is to sum­mar­ise the sub­acute col­lec­tions of necrot­ic pan­creat­ic tis­sue and its com­pli­ca­tions, dis­cuss­ing treat­ment ­options of the com­plex pan­creat­ic and per­i­pan­creat­ic col­lec­tions ­found in ­these ­patients, focus­ing on the man­age­ment of sub­acute pan­creat­ic necro­sis.