When Should We be Concerned for Pancreatic Necrosis?

Excerpt

It is now recognized that the main mode of death in acute pancreatitis is multiple organ dysfunction syndrome (MODS) but the relative importance of pancreatic necrosis to the development of MODS has been the subject of some debate. In this paper, Remes-Troche and colleagues (DOI: 10.1007/s00268-006-0148-8) try to shed further light on this by describing the experience in 165 patients admitted to a single centre. Two interesting statistics emerge: First, less than 40% of patients with evidence of pancreatic necrosis on CT had any evidence of organ dysfunction. Second, only half of the patients who developed MODS had pancreatic necrosis. The authors conclude that pancreatic necrosis itself is not synonymous with severe pancreatitis and that the main determinant of mortality is organ dysfunction. These findings are in keeping with those of Tenner1 and Lankisch2 who in similar series of patients with pancreatic necrosis, described an incidence of organ dysfunction in 49% and 55% respectively. Isenmann3 and colleagues found a much higher incidence of organ dysfunction in patients with pancreatic necrosis, but all of these studies demonstrated an increase in the incidence of organ dysfunction when pancreatic necrosis was present, a finding also confirmed by Remes-Troche and colleagues. The association between infected necrosis and increased incidence of organ dysfunction is a consistent finding. …