Surgical Therapy and Management of Other Complications

Surgical therapy is used to treat infected necrosis or complications. The following chapter is on surgical management of pancreatitis. Surgical management includes necrosectomy to remove necrotic tissue with intraoperative and postoperative lavage of debris and pancreatic fluids. Percutaneous catheter-directed debridement of infected necrosis has been described, but is best directed to patients who are hemodynamically and clinical stable. Further, a number of these patients will subsequently require surgery. It is not our practice to recommend percutaneous drainage, except in carefully selected patients with pancreatic abscesses. Endoscopic drainage with placement of trans-gastric and tranduodenal catheters and nasopancreatic tubes for irrigation has been described. The experience with this method is limited and it requires specific endo-scopic experience, with experienced surgical backup. Acute fluid collections can be observed early in the course of acute pancreatitis and will usually resolve spontaneously; treatment is required only if they become symptomatic or infected. Pseudocysts are localized collections of necrotic debris and fluid within a wall of granulation tissue that persist for > 4 weeks. Regardless of its size, an asymptomatic pseudocyst does not require any therapy and may be observed indefinitely. If the cyst is symptomatic (pain, obstruction), it may be drained using a variety of methods including endoscopic, percutaneous, and surgical. Cysts may be drained endoscopically either by cyst-gastrostomy or cyst duodenostomy or by transampullary stent drainage. There is a separate chapter on endoscopic management of pancreatitis (see Chapter 138,"Pancreatitis: Endoscopic Therapy"). Percutaneous drainage is attempted if the location precludes endoscopic cystgastrotomy or when multiple noncommunicating cysts are observed. If the pseudocyst does not resolve with drainage, a proximal pancreatic duct stricture may be present and an ERCP should be performed. ERCP prior to cyst drainage should only be attempted if the pseudocyst can be immediately drained, because if there is contrast entry into the pseudocyst (as in communicating cysts) it increases the chance of infection in the event that drainage is not performed. Pseudocysts may become infected, rupture, or hemorrhage.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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