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CT Guided Percutaneous Drainage in Necrotizing Pancreatitis - Highly Successful in Appropriately Selected Patients - Single Center Experience

Pranav Sharma, Salil Sharma, Amitabh Yadav, Eran Rotem

Objective The purpose of the study is to select & assess the effectiveness of computed tomography Guided percutaneous drainage in patients with pancreatitis according to the clinical and imaging parameters.

Materials and Methods The study was performed from January 2012 to January 2017. The study included 126 consecutive patients (103 men and 23 women; median age 39 years) with necrotizing pancreatitis who underwent percutaneous catheter drainage via computed tomography guidance and were evaluated according to the clinical criteria, radiological scores, drainage and catheter characteristics, and complications. A retrospective review of our cross-sectional interventional radiology database over 60 months (5 years) identified all patients who underwent primary computed tomography -guided percutaneous drainage for acute necrotizing pancreatitis.

Results Successful percutaneous drainage outcome was achieved in 108 of 126 patients (85.7%). No surgery was required in 95 patients (75%). Of these 108 patients, 13 patients had the liquefiable part of the collection drained by percutaneous drainage, but the phlegmon caused persistent sepsis, and had to undergo elective surgical necrosectomy. Rest of the 18 patients did not have a successful outcome on percutaneous drainage; of these, 16 patients had treatment failure on percutaneous drainage then surgery was performed, and 2 patients passed away with treatment failure on percutaneous drainage and surgery. The procedurerelated complications were observed in six patients of which one had hemorrhage due to the catheter eroding the vessel and five had a pancreatico-cutaneous fistula. Of the total 126 patients, 110 patients were managed as outpatients with regular clinic visits.

Conclusion Percutaneous catheter drainage is a safe and effective technique for treating infected acute necrotizing pancreatitis. Appropriate selection of patients should be performed to maximize the benefit of percutaneous procedures. Treating necrotizing pancreatitis requires dedicated multidisciplinary team efforts from the physicians, surgeons, radiologist and the drain management team.