CASE STUDY
PAPER PRESENTED AT THE CONGRESS SOBRICE 2015
USE OF HIGH CALIBER DRAINS - URESIL
Title:PERCUTANEOUS DRAINAGE OF NECROHEMORRHA PANCREATITISGICA: REPORT OF TWO CASES
Theme:non-vascular interventions
Authors:Renan Rocha da Nobrega; Marcela Pecora Cohen; Ricardo Miguel Costa de Freitas; Ricardo Miguel Costa de Freitas;
Institution:INSTITUTE OF RADIOLOGY OF THE HOSPITAL DAS CLINICS FM-USP
Summary:
Goal:to describe the case of two patients with necrohemorrhagic pancreatitis treated exclusively with antimicrobials and image-guided percutaneous drainage.
Case reports:(Case #1) male patient, 56 years old, admitted with epigastric pain, nausea, amylase 3,633 mg/dL, C-reactive protein (CRP) 37.8 mg/dL, leukocytosis (15,700/mm3) and edematous pancreatitis of biliary etiology on CT scan computerized (CT) – classification of severity according to the Balthazar criteria moderate upon admission and severe after 10 days. He evolved with multiple retroperitoneal collections, being submitted to percutaneous drainage of the collections guided by CT and fluoroscopy with five large caliber drainage catheters (16 to 28F) and serial washing of the drains in the following four weeks. The patient was discharged after clinical and laboratory improvement and resolution of the collections; (Case #2) female patient, 36 years old, admitted with abdominal pain and distention; amylase 1,378 mg/dL, CRP 37.8 mg/dL, leukocytosis (12,400/mm3), LDH 1,966 mg/dL, hypertriglyceridemia and CT signs of severe necrotizing pancreatitis (Balthazar criteria). After three days of hospitalization, we opted for percutaneous drainage of retroperitoneal collections with seven large-caliber drains and antibiotic therapy, with progressive clinical and laboratory improvement, removal of the drains in 30 days, followed by hospital discharge.
Discussion: necrohemorrhagic pancreatitis represents the most serious complication of acute pancreatitis. Mortality rates vary between 30 and 50% and have been improving with advances in surgical and clinical care. Surgical necrosectomy has been the standard treatment, but percutaneous drainage has been the treatment option in some patients, with variable success rates. The indication of the percutaneous approach for NIBP remains controversial and the severity criteria (Ranson, Balthazar) seem to be relevant in the therapeutic decision.
See the list of papers approved by Congress at the link: http://www.sobrice2015.com.br/SOBRICE%20-%20trabalhos%20aprovados.pdf