Multidisciplinary Management of Complicated Pancreatitis: What Every Interventional Radiologist Should Know
| Autor: | John B. Ammori, Umar Hayat, Brook R Glessing, Amir Ata Rahnemai-Azar, Sidhartha Tavri, Christopher Sutter |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Biopsy Fine-Needle MEDLINE Multidisciplinary team Radiography Interventional Endoscopic drainage Necrosis Pancreatic collection Multidisciplinary approach medicine Humans Radiology Nuclear Medicine and imaging Endoscopy Digestive System Vascular Diseases Patient Care Team business.industry General surgery General Medicine medicine.disease Debridement Pancreatitis Acute Disease Acute pancreatitis Drainage Stents business Algorithms |
| Zdroj: | AJR. American journal of roentgenology. 217(4) |
| ISSN: | 1546-3141 |
| Popis: | Management of acute pancreatitis is challenging in the presence of local complications that include pancreatic and peripancreatic collections and vascular complications. This review, targeted for interventional radiologists, describes minimally invasive endoscopic, image-guided percutaneous, and surgical procedures for management of complicated pancreatitis and provides insight into the procedures' algorithmic application. Local complications are optimally managed in a multidisciplinary team setting that includes advanced endoscopists; pancreatic surgeons; diagnostic and interventional radiologists; and specialists in infectious disease, nutrition, and critical care medicine. Large symptomatic or complicated sterile collections and secondary infected collections warrant drainage or débridement. The drainage is usually delayed for 4-6 weeks unless clinical deterioration warrants early intervention. If collections are accessible by endoscopy, endoscopic procedures are preferred to avoid pancreaticocutaneous fistulas. Image-guided percutaneous drainage is indicated for symptomatic collections that are not accessible for endoscopic drainage or that present in the acute setting before developing a mature wall. Peripancreatic arterial pseudoaneurysms should be embolized before necrosectomy procedures to prevent potentially life-threatening hemorrhage. Surgical procedures are reserved for symptomatic collections that persist despite endoscopic or interventional drainage attempts. Understanding these procedures facilitates their integration by interventional radiologists into the complex longitudinal care of patients with complicated pancreatitis. |
| Databáze: | OpenAIRE |
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