Mahendra K Mittal
Background The efficacy of percutaneous catheter drainage in the management of acute pancreatitis and the factors affecting the outcome of the therapy were studied. Methods It is prospective and retrospective observational analysis. Patients of acute interstitial edematous and acute necrotising pancreatitis with acute peri-pancreatic fluid collections and walled off necrosis were referred for image guided percutaneous drainage. Success rate of percutaneous drainage and the variables that affect its outcome were assessed. CT diagnosed cases of acute pancreatitis with peri-pancreatic collection (APFC and WON) referred for image guided percutaneous drainage were included in the study. Results Successful resolution on PCD was seen in 60% of the cases (n-60) where there was improvement in clinical outcome with control in sepsis and temperature, in our study surgical necrosectomy was performed in 35% of the cases (n-35). Successful resolution on PCD in patients with severe necrotising pancreatitis was 41.94% as compared to moderate and mild group which was 88.57% and 100% respectively. Homogenous peri-pancreatic collection (APFC and WON) was observed in 36 patients where the outcome was successful in 31(86.11%) of the patients. In the patients with heterogenous peri-pancreatic collection (APFC and WON), out of 64 patients successful outcome was seen in (n=29; 45.31%) of the patients. Presence of MODS (Marshals criteria was considered before defining MODS) (n -29) was a negative predictor of success. In our study statistical significance of MODS and negative outcome of success was noted. Successful outcome was seen in only (n=2; 6.9%) of the cases. Presence of more than 30% necrotic tissue was seen in (n=59) cases where successful resolution was seen in (n=26; 44.07%) of the cases. (n=33) cases had less than 30% necrosis and success rate was in (n=26; 78.79%) of the cases. Age, comorbidities, cause of pancreatitis and gender had no significant correlation statistically in predicting successful resolution on PCD. Conclusion Percutaneous Catheter drainage is an efficacious method in the management of complicated acute pancreatitis. So PCD is efficacious technique in walled off pancreatic necrosis. Heterogenecity of collection, severity of pancreatitis, multiple organ dysfunction syndrome and increased percentage of pancreatic necrosis have negative predictive values in its management.
