Infektionen im Rahmen der nekrotisierenden Pankreatitis

Zusammenfassung

In der Praxis sollten Patienten mit Nachweis von > 50 % Nekrose im CT, einem erhöhten CRP und Prokalzitonin wegen des erhöhten Risikos einer schweren Pankreatitis und septischer Komplikationen besonders überwacht werden. Eine ERCP und Sphinkterotomie ist bei Patienten mit biliärer Pankreatitis und impaktierten Gallensteinen, biliärer Sepsis oder obstrukivem Ikterus indiziert. Bei Patienten mit nekrotisierender Pankreatitis und septischem Krankheitsbild sollte eine FNA zur Differenzierung von sterilen und infizierten Nekrosen durchgeführt werden. Die symptomatische Basistherapie besteht aus einer ausreichenden Volumensubstitution. Die Antibiotikaprophylaxe bei nekrotisierender Pankreatitis führt zu einer Reduktion von septischen Komplikationen bei schwerer nekrotisierender Pankreatitis. Die chirurgische Therapie ist bei septischen Patienten mit infizierten Nekrosen indiziert. Das Therapieverfahren der Wahl ist weiterhin die offene Nekrosektomie und die anschließende geschlossene Lavage der Bursa omentalis und des Retroperitoneums.

Abstract

Patients with CT evidence of more than 50 % necrosis, or an increased CRP or procalcitonin are at risk of developing severe pancreatitis and septic complications and should be monitored in an intensive care unit. ERCP and sphincterotomy are indicated in patients with biliary pancreatitis and impacted gall stones, biliary sepsis, or obstructive jaundice. In septic patients with necrotizing pancreatitis, a FNA should be performed for differentiation of sterile and infected pancreatic necrosis. Adequate volume resuscitation and analgesic treatment are the most important treatment of acute pancreatitis. Antibiotic prophylaxis reduces septic complications in severe necrotizing pancreatitis and should be started early. Surgical therapy is indicated in patients with infected pancreatic necrosis. The surgical technique of choice is open necrosectomy with postoperative closed lavage of the lesser sac.

akute Pankreatitis - chirurgische Therapie - Antibiotikatherapie - infizierte Pankreasnekrosen

Acute pancreatitis - surgical therapy - antibiotics - infected pancreatic necrosis

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