One of the most serious complications of pancreatic necrosis is the development of the infected form of the disease. Mortality with this disease reaches 40% of the mark. Infected form of pancreatic necrosis is a predisposition for the development of purulent complications such as purulent peritonitis, as well as a pancreatogenic abscess of reflux of the retroperitoneal space. This disease is very common, but today there are still many controversial points in the tactics of his treatment, since there is no generally accepted scheme of conservative therapy, the system according to the indications and the extent of surgical intervention.
In most cases, infected pancreatic necrosis can be determined by purulent inflammation of extra-pancreatic fluid reservoirs and pancreatic tissue. This form of the disease most often occurs in 72 hours from the appearance of signs of pancreatic necrosis, and is characterized by hyperthermia of a hectic nature, Mondor's triad and changes in such indicators as arterial pressure to the state of arterial hypotension and heart rate before tachycardia. In laboratory studies of patients with infected pancreatonecrosis, leukocytosis with a shift of the leukocyte formula to the left side, anemia, hyperkalemia, a decrease in diastasuria, amylase and bilirubin increase due to the indirect and direct fraction, the level of such nitrogenous slags as urea nitrogen, creatinine and transaminases ALT andAST.
When examining patients with an infected form of the current disease, the CT scan identifies the swelling and heterogeneity of the structure of the gland itself in combination with overestimated echogenicity and parapancreatic fiber infiltration into the pancreas, necrotic foci in the gland tissues over 50% of the total area. In the ultrasound study, in patients suffering from infected pancreatic necrosis, a heterogeneous gland structure, fluid in the pleural cavity and free abdominal cavity, fluid in the projection of the tail, the body and head of the pancreas of reduced echogenicity and biliary hypertension are observed.
As a measure for the treatment of an infected form of pancreatic necrosis, drainage is used in the retroperitoneal space and in the abdominal cavity, non-secrecestrectomy, omentobursostomy, cholecystostomy and laparotomy. Selective catheterization of the celiac trunk and program operations with non-secrecestrectomy are performed. Plasmapheresis with full plasma substitution and prolonged epidural analgesia with ropivacaine are also used. Internally, octreotide is administered at the maximum dosages.