Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 172

The presence of fever early in acute pancreatitis is usually secondary to the release of inflammatory mediators. Later, the development of clinical and laboratory markers of sepsis in the absence of any extrapancreatic infection (respiratory, urinary, venous catheter) is the basis for the diagnosis of infected pancreatic necrosis. The presence of gas within the (peri)pancreatic area on computed tomography (CT) confirms the diagnosis (Figure 14.1). In the absence of pancreatic gas bubbles, which occurs in up to 60% of patients [30], fine needle aspiration (FNA) may be required to confirm the diagnosis of infection within the pancreatic necrosis. However, culture of FNA samples produces false‐negative results in about 25% of cases and frequently does not modify the therapeutic approach in patients with sepsis [30]. In our center, FNA for culture and antibiotic resistance testing is only performed once drainage of the necrotic collection has been indicated based on clinical, laboratory, and imaging data.

Finally, serum measurements of procalcitonin may be a valuable tool supporting the diagnosis of infected pancreatic necrosis in patients with acute necrotizing pancreatitis and without extrapancreatic infection [31,32].

Figure 14.1 CT scan of a patient with walled‐off necrosis (short arrows). Presence of gas bubbles indicates the presence of infected (peri)pancreatic necrosis (long arrows).

Source: courtesy of J.E. Domínguez‐Muñoz.