Review
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World J Gastroenterol. Apr 14, 2010; 16(14): 1707-1712
Published online Apr 14, 2010. doi: 10.3748/wjg.v16.i14.1707
Walled-off pancreatic necrosis
Michael Stamatakos, Charikleia Stefanaki, Konstantinos Kontzoglou, Spyros Stergiopoulos, Georgios Giannopoulos, Michael Safioleas
Michael Stamatakos, Charikleia Stefanaki, Spyros Stergiopoulos, Georgios Giannopoulos, Michael Safioleas, 4th Department of Surgery, Medical School, University of Athens, Attikon Hospital, Athens, 12462, Greece
Konstantinos Kontzoglou, 2nd Department of Propaedeutic Surgery, Medical School, University of Athens, Laikon Hospital, Athens, 11527, Greece
Author contributions: Stamatakos M designed the study and found the references; Stefanaki C wrote the manuscript; Kontzoglou K, Stergiopoulos S, Giannopoulos G and Safioleas M contributed to the editing; all authors approve of the manuscript.
Correspondence to: Michael Stamatakos, MD, PhD, 4th Department of Surgery, Medical School, University of Athens, Attikon Hospital, Athens, 12462, Greece. stamatakosmih@yahoo.gr
Telephone: +30-210-5831386 Fax: +30-210-5326412
Received: December 20, 2009
Revised: January 14, 2010
Accepted: January 21, 2010
Published online: April 14, 2010
Abstract

Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.

Keywords: Walled-off pancreatic necrosis; Infected pseudocyst; Severe pancreatitis; Acute necrotizing pancreatitis; Pancreas; Inflammation; Alcoholism