Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. In this review, we summarize the current management and therapies for acute necrotizing pancreatitis.
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Microbial dynamics of acute pancreatitis: integrating culture, sequencing, and bile impact on bacterial populations and gaseous metabolites Agnieszka Chmielarczyk, Edyta Golińska, Anna Tomusiak-Plebanek, Natalia Żeber-Lubecka, Maria Kulecka, Antoni Szczepanik, Katarzyna Jedlińska, Krzysztof Mech, Konrad Szaciłowski, Agata Kuziak, Agata Pietrzyk, Magdalena Strus Frontiers in Microbiology.2025;[Epub] CrossRef
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Chrm3 protects against acinar cell necrosis by stabilizing caspase‐8 expression in severe acute pancreatitis mice model Ning Huang, Ghulam Murtaza, Lujing Wang, Jing Luan, Xinlei Wang, Yumiao Sun, Xing Wu, Yuxi Tao, Shuoxi Shi, Peihua Cao, Yu Qiao, Dong Han, Jiayuan Kou, Ning Ma, Xu Gao Journal of Cellular Biochemistry.2020; 121(3): 2618. CrossRef
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An endoscopic or minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis Yong Hu, Chunyan Li, Xin Zhao, Yunfeng Cui Revista Española de Enfermedades Digestivas.2019;[Epub] CrossRef
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Acute Pancreatitis Task Force on Quality: Development of Quality Indicators for Acute Pancreatitis Management Elaina Vivian, Leslie Cler, Darwin Conwell, Gregory A. Coté, Richard Dickerman, Martin Freeman, Timothy B. Gardner, Robert H. Hawes, Prashant Kedia, Rajesh Krishnamoorthi, Hellen Oduor, Stephen J. Pandol, Georgios I. Papachristou, Andrew Ross, Amrita Seth American Journal of Gastroenterology.2019; 114(8): 1322. CrossRef
Outcomes from different minimally invasive approaches for infected necrotizing pancreatitis Yong Hu, Xun Jiang, Chunyan Li, Yunfeng Cui Medicine.2019; 98(24): e16111. CrossRef
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Hemodynamic Instability Secondary to Inferior Vena Cava Compression: A Rare Complication of Massive Walled-off Pancreatic Necrosis Tanvi Goyal, Toseef Javaid, Anirudh Goyal, Zubair Khan ACG Case Reports Journal.2019; 6(10): e00269. CrossRef
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Journal of Gastrointestinal Infections.2019; 9(1): 28. CrossRef
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Minimally Invasive Retroperitoneal Approach for Pancreatic Necrosectomy via a Percutaneous Drainage Tract AA Polydorou, EV Pantiora, A Vezakis, P-T Arkoumanis, CJ Psichogios, EA Kontis, Georgios P Fragulidis, G Polymeneas Hellenic Journal of Surgery.2018; 90(1): 9. CrossRef
INT-777, a bile acid receptor agonist, extenuates pancreatic acinar cells necrosis in a mouse model of acute pancreatitis Baiqiang Li, Na Yang, Chuling Li, Chuwei Li, Kun Gao, Xiaochun Xie, Xiaowu Dong, Jing Yang, Qi Yang, Zhihui Tong, Guotao Lu, Weiqin Li Biochemical and Biophysical Research Communications.2018; 503(1): 38. CrossRef
Diagnostik und stadienadaptierte Therapie der akuten Pankreatitis U. Herbers, C. Trautwein, F. Tacke, A. Koch Medizinische Klinik - Intensivmedizin und Notfallmedizin.2018; 113(7): 593. CrossRef