How I do it — Necrosectomy in acute pancreatitis. Open drainage with diverting ileostomy for acute necrotizing pancreatitis

Abstract

Infected pancreatic necrosis which spreads extensively in the retroperitoneal space requires open drainage to prevent the formation of residual abscess. With open drainage and repeated debridement, we often encountered patients who suffered from abdominal complications such as prolapse of the small intestine through the wound and injury to the intestine. In order to improve the open drainage method, we combined diverting ileostomy with open drainage. Diverting ileostomy was effective in decompressing the small intestine; this prevented prolapse and reduced the incidence of paralytic ileus. Prophylactic diverting ileostomy appears to result in the reduction of complications during open drainage and has advantages in the subsequent management of critically ill patients with infected pancreatic necrosis.