DUODENAL DECOMPRESSION IN PATIENTS WITH BILIARY NECROTIZING PANCREATITIS
One of the likely mechanisms of infection of sterile necrotic masses in acute pancreatitis is duodenobiliopancreatic reflux. This mechanism is most relevant in acute biliary pancreatitis, after external drainage of the biliary tract, or endoscopic papillosphincterotomy. Therefore, the study of the role of duodenoilliopancreatic reflux as a source of infection in acute pancreatitis is actual. Clinical, duodenomanometric and microbiological studies were carried out in 65 operated patients with severe and moderate acute necrotic biliary pancreatitis in the 1A-B phase. During the operation, all patients were measured with the initial duodenal pressure by an open catheter using the Waldman apparatus, and a test culture of the non-pathogenic strain M-17 E. coli was injected into the intestinal canal. Postoperative active duodenal decompression, within 5 days, was performed in 40 patients; in 25 patients only nasogastric sensing. All patients, 2 and 4 days after surgery, were re-administered colibacterin into the stomach through a nasogastral tube (gastric canal of the duodenal). Bile sampling for microbiological examination was performed after 1, 3, and 5 days, using a sterile catheter, by aspirating bile through a cholecystostomy, or choledochostomy tube. Identification of the test pathogen was performed by standard methods. It was proved that active duodenal decompression, by 4-5 days after surgery, in patients of the main group, allowed to normalize the intraduodenal pressure, and 2-4 times to reduce the incidence of infection of acute necrotic biliary pancreatitis and the development of its purulent complications, in comparison with the control group.