Abstract:
Background: Acute pancreatitis is a disease with significant morbidity and mortality particularly in the setting of the two main determinants of severity - infected local complications such as pancreatic necrosis and organ failure. There has been an evolution of treatment of pancreatic necrosis with percutaneous drainage one of the current preferred modalities, however they are known to have a significant failure rate. Aims and methodologies: The aims and methodologies of this thesis are to: 1) investigate through a systematic review the mechanism of extra-pancreatic, non-colonic infection leading to infection of pancreatic necrosis; 2) review the rate and reasons for failure in the literature of percutaneous drains in draining abdominal abscesses; 3) investigate through computational modelling and experimental testing current percutaneous drain design elements and how they can be improved and 4) investigate the use of enzymatic agents to enhance the drainage and liquefaction of pancreatic necrosis including novel agents such as secretions from the medicinal maggot Lucilia sericata. Results: 1) Extra pancreatic infectious complications occur in 32% of patients with acute pancreatitis which suggests a causal relationship for the 50% of non-enteric growth in infected pancreatic necrosis; 2) The median rate of percutaneous drain failure for intra-abdominal abscesses is 49% with poor reporting of the reasons for failure with no current classification system available; 3) Abscess fluid viscosity, drain radius and use of suction significantly contribute to fluid flow through a percutaneous drain and the most commonly used percutaneous drain design can be re-designed with a subsequent increase in flow; 4) The currently used irrigation solution of Normal Saline is not successful in degrading necrosum compared to other enzymatic agents, with human Gastric Juice showing significant ability to liquefy necrosum. The secretions of the medicinal maggot Lucilia sericata is also successfully able to degrade human pancreatic necrosum. Conclusions: The treatment of infected pancreatic necrosis can be substantially improved through re-design of current percutaneous drains and use of enzymatic solutions to liquefy necrosum and enhance drainage