A study of interventions and their outcome in the management of acute pancreatitis
DOI:
https://doi.org/10.18203/2349-2902.isj20194044Keywords:
Acute pancreatitis, Necrotizing pancreatitis, Mortality, MorbidityAbstract
Background: Acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it, all render it the most formidable of catastrophes. Aim of the study is to evaluate the treatment outcome in acute pancreatitis.
Methods: All the patients who underwent surgery for chronic pancreatitis were included in the study. initial APACHE II score at admission and CT severity index was evaluated.
Results: Edematous pancreatitis accounts for 80–90% of acute pancreatitis and remission can be achieved in most of the patients without receiving any special treatment. Necrotizing pancreatitis occupies 10–20% of acute pancreatitis and the mortality rate is reported to be 14-25%. Alcohol (45.8%) was the most common causes of acute severe pancreatitis in this study. Males were predominately affected (Male: Female = 29:5). Complication rate or morbidity is 50%. The initial APACHE II score at admission and CT severity index in the first scan were high in patients who underwent necrosectomy and the patients who died. The overall mortality in this study was 30.6%.
Conclusions: In conclusion, one reason attributed to high mortality was due to the subgroup of patients who underwent PCD alone and failed to show any change in the recovery nor deterioration and lead to gross nutritional depletion and death, secondly those patients who underwent step up approach and ultimately needed surgery have more aggressive disease evidenced by high APACHE II score, CT severity index and % of necrosis.
References
Bradley III EL, Dexter ND. Management of severe acute pancreatitis: a surgical odyssey. Ann Surg. 2010;251(1):6-17.
Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. W J Gastro: WJG. 2007;13(38):5043.
Villaseñor A, Kinross JM, Li JV, Penney N, Barton RH, Nicholson JK, et al. 1H NMR global metabolic phenotyping of acute pancreatitis in the emergency unit. J Proteome Res. 2014;13(12):5362-75.
Doctor N, Agarwal P, Gandhi V. Management of severe acute pancreatitis. Indian J Surg. 2012;74(1):40-6.
Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232(5):619.
Zerem E. Treatment of severe acute pancreatitis and its complications. WJG. 2014;20(38):13879.
Navarro S. Historical review of our knowledge of acute pancreatitis. Gastroenterología y Hepatología (English Edition). 2018;41(2):143.
Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. WJG. 2007;13(38):5043.
Werner J, Uhl W, Hartwig W, Hackert T, Müller C, Strobel O, BüCHLER MW. Modern phase-specific management of acute pancreatitis. Digest Dis. 2003;21(1):38-45.
Wani SV, Patankar RV, Mathur SK. Minimally invasive approach to pancreatic necrosectomy. J Laparoendoscopic Adv Surg Tech. 2011;21(2):131-6.
Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Annals Surg. 2000;232(5):619.
Banks PA. Practice guidelines in acute pancreatitis. American J Gastroenterol. 1997;92(3):377-86.
El Boukili I, Boschetti G, Belkhodja H, Kepenekian V, Rousset P, Passot G. Update: Role of surgery in acute necrotizing pancreatitis. J Visceral Surg. 2017;154(6):413-20.
Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol. 1998;170(4):969-75.
Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, van Erpecum KJ, Gooszen HG. Early endoscopic retrograde cholangio-pancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg. 2008;247(2):250-7.
