[Open treatment in acute severe pancreatitis].
Technical procedures normally used for open packing in our Institute (ICU) are described. Results of this procedure, utilized in thirteen patients suffering from infected pancreatic necrosis and multiple organ failure are reported. The grade of pancreatitis severity has been studied in detail. At admission patients presented a mean Ranson score of 6 and the morphological alteration sec. Balthazar was D in six patients and E in seven. At least two organs were insufficient at the beginning of our observation and the mean number of insufficient organs was 4. The mean APACHE II score was 20. Necrosis was documented in all patients. They were all admitted to ICU and the mean time of treatment was 50 days. Daily debridement was performed and continuous lavage was later added to daily open review. Three patients died, one from local bleeding and two from respiratory insufficiency. No patient died of sepsis and no mortality was observed in the last six cases. According to the severity of Ranson score, APACHE II, the number of insufficient organs and TAC morphological alteration predicted mortality rate should have been 70-80%; on the contrary, it was 25%. In conclusion open packing seems to be the correct treatment for infected pancreatic necrosis, particularly when it is complicated by multiple organ dysfunction.
Padalino
P
P
Istituto di Chirurgia d'Urgenza, Ospedale Policlinico IRCCS, Università degli Studi di Milano.
Chiara
O
O
De Rai
P
P
Ravizzini
C
C
Segala
M
M
Andreoni
B
B
Nespoli
A
A
Tiberio
G
G
D018806:APACHE; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D007507:Therapeutic Irrigation
Trattamento aperto nella pancreatite acuta severa.