title: [Diagnosis of severity as a basic parameter in the treatment of acute biliary pancreatitis].
abstract: BACKGROUND
  Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish their severity in order to plan the appropriate treatment.
  
  
  METHODS
  58 ABP patients were diagnosed by ultrasound (77.5%) or by laboratory findings (22.4%). Following Ranson and APACHE II scoring 17 cases (29.3%) were classified as severe, 41 (70.6%) as mild. All patients with severe ABP, had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done.
  
  
  RESULTS
  In severe cases operative endoscopy cured pancreatic inflammation in 12 cases. Subsequent LC never showed serious morbidity, apart from subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 7.3% morbidity. IOC showed choledochal stones in 31.7% of cases, while in severe cases stones in the biliary tree were shown in 88.2% of cases.
  
  
  CONCLUSIONS
  In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days.
authors.affiliation: Cattedra di Chirurgia Generale II, Università degli Studi, L'Aquila.
authors.forename: M
authors.initials: M
authors.lastname: Schietroma
authors.forename: R
authors.initials: R
authors.lastname: Lattanzio
authors.forename: A
authors.initials: A
authors.lastname: Risetti
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: F
authors.initials: F
authors.lastname: Carlei
authors.forename: M
authors.initials: M
authors.lastname: Cerimele
authors.forename: N
authors.initials: N
authors.lastname: Bellucci
authors.forename: M A
authors.initials: MA
authors.lastname: Pistoia
authors.forename: M
authors.initials: M
authors.lastname: Simi
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index