Outcome of severe acute pancreatitis.
BACKGROUND
The treatment of severe acute pancreatitis has been evolving from routine operative management to nonoperative care for patients without evidence of pancreatic infection.


METHODS
Retrospective chart review of patients with severe acute pancreatitis at a single institution during a 9-year period.


RESULTS
Sixty consecutive patients had severe pancreatitis. Forty-two had pancreatic necrosis on computed axial tomography (13 infected and 29 sterile). Patients with infected necrosis and 8 with sterile necrosis had operative debridement; the remaining patients were managed without operation (n = 39). The overall mortality was 15%. Mortality was directly related to the Acute Physiology and Chronic Health Examination II and Marshall organ failure scores (P <0.001). Patients who died had a greater incidence of nosocomial infection.


CONCLUSIONS
Patients with infected pancreatic necrosis require early operative debridement, whereas those with sterile necrosis or severe pancreatitis without necrosis can usually be managed safely without surgery.
Malangoni
Mark A
MA
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Dr., Cleveland, OH 44109, USA. mmalangoni@metrohealth.org
Martin
Adam S
AS
D018806:APACHE; D000328:Adult; D019072:Antibiotic Prophylaxis; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D003646:Debridement; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome