[Acute necrotizing pancreatitis: the results of the management of 38 patients].
BACKGROUND
We evaluated the patients who underwent surgical or nonoperative treatment for acute necrotizing pancreatitis.


METHODS
The study included 38 patients (22 males, 16 females; mean age 51.3 years; range 16 to 79 years) with acute necrotizing pancreatitis. Surgical treatment was performed in 23 patients, while 15 patients were treated conservatively.


RESULTS
Gallstone (in 17 patients) was the most common cause of pancreatitis. Twenty-five patients had sterile necrotizing pancreatitis, while 13 patients had infected necrotizing pancreatitis. Fifteen of the 25 cases with sterile necrosis were treated conservatively. The other 10 patients were initially treated by conservative methods, and were later treated surgically (due to six incorrect diagnosis, three organ failures, and one symptomatic pseudocyst). We applied continuous lavage to six of those patients and conventional drainage to four of them. Mortality rate was 23.7% globally; 24.0% in the sterile necrosis group and 23.1% in the infected necrosis group. Mortality rate was 21.7% in the surgical treatment group, and 26.7% in the conservative treatment group. There were no statistically significant differences between those groups (p>0.05). Eleven of the 29 patients who survived had some complications.


CONCLUSIONS
The management of sterile pancreatic necrosis is still a matter of debate. Most patients with sterile necrosis can be treated with conservative methods. Indication for surgery in sterile necrosis should be based on persisting or advancing organ complications and sepsis signs despite intensive care therapy. The patients with infected necrosis should be treated surgically. Surgical intervention is best deferred until the demarcation of necrosis is complete.
Tireli
Mustafa
M
Department of General Surgery Medicine Faculty of Celal Bayar University, Manisa, Turkey. mustafatireli@yahoo.com
Yildirim
Atilla
A
Güçlü
Cem
C
Calik
Bülent
B
Diliüz
Burcu
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014421:Turkey / Q000453:epidemiology