title: Severe acute pancreatitis: surgical management in a third-level hospital.
abstract: BACKGROUND
  Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation.
  
  
  METHODS
  We studied patients diagnosed with pancreatitis from January 1, 2000 to December 31, 2007.
  
  
  RESULTS
  We analyzed records of 82 patients, 63.4% were male and the most common etiology of pancreatitis was biliary in 63.4% of patients. Morbidity was 62.19%; 35.36% had pulmonary complications. In 15.85% of patients there was enterocutaneous fistula and 10.9% had bleeding. Mortality was 20.73%. In our hospital, all patients with severe acute pancreatitis are managed in the intensive care unit. Parenteral nutrition is only indicated in patients intolerant to oral feeding or with inability to place a nasojejunal tube. Use of antibiotics is based on carbapenem, and surgical indications are infected pancreatic necrosis, persistent sterile pancreatic necrosis, fulminant acute pancreatitis and abdominal hypertension, and complications such as intestinal perforation and bleeding.
  
  
  CONCLUSIONS
  It is recommended that patients with severe acute pancreatitis are managed by a multidisciplinary team in an intensive care unit. The role of parenteral nutrition and antibiotics should be individualized.
authors.affiliation: Servicio de Cirugía General, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano de Seguro Social, México, DF, Mexico. erckser75@gmail.com
authors.forename: Erick
authors.initials: E
authors.lastname: Servín-Torres
authors.forename: José Arturo
authors.initials: JA
authors.lastname: Velázquez-García
authors.forename: Germán
authors.initials: G
authors.lastname: Delgadillo-Teyer
authors.forename: Luis
authors.initials: L
authors.lastname: Galindo-Mendoza
authors.forename: Francisco
authors.initials: F
authors.lastname: Bevia-Pérez
authors.forename: Fausto
authors.initials: F
authors.lastname: Rivera-Bennet
mesh_terms: D000208:Acute Disease; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index