title: Early surgical intervention in severe acute pancreatitis: Central Australian experience.
abstract: BACKGROUND
  Severe acute pancreatitis (SAP) is a disease associated with a high mortality and morbidity; however, many patients survive due to better understanding of the disease and multidisciplinary care. Those who do not respond to intensive care management with persistent multi-organ dysfunction still have a high mortality. There is a role for early surgical intervention in two subsets of critically ill patients: the first, with acute compartment syndrome (ACS) of the abdomen with persisting organ dysfunction despite medical measures to control intra-abdominal pressure; the second, being early infected pancreatic necrosis (IPN) with the presence of gas in the retroperitoneum.
  
  
  METHODS
  The current analysis is an 8-year (2005-2012) study. The data were collected prospectively by the Surgical Department in Alice Springs Hospital. Intensive care data were also sourced from ANZICS CORE (Australia and New Zealand Intensive Care Society and Centre for Outcome and Resource Evaluation) for ICU (intensive care unit) mortality comparison between ICUs of Australia and New Zealand with Alice Springs.
  
  
  RESULTS
  There were 1163 episodes of acute pancreatitis with an annual incidence of 275 per 100 000. Of importance, 114 patients had SAP of whom 42 developed pancreatic necrosis. Eleven patients required surgical intervention. Five patients had decompressive laparotomies for ACS and six patients had laparotomies for IPN. The mortality of patients with SAP was 0%.
  
  
  CONCLUSIONS
  The two subsets of patients with either ACS or early IPN require early surgical intervention either by decompressive laparotomy or open necrosectomy with laparostomy. The authors attribute improved survival in this cohort due to these interventions.
authors.affiliation: Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia. aojacob@gmail.com.
authors.forename: Abraham O
authors.initials: AO
authors.lastname: Jacob
authors.affiliation: Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Stewart
authors.affiliation: Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
authors.forename: Ollapallil
authors.initials: O
authors.lastname: Jacob
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D010179:Pancreas / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: abdominal compartment syndrome; infected pancreatic necrosis; laparostomy; necrosectomy; severe acute pancreatitis