ACUTE NECROTISING PANCREATITIS

Abstract

Background: Pancreatic necrosis represents a severe form of acute pancreatitis. Opinions vary about the need and exact timing of surgery in patients with necrotising pancreatitis. In these patients we evaluate timing of surgery, and factors affecting the mortality. Patient and methods: This study included 49 consecutive patients of acute necrotising pancreatitis who had undergone surgical management. Age, sex, etiology, organ failure, mortality, ICU stay, hospital stay, different timings of surgery were evaluated. Results: Ethanol abuse (61%) of pancreatitis followed by gall stone (18%), idiopathic (18%). Surgical procedure consisted of pancreatic necrosectomy with post operative closed lavage. There were 46 males and 3 females, median age was 35 years (17-80 years). In 14.2% patients necrosis was sterile. 71% of patients required post of ventilatory support and median ICU stay was 8 (0-48) days. 50% developed post operative complications in the form of pancreatic fistula (32%), biliary fistula (4%), colon fistula (6%), significant haemorrhage (4%). There was 24% mortality. The survivors compared to non survivors as shown in Table below.TABLE 1: Comparison of Survivors and NonsurvivorsConclusion: Necrosectomy and post operative continuous lavage is a safe and effective method for treatment of PN with acceptable morbidity and mortality. Two to four weeks period is "golden period" for necrosectomy.