Abstract
Objective To compare the conventional treatment and continuous veno-venous haemofiltration (CVVH) in severe acute pancreatitis (SAP) for the prevention of pseudocyst and walled-off necrosis. Patients and Methods. Forty-two patients were divided into two treatment groups: conventional treatment group contained 24 patients and CVVH had 18. Conventional treatment group patients were treated symptomatically and according to the causes. CVVH group patients were treated symptomatically, and CVVH was done within 2 hours of admission. Results In both groups, there was a decrease in amylase, lipase, CRP, IL-6, IL-10, TNF-alpha, Ranson score, Balthazar score, and APACHE-II score after 72 hours, but the decrease was significantly greater in CVVH patients. There were no any local pancreatic complications in CVVH patients, but 1 patient had an acute peripancreatic fluid collection, 2 patients had pseudocyst, and 2 patients had walled-off necrosis (WON), and a mortality one was seen in the conventional treatment group. Conclusion The present study shows that early CVVH may be able to prevent the formation of pseudocyst and win in SAP patients.
Highlights
Acute pancreatitis (AP) is a sudden but reversible inflammatory process of the pancreas
The majority of pancreatitis cases in the Western countries are due to alcohol, and the majority of pancreatitis cases in the eastern countries are due to gallstone
AP was diagnosed by the following 2 or more characteristics [10, 11]: (i) Severe acute epigastric abdominal pain often radiates to the back (ii) Serum lipase or amylase is 3 times or more than the upper limit of normal value (iii) Characteristic findings of acute pancreatitis on imaging
Summary
Acute pancreatitis (AP) is a sudden but reversible inflammatory process of the pancreas. AP is the leading GI aetiology of hospitalization in the USA [1]. The majority of pancreatitis cases in the Western countries are due to alcohol, and the majority of pancreatitis cases in the eastern countries are due to gallstone. 80% patients have mild pancreatitis, and 20% of patients have severe pancreatitis. About 15-25% of acute pancreatitis develops into severe pancreatitis [2]. The severity of pancreatitis has been redefined by the revised Atlanta classification system in 2012 [3] by international consensus, which classifies acute pancreatitis in mild, moderate, and severe types (Figure 1)
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