Management Modalities and their Outcome in Patients of Acute Pancreatitis: A Cross Sectional Study

Abstract

Background: Acute pancreatitis is a potentially serious condition with wide variation in severity rangingfrom mild and self-limiting to a rapidly progressive illness leading to multi-organ failure.Aim and Objective: To study early enteral feeding and their outcome in patients of acute pancreatitis.Methodology: Present study was a prospective study carried out in 60 patients out of 50 were male (83.3%) and 10 female (16.6 %) admitted as acute pancreatitis in the department of surgery, Shalinitai Meghehospital and Research centre, Datta Meghe Medical College, Nagpur. A thorough history was taken anddetailed clinical examination was conducted of all the patients on admission. All the patients were subjectedto biochemical and Radiological investigations. Radiological investigations like X-Ray chest abdomen andUltrasonography were carried out initially in all the patients. CT Abdomen performed as per requirement.Severity of disease was accessed on admission on the basis of BISAP scoring system. Conservativemanagement was instituted with early enteral feeding for all patients. All patients who recovered weredischarged and followed up on outpatient basis. Data was analyzed with appropriate statistical tests.Results: All the patients were initially managed conservatively with early enteral feeding. Type of feedingwas according to the severity of the illness. Oral in mild / moderate pancreatitis and nasogastric feedingin severe pancreatitis. Mild and moderate variety tolerated enteral feeding well thus need for intravenousinfusion was obviated. Out of these, 1 patient (1.7 %) required interventional management due to acutenecrotizing pancreatitis. This patient later required intravenous infusion and TPN in view of progressiveclinical deterioration due to necrotizing pancreatitis. The management of complications was essentiallyconservative. Acute necrotizing pancreatitis has a mortality of 100 % even with aggressive management.The overall mortality rate in our study was 1.7% .Conclusion: Conservative management is the mainstay of treatment in acute pancreatitis. Early enteralfeeding obviates the need for intravenous infusion in mild and moderate pancreatitis and in selected casesof severe acute pancreatitis. Early enteral feeding has advantages over Parenteral nutrition and reducesmortality, infectious complications, preventing malnutrition, reduction in length of hospital stay. Earlydetection and aggressive management of in acute severe pancreatitis can prevent its progression to acutenecrotizing pancreatitis and its complications.