Management of Acute Pancreatitis in a Regional Hepato-pancreatic-biliary (HPB) unit - a retrospective review

Abstract

Aim: To review the management of patients admitted between March 2016 and March 2018 with acute pancreatitis to the HPB unit in the Mater Hospital, Belfast in line with the International Association of Pancreatitis (IAP) guidelines. Methods: Patients were identified retrospectively through clinical coding. We reviewed their charts for aetiology, specialist referral indication, imaging, ICU admission and management, nutritional support, ERCP and MRCP use, interventions (surgical, endoscopic and radiological), timing of cholecystectomy and mortality rate. Results: There were 41 patients, 38 of which were referred from other hospitals. Most common cause was gallstones, then alcohol. All patients received appropriate ICU care and nutritional support. Early imaging was carried out in the referring hospital. 10 patients had imaging performed at the appropriate time. 16 patients required surgical intervention and 15 required radiological intervention. 7 patients had ECRP, 5 of which were done according to guidelines and 5 had MRCP before ERCP. All cholecystectomies were done at the appropriate time. 3 patients died during admission. Conclusion: Acute pancreatitis was managed according to IAP guidelines. 73% of patients admitted to the regional HPB unit required radiological or surgical intervention. Education is required for the general surgical units of the referring hospitals regarding the use of IAP guidelines to initiate appropriate management of patients with acute pancreatitis.