Secondary acute pancreatitis: aetiology, prevention, diagnosis and management.

Abstract

Abstract Secondary acute pancreatitis occurs soon after surgery, upper abdominal trauma or the clinical investigations of endoscopic retrograde choledochopancreatography (ERCP) or translumbar aortography (TLA). In this study of secondary acute pancreatitis, 30 patients developed acute pancreatitis after surgery, 12 following trauma and 8 following ERCP or TLA. These 50 patients were drawn from a total of 501 patients with all forms of acute pancreatitis admitted to Glasgow Royal Infirmary from 1960 to 1976. Thirty-seven of the patients were part of a prospective study of 361 patients, while the remainder were examined retrospectively. Important features in the prevention of secondary acute pancreatitis are avoidance of forceful surgical dilatation of the lower common bile duct and unnecessary operative procedures at the sphincter of Oddi. Careful technique is nessary when performing ERCP or TLA. In the prospective phase of this study, early diagnosis of secondary acute pancreatitis was achieved by careful clinical observation and biochemical screening of ‘at risk’ patients. The mortality rate in patients studied retrospectively was 46 per cent while in those studied prospectively it was 13.5 per cent. Postoperative acute pancreatitis had the highest mortality rate (30 per cent) and most frequently followed biliary tract surgery. A disproportionately large number of patients developed pancreatitis after sphincterotomy or sphincteroplasty. Early laporotomy is advocated in patients with pancreatitis occurring after blunt abdominal trauma. Where the initial management was conservative in this group, late pseudocyst formation requiring surgical drainage was common.