[The multidisciplinary management of acute pancreatitis: a review of 244 cases]

M Roseano, S Lovadina, L Calligaris, I Ursic, A Cuviello, G Liguori
Annali Italiani di Chirurgia 2004, 75 (4): 443-53

BACKGROUND: Acute pancreatitis (AP) has still a high mortality rate; therefore the accuracy of the predictors of severity actually employed and the therapeutic choices are under debate. The aim of this work is to valuate the accuracy of the prognostic factors actually employed and the results of a multidisciplinary treatment of the AP.

METHODS: A consecutive series of 244 patients affected by AP (168 mild, 76 severe) is analysed. Mean age 64.4 years (range 17-94 years old). As regard as aetiology is concerned, 166 are biliary pancreatitis, 42 alcoholic, 27 idiopathic, 9 iatrogenic. Ranson's score, Balthazar criteria, and ASA are employed to assess the high-risk patients. The treatment is medical and in severe AP the patient is admitted in ICU. 80 patients affected biliary AP undergo an ERCP. An endoscopic papillotomy is performed in 55 cases and in 49 biliary stones are removed. 90 patients underwent a delayed colcistectomy. 11 patients underwent a surgical treatment: 9 for infected necrotic pancreatitis, 1 for a hemorrhagic shock, 1 for peritonitis. The overall mortality, the mortality related to the severity of the AP, the prognostic evaluation of the etiology, the ASA index, the Ranson and Balthazar scores are evaluated.

RESULTS: The overall mortality rate is 2.8% (0.6% in the mild AP and 7.8% in the severe AP). In the surgical group the mortality rate is 18.1%. The Ranson's score is the only independent factor in the multivariate analysis (p<0.0374) while also the Balthazar classification is significant in the univariate analysis.

CONCLUSION: As regard as the prognostic factors in AP are concerned, the Ranson's score and Balthazar criteria are reliable even if many other predictors of severity are tested to make progress in the early detection of the complications. As regard as the therapy is concerned, the endoscopic papillotomy and the endoscopic removal of the biliary stones is the gold standard in the treatment of the biliary AP. In the other cases of AP medical treatment shall be started as early as possible with intensive care management in the severe AP. In patients with infected pancreatic necrosis or haemorrhage or peritonitis, surgery is the only therapeutic choice while the surgical treatment in case of sterile pancreatic necrosis with MODS unresponsive to medical therapy is still under debate.


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