The treatment of severe acute pancreatitis has been evolving from routine operative management to nonoperative care for patients without evidence of pancreatic infection.
Dr Malangoni and colleague from Cleveland, Ohio undertook a retrospective chart analysis of patients with severe acute pancreatitis at a single institution during a 9 year period.
| Patients who died had a greater incidence of nosocomial infection|
|American Journal of Surgery|
The researchers reported that 60 consecutive patients had severe pancreatitis and 42 had pancreatic necrosis on computed axial tomography (13 infected and 29 sterile).
Patients with infected necrosis and 8 with sterile necrosis had operative debridement; the remaining 39 patients were managed without operation.
The researchers reported that the overall mortality was 15% and was directly related to the Acute Physiology and Chronic Health Examination II and Marshall organ failure scores.
Patients who died had a greater incidence of nosocomial infection.
Dr Malangoni concludes, “Patients with infected pancreatic necrosis require early operative debridement, whereas those with sterile necrosis or severe pancreatitis without necrosis can usually be managed safely without surgery.”