Controversies in the management of acute pancreatits

Acute pancreatitis accounts for three to five percent of admission to hospital for abdomen pain. Though most are of mild form, the severer form takes a toll of some ten percent.

This study aims to make a retrospective analysis of some fifty four admissions for acute pancreatitis admitted to Kathmandu Medical College Teaching Hospital in the past twenty four months. It also aims to highlight some of the controversies that have come up as to its management.

Among the 54 admissions for acute pancreatitis, there were thirty nine patients. Sixteen (41%) of them were female and twenty three (51%) male. Their ages ranged from twenty one to ninety years, with an average of forty one years. Surprisingly no patients were between sixty to eighty years bracket. Thirteen (33%) of the patients had gall stones in ultrasound. Two (5%) of the patients were suffering from mumps and Eleven (28%) no causal factors were found. While thirteen (33%) patients suffered from alcoholic pancreatitis. All of them were male. Of the alcoholic group, five (38%) had recurrent attacks. Five (38%) from the biliary and two (18%) from the idiopathic group had recurrent attacks. Four patients were operated on emergency basis. Three with the diagnosis of peritonitis and another eighty four year old lady with features of associated cholangitis were found to have acute pancreatitis at operation. One of them underwent peritoneal toileting; two had cholecystectomy and peritoneal toileting while the eighty four year old lady underwent cholecystectomy, common bile duct exploration and peritoneal toileting. All fared well post-operatively.