[Severity and treatment of acute pancreatitis]

As of Dec. 1984 we have been involved in the treatment of 55 patients with acute pancreatitis (gallstone associated, 21; alcoholic, 4; postoperative, 11 and others, 19). An attempt was made to grade these patients according to the severity by modification of Bank's criteria, using seven indices such as shock, respiratory failure, renal failure, metabolic abnormalities, hematological disorders, neurological disturbances and abdominal findings including those obtained intraoperatively. We designated mild, moderate and severe pancreatitis according to the sum total of abnormal criteria above. The mild, moderate and severe pancreatitis have zero, one and more than two abnormal indices, respectively. The severity of the pancreatitis correlated well with the pathological finding of the pancreas, the numbers of other organ failures and mortality rate. The mortality rate during admission of the patients with mild, moderate and severe pancreatitis were four, 14.3 and 70.6%, respectively, the overall mortality rate being 27.2%. Recently, we have introduced plasmapheresis into a new candidate for the treatment of acute severe pancreatitis. Our principle for the management of acute pancreatitis is conservative therapy. However, the patients with moderate and severe pancreatitis need more combined therapeutic interventions with surgery, peritoneal lavage and plasmapheresis if the patients indicate no improvement of severity in spite of intensive conservative treatment.