Acute Pancreatitis in Fiji: Epidemiology, Management, and Challenges in a Developing Pacific Island Nation

Acute pancreatitis is a common acute surgical condition worldwide as well as in Fiji. The incidence, epidemiology, management, and outcomes have not been previously documented. The aims of this study were to determine the causes, treatment and outcomes of acute pancreatitis at Colonial War Memorial Hospital (CWMH) in Fiji.

This was a retrospective, single center, descriptive study conducted over a 5-year period for all adult patients diagnosed with acute pancreatitis at CWMH, a tertiary hospital and regional referral center.

There were 156 patients; 50% were female; 53% were of I-Taukei origin; and a median age of 44.5 years. The most common cause identified was idiopathic/unknown (38%) followed by gallstones (36%), alcohol (13%), hyperlipidaemia (7%) and others (6%). The incidence was 49 per 100 000 with majority mild (89%) in severity, 10% moderately severe and 1% severe. Inappropriate prophylactic antibiotics were given to 30% of the patients. For gallstone pancreatitis, only 17% had cholecystectomy on index admission while 20% underwent cholecystectomy within 6 weeks. Major morbidity occurred in 8%. There were no inpatient mortality recorded. No patients received minimally invasive treatment for complicated pancreatitis.

The management of acute pancreatitis in Fiji is largely in line with international standards, but in some aspects severely limited by lack of resources, a common issue in developing countries. Establishment of pathways for antibiotic use and index admission cholecystectomy is recommended. Further resourcing for infrastructure and training is needed to improve diagnosis for etiology, as well as radiological and endoscopic treatment of complications.