[Management of pancreatic necrosis]

The authors report on the results of operations successively carried out in the last one and a half years on 10 patients with pancreatic and peripancreatic necrosis. On admission objective prognostic signs were quantified according to Ranson (average: 4.89), and the prognoses of serious disease-processes were correctly determined. On admission on the intensive care unit APACHE II points were calculated (average: 13.9), and the individual risk of hospital mortality (average: 42.2%) was defined. In spite of this high average, only 2 patients were lost (20% actual mortality). This can be attributed to monitoring the patients in the intensive care unit, successful therapy of multiorgan dysfunctions and failures, radical necrectomy, continuous lavage of the lesser sac, epidural sympathicolysis, reoperations performed in time, total parenteral and jejunal nutrition, and antibiotic therapy based on results of serial cultures. The authors point to the possibility of infection originating sometimes from the treatment applied, mostly from repeated operations. For the sake of improvement and international comparison of the results they suggest the application of Ranson- and APACHE II scores in medical, surgical and intensive care units, where the treatment of patients with acute pancreatitis takes place. The subsequent complete restitution of the saved patients justifies the long-lasting and expensive treatment.