[The diagnosis and treatment of acute pancreatitis]

Acute pancreatitis is a disease in which there are still considerable difficulties of etiologic, diagnostic and therapeutic nature due to a lack of knowledge of the mechanism responsible for the pancreatic autodigestion process. With the objective of evaluating the diagnostic criteria and therapeutic options, with particular emphasis on surgical treatment, we undertook a prospective clinical study of 153 cases of acute pancreatitis, over a period of 66 months (January 1986-June 1991) based on a specially prepared computerised register. The analysis of the results we obtained allows us to emphasise the following: a) the most common etiology was the alcoholism, closely followed by cholelithiasis, with values of approximately 40% for both; b) abdominal ultrasonography allowed the diagnosis of acute pancreatitis in 51.2% and the diagnosis of associated pathology in 56.7%, particularly cholelithiasis (41.7%); c) abdominal CT diagnosed acute pancreatitis in all 15.7% of the cases on which it was performed; d) medical therapy alone was performed in 43.1%, associated with the peritoneal lavage in 10.5% and with surgical therapy in 46.4%; e) indication for surgical therapy was a doubtful diagnosis in 32.4%, clinical-laboratory deterioration in 8.5%, treatment of associated biliary pathology in 47.9%, pancreatic abscess in 5.6% and pancreatic pseudocyst also in 5.6%; f) surgical treatment of the biliary tract was performed in 67%, with an operative mortality of 2.1%.(ABSTRACT TRUNCATED AT 250 WORDS)