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[Severe acute pancreatitis. Its management and experience]
Chirurgia (Bucharest, Romania : 1990)
|February 14, 1998
Summary
This study on acute pancreatitis found that early surgical intervention for severe cases is not always necessary. A conservative approach with intensive care and delayed surgery for complications improves outcomes in acute severe pancreatitis.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Gastroenterology
- Diagnostic Imaging
Context:
- Acute pancreatitis management presents diagnostic and therapeutic challenges.
- Distinguishing between acute benign pancreatitis (ABP) and acute severe pancreatitis (ASP) is crucial for treatment.
- Historical treatment strategies for ASP often involved early surgical intervention.
Purpose:
- To establish an optimal diagnostic and therapeutic strategy for acute severe pancreatitis (ASP).
- To evaluate the role of multiparametric bioclinical and CT-based morphological scores in pancreatitis assessment.
- To guide surgical indications and timing in ASP management.
Summary:
- A study of 91 acute pancreatitis cases (1992-1996) utilized Ranson, Imrie, Apache II, and CT scores to classify patients.
- 59 cases were ABP (64.84%) and 32 were ASP (35.16%). CT effectively diagnosed necrosis and infections, guiding surgical decisions in 30% of cases.
- Initial medical management was universal; surgical intervention occurred in 91.63% of ASP cases, with high complication rates (locoregional 72.41%, general 44.51%) and mortality (43.75%).
Impact:
- Recommends initial surgical abstention and early reanimation for ASP patients to prevent general complications.
- Advocates for surgical treatment of ASP complications rather than primary intervention.
- Suggests delayed surgical treatment for biliary etiology ASP after two months and CT confirmation of remission.