Outcome of severe acute pancreatitis

Am J Surg. 2005 Mar;189(3):273-7. doi: 10.1016/j.amjsurg.2004.11.013.


Background: The treatment of severe acute pancreatitis has been evolving from routine operative management to nonoperative care for patients without evidence of pancreatic infection.

Methods: Retrospective chart review of patients with severe acute pancreatitis at a single institution during a 9-year period.

Results: Sixty consecutive patients had severe pancreatitis. Forty-two had pancreatic necrosis on computed axial tomography (13 infected and 29 sterile). Patients with infected necrosis and 8 with sterile necrosis had operative debridement; the remaining patients were managed without operation (n = 39). The overall mortality was 15%. Mortality was directly related to the Acute Physiology and Chronic Health Examination II and Marshall organ failure scores (P <0.001). Patients who died had a greater incidence of nosocomial infection.

Conclusions: Patients with infected pancreatic necrosis require early operative debridement, whereas those with sterile necrosis or severe pancreatitis without necrosis can usually be managed safely without surgery.

MeSH terms

  • Adult
  • Antibiotic Prophylaxis*
  • Cross Infection / mortality
  • Cross Infection / prevention & control*
  • Debridement*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Needs Assessment*
  • Pancreatitis, Acute Necrotizing / etiology
  • Pancreatitis, Acute Necrotizing / mortality
  • Pancreatitis, Acute Necrotizing / surgery*
  • Retrospective Studies
  • Treatment Outcome