The Current Status of Treatment for Patients with Severe Acute Pancreatitis

ABSTRACT

INTRODUCTION AND AIM: Acute pancreatitis is an inflammatory process of varying severity, ranging from a mild, self-limiting form to severe acute pancreatitis, which leads to complications such as necrosis, pseudocyst formation, and organ failure. This highly lethal condition should be differentiated from acute abdomen caused by other diseases as early as possible so appropriate management can be carried out. PATIENTS AND METHODS: A survey was carried out to determine the current status of management for this particular disease in Korea. A total of 269 patients were collected from 13 university hospitals during a four and a half year period (January 2000 to June 2004). RESULTS: Of the 269 patients, 103 (38.3%) were managed with surgery, and 166 (61.7%) were managed with conservative treatment. The most commonly performed surgical procedure was debridement of necrotic tissue with closed drainage. The most common etiology was alcohol, with 143 cases (53.4%), followed by gallstones, with 48 cases (17.9%). E. coli was the most commonly cultured bacterium. The mortality rate in surgically managed patients was 9.7%. The mortality rate in conservatively treated patients was 7.2% . CONCLUSION: Patients with infected pancreatic necrosis should be managed with surgical necrosectomy and drainage. However, patients with sterile necrosis should be managed conservatively unless organ complications or severe clinical deterioration develops despite intensive therapy. Patient survival is improved through early diagnosis, followed by adequate drainage in combination with intensive care.