The Surgical Treatment of Acute Necrotizing Pancreatitis : Does Presense of Infection Affect on Determinant of Intervention?

ABSTRACT

We retrospectively analyzed 17 necrotizing pancreatitis patients who were treated surgicaly at the Department of Surgery, Yonsei University, from April 1983 to October 1996 in order to identify that the presence of intra-abdominal infection. The mean age was 46.5 years old. There were 11 male patients and 6 female patients. The most common etiology was alcohol and trauma. The mortality rate was 6%, for which etiology was alcohol. We grouped the patients into three groups, which is the infected, non-infected, and no culture performed. There were 6 non-infected patients, 6 infected patients, and 5 no culture performed patients. The most frequent infecting organism was E. coli. Others were E. faecalis, P. aeruginosa, K. pneumonia, and E. cloacae. There were 6 non-infected patients. The complication rate was 50% in infected cases, the 67% in non-infected cases, and 80% in no culture performed cases. In non-infected patients, Ranson's criteria, APACHE II score, total transfusion of packed red blood cell, and hospital stay were greater than infected patients. The ICU stay was longer in infected patients. However, there were no significant differences among the three groups. The basic operation procedure was necrosectomy and drainage. Others were cholecystectomy, segmental resection of colon, etc. We concluded that the presense of intra-abdominal infection should not be the sole determinant for intervention, so, the early and aggressive surgical intervention in case of symptomatic pancreatic necrosis is more beneficial irrespective of infection.