Scoring of acute pancreatitis and its impact on consequent treatment

ABSTRACT

Acute pancreatitis is a serious disease in surgical practice which may have fatal outcome. The aim of this study was to evaluate the benefits of assessing the severity of acute pancreatitis using various scoring systems and to determine their impact on consequent treatment and prognosis. Nineteen patients were studied in a series. The Ranson's, APACHE II, Multiple organ system failure [MOSF] and abdominal CT scoring systems were used. Seventeen patients [89.4%] had Ranson's score <3, APACHE II score 1-4, CT scoring 0-2 and MOSF score 0. They had clinically mild acute pancreatitis and recovered without mortality. Another 2 patients [10.6%] had Ranson 's score 4 and 6 respectively, APACHE II score 14 and 15, CT scoring 2 in early stage and 3 in late stage; and MOSF score 0 in early stage and 3 in late stage. These two patients developed clinically severe disease with pancreatic necrosis and abscess. Both developed multiorgan failure and died inspite of intensive medical therapy and surgical intervention. Scoring of acute pancreatitis allowed prompt identification of patients with severe disease in need of intensive care unit referral and allowed following up of the course of the disease. Simultaneous scoring by different scoring systems gave better evaluation especially by scores that can be repeated as APACHE II and CT scores. Multiorgan failure was associated with mortality. Endoscopic sphincterotomy was guided by the present pathology rather than the scoring. Infected pancreatic necrosis was an indication for surgical intervention but it still has bad prognosis in spite of early scoring, intensive therapy and surgical intervention