Acute necrotizing pancreatitis. Experience with 78 cases in 12 years (1984-1996).

Our experience includes 78 patients , all with CT evidence of necrotizing pancreatitis and a mean Ranson score of 6.6 (6 to 10). Age range was 38 to 72 years. The etiology of the pancreatitis was : alcohol, 40 patients, gallstones, 32 patients and ERCP, 6 patients. We adopted the policy of conservative management and operated only in two situations : -1) Suspicion of infection -2) Failure to improve after two weeks of supportive therapy. The mean duration of hospitalization was nine weeks (6 weeks to 6 months). 58 patients underwent abdominal exploration, necrosectomy and extensive retroperitoneal debridement followed by irrigation-suction of the lesser sac. 10 patients required one re-operation and 2 patients required two re-operations each. 20 patients did not undergo any operation. There were 2 early deaths (under one week of onset). Of the patients who underwent operations, there were 4 deaths from uncontrollable sepsis and multi organ system failure at 3 months, 5 months, 5 months and 6 months respectively. 4 of the deaths (2 early and 2 late) occurred in the ERCP pancreatitis group. Our overall result of 6 deaths out of 78 cases is comparable with the result of more aggressive protocols reported in the literature.