Complications and outcome in conservative management of acute pancreatitis

Objective

Acute pancreatitis (AP) remains a potentially life-threatening disease and, despite international accepted treatment guidelines, the management of AP differs among hospitals.

Methods

This retrospective study analyzes all the complications for 254 patients hospitalized in our department for AP in the past 10 years (1995–2004).

Results

The analysis included 245 patients (55% men, age 57 ± 10 years). The aetiology of AP was alcoholic in 19.5% and biliary in 58.9% of patients (other causes, 21.6%). Ten patients died of septic multiorgan failure (mortality, 10/245; 4.1%). Severe complications occurred in 53 patients (21.6%), including acute renal failure in four, ileus in 19, and respiratory or cardiac failure in 13 patients. Eight patients needed emergency surgery. Sepsis occurred in nine patients. Other complications were: pneumonia, delirium, cholecystitis, diabetes mellitus, gastric or duodenal ulcers, and pericardial effusion. Of 245 patients, 156 (63.7%) had at least one complication. Mechanical ventilation, hemoperfusion, or hemodialysis was rarely necessary. Computed tomography (CT) was performed in 206 of 245 patients (84.1%) and showed pancreatic necrosis in 47 patients (22.8%). C-reactive protein during the first 48–72 hours and CT findings proved useful in predicting the outcome in multivariate statistical analyses. By logistic regression, however, complication rates were associated with Ranson score, but not with CT findings, C-reactive protein, sex, age, etiology, or serum enzymes.

Conclusion

A conservative management of AP results in a low rate of complications and mortality. Clinical assessment (Ranson score) is sufficient to predict the severity of pancreatitis in most patients. None of our patients with AP need any special treatment and the cost-effective care is sufficient.