IMPROVED RESULTS AFTER AGGRESSIVE TREATMENT OF COLONIC INVOLVEMENT INNECROTIZING PANCREATITIS

Background/Aims: Colonic involvement is a rare but serious event in ne crotizing pancreatitis. Early detection of this complication is diffic ult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the last few years: an a ggressive regimen of early resection and a conservative approach with ileostomy and observation. Materials and Methods: Fourteen of 118 pati ents treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first t wo patients were treated by a conservative approach the following 12 b y immediate large bowel resection. Follow-up results of all surviving patients were obtained. Results: Patients with colonic lesions demonst rated an advanced septic state compared to patients who did not presen t this complication. Differences in the average Apache 2 scores on adm ission and the incidence of multiple organ failure were significant (A pache 2 score;16.6 versus 11.9, p=0.028, Wilcoxon; multiple organ fail ure; 71% versus 35%, p=0.028, Fisher's exact test). Results after esta blishment of early discontinuity-resection of colonic necrosis compare d favorably to those of a conservative strategy (mortality 4/12; 33% v ersus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Re storative surgery was performed in 6 patients without substantial morb idity and no mortality. Follow-up results were satisfactory in the maj ority of the patients. Conclusions: Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancre atitis.