MODIFICATIONS IN THE TREATMENT OF SEVERE ACUTE-PANCREATITIS

Report about the treatment of necrotizing pancreatitis in the years 19 88 until 1991. A rigorous conservative therapy was preferred, so that only 8.6% of the 140 patients underwent surgery. In 11 cases a continu ous veno-venous hemofiltration (CVVH) was applied to patients with mos t serious clinical course and multi-system failure. The overall lethal ity rate of all treated patients was 7.9%. The present results show, t hat, eliminating mediators by hemofiltration, system failure in connec tion with sterile necrosis can be treated with a good success rate. Th erefore toxic organ failure should no longer be regarded as an imperat ive indication for operation. We recommend strict intensive care inclu ding CVVH and antibiotical prophylaxis for treatment of sterile necros is, while surgical therapy should only be applied to patients with bac terial contamination of pancreatic necrosis.