INFECTED RETROPERITONEAL FAT NECROSIS ASSOCIATED WITH ACUTE-PANCREATITIS

Treatment of necrosis associated with acute pancreatitis is controvers ial. Forty consecutive patients (63.4 +/- 1.4 years of age) with necro tic retroperitoneal fat associated with nonalcoholic pancreatitis were treated by debridement and closed drainage. None of the patients had overt pancreatic necrosis. Fight percent of the patients were operated upon 48.4 +/- 2.9 days (late referrals) and 20 percent on 4.3 +/- 0.6 days after the onset of pancreatitis. The main indication for operati on was clinical deterioration. Ah patients had bacterial infection of the necrosis and none had a preoperative invasive procedure. Twenty-fi ve percent of the patients had colonic necrosis at initial operation; this did not progress thereafter. No patient had histologically identi fiable pancreas, which remained grossly intact at the conclusion of op eration. Morbidity included postoperative ''septic shock'' in 97.5 per cent of the patients, renal failure in 40.0 percent and enterocutaneou s fistula in 47.5 percent. Reoperation for a persistent septic focus w as required for 25 percent of the patients. The mortality rate was onl y 2.5 percent. No patient operated upon early had colonic necrosis or postoperative worsening of renal function or a fistula or required reo peration. The outcome suggests that most patients with infected retrop eritoneal fat necrosis do not require pancreatic resection. Open drain age or use of continuous lavage, or both, are not necessary to achieve a low mortality rate.;Retroperitoneal necrosis can harbor infection m uch earlier than commonly believed. While mortality has not been clear ly shown to be related to early or late debridement, early operation u pon patients with infected necrosis may decrease the morbidity rate.