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 past few years: an a ggressive regimen of early resection and a conservative approach by il eostomy and observation. Materials and Methods: Fourteen of 118 patien ts treated for necrotizing pancreatitis from 1988 to 1995 presented wi th colonic necrosis. The diagnosis of necrosis was made if the color o f the bowel wall demonstrated ischemia or hemorrhagic infarction or pu lsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach, the following 12 pa tients by immediate large bowel resection. Follow-up results of all su rviving patients were obtained. Results: Patients with colonic lesions demonstrated an advanced septic state compared to patients who did no t present this complication. Differences in. the average Apache 2 scor es on. admission. and the incidence of multiple organ failure were sig nificant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multi ple versus 35%, p = 0.028, Fisher's exact test). Results after establi shment of early discontinuity-resection. of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% ver sus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Rest orative surgery was performed in. 6 patients without substantial morbi dity and no mortality. Follow-up results were satisfactory in the majo rity of the patients. Conclusions: Early resection of colonic lesions improves results in this dangerous complication, of necrotizing pancre atitis.