NONOPERATIVE THERAPY FOR ACUTE NECROTIZING PANCREATITIS

Acute necrotizing pancreatitis is a highly morbid and lethal condition . We performed a retrospective study of all patients admitted to Louis iana State University Medical Center between 1980 and 1995 with a diag nosis of pancreatitis (N = 617) and specifically examined those (N = 2 6) who developed acute necrotizing pancreatitis. During the period 198 0 to 1989, there were 7 patients who progressed to acute necrotizing p ancreatitis. Six of these seven patients died (mortality, 86%). These patients were managed with multiple operations for debridement and nec rosectomy. The age ranged from 31 to 86 years in this group, with a me an of 58.5. The patients' total hospital days ranged from 2 to 125 day s with a mean of 63.5 days. in 1989, we adopted an initial nonoperativ e approach to necrotizing pancreatitis and began using CT-guided cathe ter drainage for this condition. During this time period, 19 patients have progressed to necrotizing pancreatitis. The range of hospital day s was from 13 to 90 days, with a mean of 43.8 days. There were 2 death s in this last group, resulting in a mortality rate of 10.5 per cent. All of these patients were treated nonoperatively in the acute phase o f their illness. Two patients (15.8%) subsequently underwent laparotom y and drainage when the collections were not amenable to CT-guided dra inage. Morbidity in this population approached 70 per cent; however, t he mortality was only 10 per cent compared to 86 per cent in the previ ous group. Although nonoperative therapy has its associated morbidity, and although we understand the controversy surrounding the management of this condition, it appears at least in this population to have muc h less mortality than those who were treated operatively in the acute phase.