Therapy of severe biliary necrotizing pancreatitis

Aims: The authors analysed therapeutic tactics and results of severe biliary necrotizing pancreatitis.

Patients and methods: 84 patients were treated (mean age of 48.6 years) with severe acute necrotizing pancreatitis. The origin of the pancreatitis was gallstone disease in 19 (5 male, 14 female, mean age of 56.6 years) cases. In these cases besides early naso-jejunal feeding, prophylactic antibiotic administration (imipenem-cilastatin), percutaneous peripancreatic drainage, late planned necrosectomy and postoperative closed bursa omental lavage early endoscopic sphincterotomy (EST) was performed within 72 hours from the beginning of the pancreatitis. If surgery was needed, cholecystectomy and cystic duct drainage were performed. When the pancreatitis recovered without surgery, elective cholecystectomy was indicated in 2 cases. Early operation was performed in 6 (31.6%) cases, because of acute advanced cholecystitis. The indication of late operation was septic necrosis in 7 (36.8%) cases and MOF in 2 (10.5%) cases. Percutaneous drainage was performed in 5 (26.3%) of the 19 patients.

Results: Two patients (10.5%) recovered without surgery. The mean number of operation was 1.5 (1–4). Reoperation was performed with the indication of septic necrosis in 5 cases, bleeding in 3 cases and colon necrosis in one case. The mean hospital stay was 40.5 (11–98) days. The mortality rate in the biliary pancreatitis group was 26.3% and 16.7% in the whole group (84 patients).

Conclusions: On the basis of the results the authors suggest the early EST besides the basic therapy in severe biliary necrotizing pancreatitis. In operated cases cystic duct drainage is useful. The higher age might have been the reason for the higher mortality rate in the patients with biliary pancreatitis.