Evaluation and treatment of acute and chronic pancreatitis. A review of 380 cases

Abstract

The cases of 380 patients with pancreatitis were analyzed retrospectively. There were 237 men (62%) and 143 women (38%). Etiologic factors included: alcoholism, 62%; biliary lithiasis, 16.6%; idiopathic, 12%; miscellaneous, 7%; and trauma, 2.4%. Acute pancreatitis occurred in 279 patients (73%); 189 (67%) were treated nonoperatively, 90 (33%) underwent operation; electively in 43 and urgently in 47. Postoperatively, one patient (2.3%) died in the elective group and 14 (30%) in the emergency group. Chronic pancreatitis occurred in 101 patients. Their pertinent findings were: alcoholism in 78%, biliary lithiasis in 8%, absence of abdominal pain in 15%, diabetes in 40%, and jaundice in 20%. Fifty patients were treated without operation; 43 were alcoholics, 17 of them died in the follow-up period. Fifty-one patients, 36 of them alcoholics, underwent a variety of operations, with three deaths (6%); 21 were improved after operation. It was concluded that 30% of patients with acute pancreatitis require operation, mainly to correct biliary lithiasis. Emergency operations dictated by relentless deterioration or uncertain diagnosis had a high operative mortality (30%), particularly in patients with necrotizing or hemorrhagic pancreatitis. Operative treatment for chronic pancreatitis was most effective when directed toward specific goals, including pseudocysts, obstructed pancreatic or common bile ducts. Operations done without specific anatomical objectives were often therapeutic failures.