Management of complications after operations for acute pancreatitis

After early operation in 49 patients and delayed operation in 114 patients, all with acute hemorrhagic‐necrotizing pancreatitis, 65% of patients developed local or general complications. Local complications were abscesses, peritonitis, bleeding, gastrointestinal fistulae or stenoses, and external pa...

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Bibliographic Details
Published in:World journal of surgery 1981-05, Vol.5 (3), p.387-391
Main Authors: Kümmerle, Fritz, Neher, Manfred
Format: Article
Language:English
Subjects:
Acute Disease
Acute Kidney Injury - complications
Acute Pancreatitis
Early Operation
Gastrointestinal Hemorrhage - complications
Heart Arrest - etiology
Hemorrhage - etiology
Humans
Pancreatic Fistula
Pancreatic Necrosis
Pancreatitis
Pancreatitis - complications
Pancreatitis - surgery
Peritonitis - etiology
Postoperative Complications
Shock, Surgical - complications
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Summary:After early operation in 49 patients and delayed operation in 114 patients, all with acute hemorrhagic‐necrotizing pancreatitis, 65% of patients developed local or general complications. Local complications were abscesses, peritonitis, bleeding, gastrointestinal fistulae or stenoses, and external pancreatic fistulae. Their cause can be traced to the large wound cavity with the tryptic wound surface as well as residual necrosis. The general postoperative complications were shock, acute renal failure, cardiorespiratory insufficiency, gastrointestinal bleeding, ileus, coagulopathy, and sepsis. These may have resulted from the local complications, or may even have been present before operation. If local septic complications do not respond to conservative treatment, they require reoperation. For gastrointestinal fistulae or stenoses, or for pancreatic fistulae, a “wait and see” attitude is recommended. Generalized complications call for aggressive intensive medical care. Despite the frequency of postoperative complications, the total mortality rate in our series was 30% in patients with partial pancreatic necrosis operated on early, and in patients who received delayed operations for acute hemorrhagic‐necrotizing pancreatitis. The 74% mortality rate in early operations of subtotal and total pancreatic necroses was admittedly high. Operative results in those patients who were under our care from the beginning, however, were more encouraging (mortality rate of 50%) and demonstrate that the correct treatment for severe acute hemorrhagic‐necrotizing pancreatitis is surgery. Résumé Cent soixante trois malades atteints de pancréatite aigüe nécrotico‐hémorragique ont subi une opération précoce (49 cas) ou retardée (114 cas): 65% d'entre eux ont développé des complications locales ou générales. Les complications locales ont été des abcès, des péritonites, des hémorragies, des fistules ou sténoses digestives, des fistules pancréatiques externes. La cause en est la large cavité résiduelle postopératoire avec ses surfaces pancréatiques cruentées et ses nécroses résiduelles. Les complications générales ont été des états de choc, des insuffisances rénales aigües, des défaillances cardio‐respiratoires, des hémorragies digestives, des iléus, des troubles de la coagulation et des infections. Elles peuvent être la conséquence des complications locales ou peuvent être apparues avant l'opération. Lorsque les complications infectieuses locales ne répondent pas au traitement conser
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01658009