Evaluation and Prognosis of Surgical Intervention for Severe Acute Pancreatitis in Al-Diwaniyah Teaching Hospital
Abstract
Background Acute pancreatitis can range from a mild, self-limiting process that responds to supportive care to severe disease with multiple organ failure and high mortality. Its incidence is increasing ,and pancreatitis is one of the most common causes of hospital admission for gastrointestinal illness. Objectives: To evaluate surgical intervention and its prognosis in severe acute pancreatitis in AL-Diwaniyah Teaching Hospital. . Patients and methods: A prospective study was conducted in general surgery department, in Al-Diwanyiah Teaching Hospital during the period between January 2018 and march 2021,76 patients with acute pancreatitis were admitted to the surgical ward, among them 31 patients(40.7%) were diagnosed as sever acute pancreatitis in whom 19 patients(25%) underwent surgical intervention. All patients were assessed at admission and 48 there after using the Ranson and, APACHE-II scoring system and classified according to the revised Atlanta scoring system. Results: From those 76 patients, 31 patients diagnosed as severe acute pancretitis(40.7%),from whom 19 patients (25%) underwent surgical intervention, among these biliary was the most common etiology (73.68%) while alcohol was (5.2%). Pseudocyst represented the most frequent indication for surgery (31.57%),followed by infected pancreatic necrosis(15.7%),while colonic perforation and bleeding were the least frequent (5.26%) for each. Conclusion :Multidisciplinary approach in the management of acute pancreatitis is highly recommended.Severe forms of acute pancreatitis should be managed in centers with special and sophisticated facilities if available.Surgery should be avoided in the early phases of severe acute pancreatitis except the special occasions of perforations or bleeding.Pancreatic necrosectomy for infected pancreatic necrosis with or without organ failure is a lifesaving .Intervention in the early phases of pancreatic pseudocyst involution almost doomed with recurrence.
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