Treatment Regimen in Patients with Acute Non-Biliary Aseptic Necrotic Pancreatitis Depending on Duration of the Disease
Objective of the research — to study the incidence of acute pancreatitis complications and to develop treatment depending on duration of the disease.
Material and Methods. The analysis included 284 patients with acute non-biliary aseptic necrotic pancreatitis. All the patients had inpatient treatment in the endoscopy and surgery clinic of Donetsk National Medical University named after M. Gorky based on the Donetsk city clinical hospital № 16 from 2006 to 2013.
The men were 160 (56.3 %), women — 124 (43.7 %). 85 (29.9 %) were patients aged 21–40, 148 (52.1 %) — aged 41–60, 40 (14.1 %) — aged 61–80, and 11 (3.9 %) — aged 81 and older.
In 179 (63 %) patients acute necrotic pancreatitis was caused by unvaried diet (an excessive intake of fat food mainly), and in 105 (37 %) — excessive alcohol or its substitute intake.
During first 24 hours from the disease onset 136 (47.9 %) of the patients were admitted, during 25–27 hours — 56 (19.7 %), and after 72 hours — 92 (32.4 %). The ultrasound investigation detected limited pancreatonecrosis in 59 (20.8 %) of the patients, and extensive — in 204 (71.8 %), subtotal-total — in 21 (7.4 %).
Results and Discussion. The analysis of the study shows that 47.9 % of the patients seek for medical help during the first day from the onset of the disease, later — 52.1 %. One third of the patients (32.4 %) address later than 72 hours after the first symptoms of the disease.
Complex conservative treatment, including non-steroidal anti-inflammatory drugs, broad range antibiotics, antisecretory agents and others helped to avoid developing acute aseptic parapancreatic liquid accumulations in 44.1 % of the patients admitted during the first day of the disease onset, and only in 12.5 % — at duration of the disease from 25 to 72 hours. With the disease duration more than 72 hours all the patients had acute aseptic parapancreatic liquid accumulations.
68 % patients admitted during the first day of the disease had enzymatic peritonitis without other liquid accumulations in abdominal cavity, 24 % had acute parapancreatic liquid accumulations in omental bursa, including enzymatic peritonitis, 8 % of the patients had acute aseptic parapancreatic liquid accumulations in retroperitoneal tissue, including enzymatic peritonitis. The patients admitted during 25–72 hours after the first symptoms of acute pancreatitis these rates were correspondingly 33.3, 47.9 and 18.8 %. The patients admitted after 72 hours of the disease onset — 4.7, 72.1 and 23.2 %.
The incidence of suppurative complications in the patients admitted during 24 hours after the disease onset was 1.5 %, in those admitted during 25–72 hours — 3.6 %, and in those admitted after 72 hours — 16.3 %. Postoperative lethality in patients admitted during 24 hours after the first symptoms of the acute pancreatitis was 2.2 %, in those admitted during 25–72 hours — 3.6 %, and in those admitted after 72 hours — 4.4 %. The most frequent cause of death in the patients admitted during the first three days after the disease onset was endotoxin shock (4 patients out of 5), and in those admitted after 72 hours — sepsis (3 out of 4).
Conclusion. The research proves that more than a half of the patients with acute aseptic necrotic pancreatitis address a doctor after 24 hours after the disease onset, and one third — after 72 hours. The complex conservative treatment was orientated at avoiding developing of acute aseptic liquid accumulations in abdominal cavity. The later after the disease onset the patients were admitted, the less effective was the complex conservative treatment, the less frequent was enzymatic peritonitis, and the more frequent was developing of acute aseptic liquid accumulations in retroperitoneal tissue as extensive infiltration of parapancreatic and paracolic fiber. The longer the duration of the disease the more frequent probability of development of suppurative complications of acute necrotic pancreatitis and the lethality increases. The most frequent suppurative complications and lethality was detected in the patients admitted after 72 hours after the first symptoms of the disease.
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