Experience of managing acute pancreatitis in a surgical unit of a tertiary care hospital

Abstract

Objective: To study the etiology, diagnosis, treatment and complications of acute pancreatitis in a tertiary care hospital.

 Methodology:

Study Design: It was a descriptive study.

The study was conducted at Surgical Unit of Benazir Bhutto Hospital (BBH) Rawalpindi from 1^st January 2014 to 31 July 2017.  All the patients who presented in emergency with abdominal symptoms and diagnosed as a case of acute pancreatitis were included in the study. All the data of gender, age, serum amylase & lipase, etiology, CT severity index, Ranson’s criteria, complications, mortality and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by SPSS 21 version.

Results: Total 161 patients were included in the study, with 60.9% females and 39.1% males. Maximum patients 31% were from age group of 26 to 40  years of age and minimum 1.2% from 71 to 85 years. Gall stones were the major cause of the disease contributing 67% of cases.  At admission Ranson’s score of the maximum patients 32.2% had total score of 1, While only 1.2% had moderate pancreatitis.  After 48 hours of admission 24.2% had 2 score while only 1.2%had severe pancreatitis.  The radiological CT severity index 82.6% patients had mild pancreatitis while1.2% patients had severe disease. 93.1% patients were managed conservatively, 1.9%  patients went Cystogastrostomy, 1.2% patients needed Exploratory laparotomy and  1.2% patients went for Pancreatic Necrosectomy.  On calculating the morbidity 67.7% patients had no significant morbidity. 32.3% had complications including pleural effusion, ascites, pancreatic necrosis, pseudo cyst formation, shock, acute renal failure and multi organ failure.  Overall mortality rate was  3.7%.

Conclusion:

Acute pancreatitis in our set up is mainly due to gall stones. A multidisciplinary approach, measurement of severity of disease with computerized tomography scan and Ranson’s scoring system is always helpful in disease management and its complications.

Key Words :

Acute pancreatitis, Gall stones, Ranson’s scoring, Pancreatic necrosis, Pseudocyst.