Clinical profile and outcome of acute pancreatitis and necrotizing pancreatitis

Background: Acute pancreatitis includes a wide spectrum of disease, from mild self limiting symptoms to a fulminant process with multiple organ failure and high mortality. Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collections. These patients run a protracted clinical course with high morbidity and mortality. Material and methods: Clinically, radiologically and by blood investigated, diagnosed 40 patients of acute pancreatitis were prospectively evaluated for the clinical outcome with respect to presence or absence of pancreatic necrosis and severity in terms of CTSI. Results: 24 patients had acute pancreatitis without necrosis (Group A) whereas 16 patients had necrosis including >30% of gland (Group B). The rate of organ dysfunction and mortality (0% versus 25%) rate of was significantly higher in the group B. Multi organ failure (MOF) was present in 4.17% of group A and 20.84% of group B patients. 80% patients were managed conservatively, who all survived and 20% patients underwent surgical intervention of whom 50% survived. Conclusion: CECT is the modality of choice to diagnose acute pancreatitis, presence or absence of necrosis, to stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.