Severe acute pancreatitis: clinical forms of different gravity.

INTRODUCTION AND AIMS: Severe Acute Pancreatitis (SAP) is characterized by some degree of severity. The aim of this study is to indentify within severe forms the critical, early severe acute pancreatitis (ESAP). METHODS AND PATIENTS: Since 1997 to 2011 we have treated 276 acute biliary pancreatitis. SAP was 21.7% (60); among SAP were defined 13 (21.6%) ESAP as presence of organ dysfunction within 72 hours after onset of symptoms. Clinical features, organ failure, therapeutic choices and results between SAP (47) and ESAP (13) were compared.
RESULTS: The comparison has shown the following results: impairment degree of pancreas (Balthazar CT score): SAP 2.3 - ESAP 3.85; abdominal compartment syndrome (ACS): ESAP 7.6% (1/13); MODS: ESAP 46.1% (6/13); simgle organ dysfunction: SAP 51% (24/47) - ESAP 53.8% (7/13) ; hypoxemia: SAP 65.9 % (31/47) - ESAP 76.9% (10/13); pancreatic infections: SAP 6.3% (3/47) - ESAP 23% (3/13); mortality: SAP 4.2% (2/47) - ESAP 15.4% (2/13). DISCUSSION: ESAP is characterized early by major incidence of ACS, MODS, impairment degree of the pancreas. In a later phase the gravity of severe pancreatitis lies on the septic complications of fluid necrotic collections. In ESAP the mortality is higher: 15.4% because of multiorgan dysfunction (in first phase); in SAP is 4.3% because of septic complications (in later phase).
CONCLUSIONS: Treatment of SAP and ESAP is now more conservative and less invasive than in the past: intensive care, prevention of intestinal failure and assure papillary patency in the first phase of the disease. In the later phase therapeutic procedure for fluid necrotic collections is US/CT percutaneous catheter drainage.