Percutaneous peritoneal dialysis as an early treatment of acute necrotic hemorrhagic pancreatitis.

In this study, 8 years experience of early percutaneous peritoneal dialysis (PPD) in the treatment of acute necrotic hemorrhagic pancreatitis (ANHP) are presented. The introduction of methemalbuminemia and the presence of specific ascites rich in amylase, lipase and methemalbumin as early indicators of the presence of ANHP enabled us to confirm the diagnosis in 53 patients, after which early institution of PPD was possible. Thirty patients survived by PPD alone and 9 patients survived by the combination of PPD and surgery, giving an overall mortality rate of 26.4%. A better survival rate of patients having a high Ranson prognostic score was obtained. The introduction of computerized axial tomography (CAT), in 1980 into our hospital allowed us to use this technique for followup. This change and the fact that we were more experienced with PPD, divided our study into two periods: 1976 to 1979, 22 patients; 1980 to 1983, 31 patients. A more aggressive medical approach to treating ANHP was observed during the second period. Surgery was delayed compared to the first period and confined to treating late complications, such as infections, by drainage procedures. Despite the fact that the results were not statistically different, a trend towards a lower mortality rate (19.3%) in the second period compared to the first period (36%) was obtained.