Resection of the pancreas for acute fulminant pancreatitis.

The records of 30 consecutive patients treated by pancreatic resection for acute hemorrhagic or necrotizing pancreatitis from 1974 to 1978 were reviewed. Formal subtotal or near to total resection of the pancreas was undertaken whenever vigorous nonoperative therapeutic measures did not bring rapid improvement of the condition of the patient. The rationale was that removal of the diseased pancreatic tissue would prohibit the progress of inflammation and abolish the development of complications directly associated to the inflammatory process itself. There was no intraoperative mortality, but 11 patients died after the operation. Of the 19 survivors, eight had an uncomplicated postoperative course, whereas 11 patients recovered only after severe complications, usually requiring multiple reoperations. Among the most important complications were intra-abdominal sepsis, septicemia, upper gastrointestinal tract bleeding, respiratory insufficiency, renal insufficiency and perforations of the gastrointestinal tract. After a follow-up period of one to five years, five patients have remained completely free of symptoms. In 12 patients, diabetes has developed, and four patients had recurrent mild attacks of pancreatitis. All but two patients have resumed their previous work or other activities of living.