The management of severe acute pancreatitis

Acute pancreatitis in Hong Kong

“…Similar low mortality rates have been reported by Albo et al Mortality associated with operation in the acute phase of pancreatitis varies greatly in different reports. Those in favour of early operation (Trapnell, 1966;Louw et al, 1967;Kune, 1968;Diaco et al, 1969;Barraclough and Coupland, 1972) claimed that there was no added risk when laparotomy and simple remedial surgery were carried out. On the other hand, Imrie (1974) and Imrie and Whyte (1975), in both retrospective and prospective studies, have shown the mortality rate of operation to be 33 and 74 times respectively that of conservative treatment.…”

“…Common duct exploration was the procedure most frequently performed (57.4 per cent) and the mortality of this procedure did not differ from that of laparotomy alone. Although we were reluctant to perform sphincteroplasty in the acute phase because of the many recognized hazards (Anderson, 1965; Louw et al, 1967;Trapnell, 1972), this operation was carried out in 19 patients without complications or deaths. In each instance a stone was impacted at the ampulla, and we believe, as do Salzman and Bartlett (1963), that under these circumstances this operation is essential and can be performed without added risk to the patient.…”

Recurrent acute pancreatitis: is it possible to exclude chronic pancreatitis?

“…The Chinese percentage reported by Gao-YanJing et al 2 is also much lower than has generally been reported in the past (from 30% to 60%). [3][4][5][6][7][8][9][10] Although this difference in frequency may derive from racial differences, differences in the distribution in etiologies may contribute. Alcohol abuse was the most frequent etiological factor (57%) in Europe, whereas the frequency of alcohol abuse in China is as low as 20.4%.…”

Towards a Novel Treatment Strategy for Acute Pancreatitis

“…A futuristic staged approach to the management of acute pancreatitis in adults, based upon cited arguments and other evidence in the text [161, 162, 163, 164]: the plan, which must first be checked out in experimental acute pancreatitis, is intended to avert early mortality – but, by controlling microvascular and gut hyperpermeability, should also limit later sepsis-related deaths. im = Intramuscular; iv = intravenous; bd = twice daily; PaO 2 = arterial oxygen tension; FiO 2 = inspired oxygen tension (set at 24% for first 6 h); ARDS = adult respiratory distress syndrome; HDU = high dependency unit; CCU = critical care unit; SAM = S -adenosylmethionine; NAC = N-acetylcysteine.…”

“…– Isoprenaline (isoproterenol) is highly effective in experimental pancreatitis – and, anecdotally also in man [162]– but dopexamine could be the preferred agent for follow-on treatment of a critically ill patient.…”