Complications in acute pancreatitis.

In a group of 260 non-selected cases of acute or subacute pancreatitis, severe complications occurred in 60 (23.1%). Long lasting shock and/or massive internal bleeding (5.4%), severe renal problems (anuria, tubular necrosis, nephrosis) (5.4%) and frank hepatic failure due to extensive liver necrosis or other severe destruction (5.0%), invariably lead to death. The clinical group of findings pointing to a fatal course usually manifested themselves during the first three days. Severe renal and hepatic lesions were in many cases secondary to shock in fulminant rapidly deteriorating cases. Prevention and efficient management of shock are thus essential prerequisites for saving the patient. Other important complications included severe intra-abdominal suppuration and abscesses, peritonitis and sepsis (3.9%), pseudocysts of the pancreas (5.4%) and biliary stasis (18.4%). Severe obstruction to bile flow with associated jaundice occurred in only 4.6% of cases; unselected operative biliary decompression does not therefore appear indicated. If an early laparotomy is performed, efficient debridement and drainage are of utmost importance. Fatal pancreatitis was associated with extensive necrosis of the pancreas in about 80% of cases; possibly subtotal pancreatic resection at an early laparotomy would have given better results in these most severe cases, as recently reported in the literature.