Pancreatitis: Principles of Management

Zimberg, Yale H.

doi:10.1016/s0039-6109(16)38590-5

Cited by 11 publications

(4 citation statements)

References 34 publications

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“…It should be undertaken if the diagnosis is in doubt or if the patient's condition deteriorates in spite of adequate conservative measures. This principle has also been advocated by Anderson (1965), Zimberg (1968) and Glazer (1975).…”

Section: Operative Managementmentioning

confidence: 80%

Acute pancreatitis in Hong Kong

Ong

Lam

et al. 1979

Journal of British Surgery

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A series of 311 Chinese patients with acute pancreatitis admitted to Queen Mary Hospital, Hong Kong, over a 10-year period is reviewed. Biliary tract disease was associated with pancreatitis in 52.4 per cent of patients and 77.9 per cent of them had stones, mud or parasites in the common bile duct. Fever and jaundice were present in 55 per cent and 41.2 per cent of patients respectively. Because of the prevalence of recurrent pyogenic cholangitis among the indigenous population, emergency operation, with the aim of common duct decompression, was conducted in 54.3 per cent of patients during the acute episode, with a mortality rate of 14.8 per cent. Five of 142 patients (3.5 per cent) died whilst on conservative treatment and all 5 had haemorrhagic pancreatitis. The overall mortality rate was 9.6 per cent. Exploration of the common bile duct, which was carried out in 57.4 per cent of patients in the acute phase, was not associated with a higher mortality than when laparotomy alone was performed, and 19 patients had sphincteroplasty without any death. Subtotal pancreatectomy was performed in 2 patients with haemorrhagic pancreatitis with 1 death.

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Section: Operative Managementmentioning

confidence: 80%

Acute pancreatitis in Hong Kong

Ong

Lam

et al. 1979

Journal of British Surgery

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“…What is not so clear is the timing of laparotomy in 'proved' pancreatitis which is failing to respond to non-operative treatment, and the right course to pursue when the abdomen has been opened. Some authors (Anderson, 1965;Zimberg, 1968) have recommended surgery after 6-12 hours, if the patient has failed to improve, but extended the time to 24 hours if an underlying biliary tract condition is suspected. It remains to be seen whether this more active approach is the correct one, but there is certainly no evidence from the literature that early laparotomy is harmful (Trapnell, 1966;Louw et al, 1967;Kune, 1968a;Diaco et al, 1969).…”

Section: Surgical Treatmentmentioning

confidence: 99%

Haemorrhagic and necrotizing pancreatitis

Glazer

1975

Journal of British Surgery

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“…The aim of both early and delayed operative treatment of acute hemorrhagic-necrotizing pancreatitis is to remove necrotic tissue, and to incise and drain abscesses. In this report, we will not consider operative treatment of acute edematous pancreatitis or operative procedures designed to provide purely symptomatic relief [2,[7][8][9][10]. In acute pancreatitis associated with biliary tract disease, operative treatment of the biliary tract disease is performed after the acute symptoms have subsided, unless complications require early operation [2,11].…”

mentioning

confidence: 99%

Management of complications after operations for acute pancreatitis

Kümmerle¹,

Neher²

1981

World j. surg.

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After early operation in 49 patients and delayed operation in 114 patients, all with acute hemorrhagic‐necrotizing pancreatitis, 65% of patients developed local or general complications. Local complications were abscesses, peritonitis, bleeding, gastrointestinal fistulae or stenoses, and external pancreatic fistulae. Their cause can be traced to the large wound cavity with the tryptic wound surface as well as residual necrosis. The general postoperative complications were shock, acute renal failure, cardiorespiratory insufficiency, gastrointestinal bleeding, ileus, coagulopathy, and sepsis. These may have resulted from the local complications, or may even have been present before operation. If local septic complications do not respond to conservative treatment, they require reoperation. For gastrointestinal fistulae or stenoses, or for pancreatic fistulae, a “wait and see” attitude is recommended. Generalized complications call for aggressive intensive medical care. Despite the frequency of postoperative complications, the total mortality rate in our series was 30% in patients with partial pancreatic necrosis operated on early, and in patients who received delayed operations for acute hemorrhagic‐necrotizing pancreatitis. The 74% mortality rate in early operations of subtotal and total pancreatic necroses was admittedly high. Operative results in those patients who were under our care from the beginning, however, were more encouraging (mortality rate of 50%) and demonstrate that the correct treatment for severe acute hemorrhagic‐necrotizing pancreatitis is surgery.

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Pancreatitis: Principles of Management

Cited by 11 publications

References 34 publications

Acute pancreatitis in Hong Kong

Acute pancreatitis in Hong Kong

Haemorrhagic and necrotizing pancreatitis

Management of complications after operations for acute pancreatitis

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