Short and long term outcome of severe acute pancreatitis

Objective: Between 1985 and 1994, 883 cases of acute pancreatitis were treated in Malmo, Sweden (population 233 000). The purpose of this study was to report the short- and long-term outcome of the 79 cases that were severe, according to the Atlanta classification. Design: Retrospective and follow-up study a median time of 7 years since the attack. Setting: University hospital, Sweden. Subjects: 79 patients with severe acute pancreatitis. Main outcome measures: Mortality, cause of death, organ failure, local complications, surgical procedures. mortality since the attack, and endocrine and exocrine dysfunction. Results: Twenty-one patients died from their attack. Organ failure was the predominant cause of death in the 13 patients who died during the first 10 days after admission, whereas infection was the most common cause of death in patients who died later. Mortality was low under the age of 60 and increased with age. Organ failure developed in 72 patients. Twenty-four patients developed pancreatic necrosis or abscesses and 18 patients were treated by necrosectomy and open or closed drainage. At follow-up, 13 patients had died, 2 from pancreatic carcinoma, 35 patients were included in the follow-up survey, 15 of these had diabetes and an additional 4 had impaired glucose tolerance, 9 patients had signs of severe exocrine dysfunction. Conclusions: There was a high incidence of endocrine and exocrine dysfunction together with, in many patients, ongoing social problems related to chronic alcoholism several years after an attack of severe acute pancreatitis.