ACTA FAC MED NAISS 2010; 27(4):229-237

Case report

UDC: 616.37-002.1-089

Early Peritoneal Lavage in the Treatment of Acute Pancreatitis - Case Report

Ivana Đorđević, Miroslav Jeremić, Miroslav Stojanović, Irena Janković, Karin Vasić, Mihajlo Đorđević

Surgery Clinic, Clinical Center Niš, Serbia

SUMMARY

Acute pancreatitis (AP) is an inflammatory process of the pancreatic parenchyma resulting in glandular autodigestion initiated by pancreatic enzymes. At the onset of AP, parenchymal edema and adiponecrosis occur (acute edematous pancreatitis). If necrosis spreads to the parenchyma, accompanied by hemorrhage and dysfunction of the gland, the condition progresses to the stage of hemorrhagic and necrotizing pancreatitis. The only way of treatment of severe forms was surgery for a long period of time. Nowdays, 80% of patients are treated with conservative therapy. The aim of our study was to establish weather early peritoneal lavage (EPL) as minimally invasive procedure can significantly reduce mortality among patients with AP. Prospectively, we analyzed the patients treated at Surgery Clinic in Niš during the year 2005. During this period, we treated six patients for severe hemorrhagic and necrotizing pancreatitis using EPL. In this paper, two cases in detail are reported. In addition to intensive therapy and reanimation, EPL was performed in the first 48-72 hours from the onset of disease. After abdominocenthesis, two drains were placed in the abdominal cavity: the first into the left subphrenial space and the second into the Douglas recessus. A continues lavage was performed 24h a day during 3-5 days, using solutions for peritoneal dialysis (Peristeril). All patients treated with EPL survived, developing well-known complications of AP like pancreatic pseudocyst and chronic pancreatitis. The mortality rate in cases of mild clinical forms has fallen to 5% (3.8-7%), while it is still high in cases of severe forms, about 20% (15-25%). In the first week of disease, most of deaths occurred as a result of multiple organ failure, while in upcoming stages of disease infection played a bigger role. The key point of treatment is to prevent development of systemic inflammatory response and MOF in the first three days. By means of peritoneal lavage, toxins are eliminated from the abdominal cavity, which is the main factor for successful treatment of AP.

Key words: acute pancreatitis, peritoneal lavage