Role of emergency laparotomy in acute pancreatitis.

Two hundred and thirty-seven cases of acute pancreatitis were reviewed and the etiology and prognostic features were analyzed. The following were found to adversely affect prognosis: female sex, old age and low blood pressure, jaundice or disorientation on admission. The results also indicate that if a patient survives the first attack of acute pancreatitis, he is unlikely to have an overwhelming fatal attack later on. One hundred and ninety-four patients were treated conservatively, with a mortality rate of 8.8 per cent and morbidity rate of 20 per cent. Thirteen patients were semi-electively operated on for biliary tract disease with no mortality. The remaining 30 patients underwent emergency laparotomy. The mortality in this latter group was 23 per cent and the morbidity rate was 77 per cent. These results suggest that emergency laparotomy should only be advised for specific indications. In addition, our data suggest that if laparotomy is performed for acute pancreatitis, the peripancreatic area should not be drained unless an abscess or pancreatic necrosis is present.