[Surgical treatment of acute hemorrhagic pancreatitis. Report of 75 cases. (author's transl)].

Out of 75 definite cases of acute hemorrhagic pancreatitis, 39 were associated with a biliary lesion of which 16 were definitively the cause of the pancreatitis (11 embedded gall stones = 1/5th of the gall stones embedded in the ampulla of Vater and producing acute hemorrhagic pancreatitis). The biliary pancreatites were twice as severe as the primary pancreatites. This justifies the emergency exploration of the bile duct in any case of severe pancreatitis, suggesting acute hemorrhagic pancreatitis. The course of the disease is unforeseeable, certain large hematomas may become reabsorbed without sequelae. Thus one should be very circumspect concerning evaluation of the lesions during the first two weeks. This is why we reject any removal of pancreatic tissue during the first two or three weeks. We noted 30 deaths out of 70 cases of acute hemorrhagic pancreatitis during the postoperative period, 19 occurred during the first week. Concerning the 11 other deaths, they were in 9 cases very severe cases of acute hemorrhagic pancreatitis. Out of 41 cures, only 11 required secondary sequestrectomy, the 30 others were obtained without reoperation, often in spite of a large hematoma and clinical signs of severity. Our present attitude includes emergency operation of any severe case of pancreatitis in order to seek a biliary lesion with cholecystectomy (certain non-palpable calculi were thus discovered), radiomanometry of the common bile duct and, if necessary, sphincterotomy. The second operation is not always necessary, it should be carried out as late as possible after the 3rd week, sequestrectomy which is generally easy, may be carried out electively and under greater conditions of safety than necrosectomy or pancreatectomy.