Surgery during acute pancreatitis. Observations in 50 patients.

Surgery was performed during the acute phase of illness in 50 of 348 patients with acute pancreatitis. The operative mortality was 40 percent. Analysis of the indications for operation, the operative findings, and the mortality rate revealed that the suspected complications for which operation was planned were not always borne out by the operative findings. In addition, the deterioration of patients while being treated conservatively, or the presence of severe acute pancreatitis preoperatively, were not predictive of the finding of hemorrhagic or necrotizing pancreatitis at operation. In a significant proportion of patients with severe pancreatitis, the diagnosis of pancreatitis was first made at laparotomy. More use should be made of the newer investigative methods to better identify any complications which may have occurred and the necessity for operative intervention.