Clinical implications derived from the morphological classification of 89 patients with acute pancreatitis.

A morphologic categorization of pancreatitis which can only be made at operation or at autopsy has prognostic and therapeutic implications. We reviewed 89 such cases and classified them as follows: 1) Edematous in 54 (60.7%). All patients underwent operation; five (9.2%) died. 2) Necrotizing in 20 (22.5%). Eighteen patients required operation. Seven (39%) patients died; two patients treated nonoperatively died. 3) Hemorrhagic in 15 (16.8%). Operation was performed in nine with five (55.5) deaths; six patients treated without operation died. These observations suggest that 50% of patients operated on for pancreatitis have the mild edematous form; most of them survive the operation. In the severe forms of pancreatitis with necrosis or hemorrhage of the pancreas, about 50% of patients die postoperatively. There were no survivors in those treated without operation, suggesting the usefulness of surgical treatment once pancreatic necrosis is suspected. However, the advisability of operation and the prognostic implications derived from the morphologic categorization of acute pancreatitis are applicable (only retrospectively) after the pancreas has been examined at operation.