Sequestrectomy and hyperalimentation in the treatment of hemorrhagic pancreatitis.

Surgical treatment has been used in those patients with hemorrhagic pancreatitis who deteriorate after several days of intensive medical therapy, or in those patients in whom the diagnosis cannot be established early in the course of treatment. Initial therapy consisted of: cholecystostomy or T-tube drainage in those patients who have gallstones, jaundice, or distended biliary tree; gastrostomy for prolonged gastric decompression; jejunostomy to provide a portal for enteroalimentation; and appropriate soft rubber drainage of the pancreatic bed as a simple, safe, and effective means of treating severe hemorrhagic pancreatitis. Adjunctive daily hyperalimentation and later sequestrectomy of necrotic pancreatic tissue provided a mortality of 20 per cent and complete rehabilitation of sixteen of thirty patients so treated. Delaying the initial approach to necrotic pancreas allows precise delineation of necrotic material so that sequestrectomy, leaving behind normal pancreas, can be carried out to avoid exocrine and endocrine deficiencies after the acute episode has passed.