The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

  • Sushil Bahadur Rawal Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Uttam Laudari Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
  • Basanta Khatiwada Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Anup Thapa Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Manoj Kumar Jha Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Jyoti Rayamajhi Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Srijan Malla Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
Keywords: Acute pancreatitis, Pancreatic necrosis, Step up approach

Abstract

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach.

Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied.

Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy.

Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

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Author Biographies

Sushil Bahadur Rawal, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Uttam Laudari, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal

Department of Surgery

Basanta Khatiwada, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Anup Thapa, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Manoj Kumar Jha, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Jyoti Rayamajhi, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Srijan Malla, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

Department of Surgery

Published
2019-12-31
How to Cite
Rawal, S., Laudari, U., Khatiwada, B., Thapa, A., Jha, M., Rayamajhi, J., & Malla, S. (2019). The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital. Journal of Society of Surgeons of Nepal, 22(2), 11-17. https://doi.org/10.3126/jssn.v22i2.28723
Section
Original Articles