The Defining Course of Patient with Necrotizing Pancreatitis after Discharge- Prospective study

Abstract Introduction: Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. Aim of the study: To study immediate post discharge course of patients with acute necrotizing pancreatitis requiring intervention in terms of duration of irrigation, volume of irrigation, duration of drainage, quality of life and need for re-admission or re-intervention to evaluate both pancreatic endocrine and exocrine function, as well as general recovery, quality of life and costs in patients who had recovered from moderate to severe acute pancreatitis with 6 months follow-up. Method: This is a prospective observational study conducted between July 2017 to December 2018 in Department of General Surgery at PGIMER Chandigarh. Total 32 patients of acute necrotizing pancreatitis were included in the study and managed in gastroenterology and surgical gastroenterology division and followed up in the departments to define the course of the patients. Results: Out of total 32 patients with acute necrotizing pancreatitis, alcohol is most common underlying risk factor and male patients (87%) are more in number. Out of 32 patients need 15 (46%) readmission and 8(25%) patient came with drain slippage. Out of 32 total patients (66%) managed by endoscopic intervention. Out of 32 patients 30 (93.8%) patients were improved their clinical status in the follow up period with step up approach. Conclusion: Acute necrotizing pancreatitis is a life threatening condition after attack of acute pancreatitis. There are higher chances of recurrent pain, readmission and need of intervention more in those patients with acute necrotizing pancreatitis discharged with drain. Hence, regular early followup with required blood investigations and imaging are to be done the patients.