[Treatment of severe acute pancreatitis (30 cases). Respective role of surgery, intensive care and artificial nutrition (author's transl)].

The authors report on a retrospective study of 30 severe acute pancreatitis. The severity of the illness is documented by operative statement and evolution of the disease = 50 p. cent of mortality. A first group of 10 patients (1972-1975) was treated by primary intensive care and rapid ablative surgery with 10 deaths. A second group of 20 patients (1976-1980) was treated by primary intensive care, artificial nutrition and secondary surgical drainage. Mortality is significantly lower in the second group (5 deaths). It is concluded that all severe acute pancreatitis should be initially managed by intensive metabolic care and respiratory support if necessary. The only indication for primary surgery is a diagnostic doubt with peritonitis or bowell infarction. The authors emphasize the improvement of the prognosis of severe acute pancreatitis related to hemodynamic and respiratory measures and to a better nutritionnal support. Surgery should be secondary on a well prepared patient. Drainage or sequestrectomy support a lower mortality than ablative surgery.