Peritoneal dialysis in the treatment of acute alcoholic pancreatitis
Stone, H.H.; Fabian, T.C.
Surgery Gynecology and Obstetrics 150(6): 878-882
1980
ISSN/ISBN: 0039-6087 PMID: 7376052 Document Number: 155833
A previous survey of patients with acute alcoholic pancreatitis established 5 simple criteria of severity, i.e., overt respiratory distress, hypoxemia, hypovolemic shock, massive fluid requirements and hypocalcemia. During the 54 mo. period, all patients with acute alcoholic pancreatitis who met at least 1 of these 5 criteria were placed in a randomized, prospective study. An odd next to last hospital number called for peritoneal dialysis through a percutaneous or operative approach for at least a 24 h trial period. An even, next to last hospital number specified continued supportive care. After 24 h of such, peritoneal dialysis could then be instituted as a lifesaving measure. Of the 34 patients primarily undergoing dialysis, 29 responded. Only 13 of 36 managed by other measures did not become worse. Of the latter group, 17 were then treated by peritoneal dialysis as a lifesaving effort and 14 of these improved significantly. Of 51 patients being given dialysis, either primarily or secondarily, only 8 deaths occurred. Reliance upon all other means of therapy, alone or in combination for the remaining 19 patients, resulted in only 13 survivors. Infection around the peritoneal catheter produced a lethal intra-abdominal sepsis in 1 patient. These results appear to offer vigorous support for the use of peritoneal dialysis in the management of severe, lifethreatening, acute alcoholic pancreatitis. Special attention must constantly be paid to protect against dialysis catheter-related infection.