Morphological aspects of necrosis as a guideline for treatment of necrotizing pancreatitis. A brief report about 50 patients.

In a retrospective study, 50 patients with obvious necrotizing pancreatitis (NP) were allocated in four groups according to the morphological aspects of the necrosis. Appearance of ascite (N1), extrapancreatic spread of necrosis towards neighboring organs (N2), a large amount of necrosis (N3), and infected necrosis (N4), appears to be an easy and useful guideline for the management of NP patients. Organ failures (72%) and mortality rate (36%) are higher when the process is infected. In the other groups, organic dysfunctions were frequent, but all the patients except one survived. The majority (80%) of patients were operated on. Only 20% of patients had successful nonsurgical treatment and they were in N3 group. This percentage may increase through a morphological approach to treating necrosis, with the use of endoscopic treatment for the disruption of pancreatic duct, and better accuracy in the management of patients with noninfected necrosis, whenever organ failures are present.