Studies of acute pancreatitis with retroperitoneal necrosis: “The suet syndrome”. Improvements in patient survival

Abstract

Over a career, 76 patients with massive retroperitoneal necrosis associated with acute pancreatitis were initially treated conservatively. Seventy-one subsequently required operative debridement, between 18 days and 13 months after onset of the disease, including 3 who were explored within the first 2 weeks. In the absence of secondary infection, clinical evidence of toxemia was variable, sometimes relatively limited and occasionally minimal, even in association with large amounts of necrotic tissue. In almost all patients the necrotic tissue consisted chiefly of adipose tissue in the retroperitoneum, including the intramesenteric spaces. In 2 patients, the parapancreatic and retroperitoneal mass appeared to consist predominantly of old, partially liquefied blood clots. Liquefaction of necrotic tissue occasionally proceeded extremely slowly over a period of months. In no patient, up to a maximal lapse of 13 months, was liquefaction complete at the time of exploration. Of the 76 consecutive patients with massive retroperitoneal necrosis, managed by delayed and often frequent debridement, 2 patients (2.6%) died. An occasional patient had significant necrosis of the pancreas, per se; approximately 90% did not. Necrotic retroperitoneal adipose tissue or associated hematoma may prove quite toxic, but was sometimes well tolerated over a prolonged period. The advent of secondary infection leads rapidly to toxemia and, possibly, to an increased rate of liquefaction.