G. Glazer

Multicentre audit of death from acute pancreatitis.

A prospective audit of acute pancreatitis involving nine hospitals in the North‐West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty‐nine patients (68 per cent) died after the first week from complications related to infection (26 patients), co‐morbid conditions (nine) or non‐infective complications (four). Twenty‐one patients (42 per cent) had been inadequately evaluated by Ransons criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection‐related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.

INTRA-OPERATIVE B-MODE ULTRASOUND SCANNING OF THE EXTRA-HEPATIC BILIARY SYSTEM AND PANCREAS

An evaluation of intra-operative B-mode ultrasound scanning of the extra-hepatic biliary tree and pancreas shows that it is a useful, noninvasive method of detecting bileduct calculi and assessing pancreatic disease. In 50 patients undergoing cholecystectomy for gallstones, ultrasound scanning was an accurate as per-operative cholangiography; the decision to explore the bileduct, made on ultrsound findings, was correct in 49/50 cases, and that made on X-ray findings was correct in 46/47 cases; there was 1 false-positive in each group. Scans of 5 patients with pancreatic disease were compared with 28 normal pancreatic scans. Infiltration of the portal vein by tumour was easily detected. Differentiation of carcinoma from chronic pancreatitis by ultrasound scanning might with more experience be possible, whilst identification of other pancreatic lesions, such as cysts, calculi, or endocrine tumours, will certainly be facilitated by this new technique.