CLINICAL PROFILE AND OUTCOMES OF ACUTE NECROTIZING PANCREATITIS: A HOSPITAL-BASED PROSPECTIVE COHORT STUDY FROM SOUTH INDIA

Abstract

Background: Acute necrotizing pancreatitis (ANP) is a severe complication of acute pancreatitis characterized by pancreatic and peripancreatic tissue necrosis, with high morbidity and mortality. This study aimed to evaluate the clinical presentation, etiology, imaging severity, management strategies, and outcomes among patients with ANP in a tertiary care setting in South India. Methods: This was a prospective cohort study conducted between October 2021 and September 2023 at GSL Medical College and Hospital, and Saveetha Medical College, India . Fifty inpatients diagnosed with ANP based on clinical, biochemical, and imaging criteria were enrolled. Data on demographics, etiology, CT Severity Index (CTSI), extent of necrosis, microbiological findings, initial and subsequent management, and outcomes were collected and analyzed using descriptive and inferential statistics. Results: The mean age of patients was 37.9 ± 9.9 years, with a male predominance (84%). The most common presenting symptom was abdominal pain (96%). Alcohol (50%) and gallstones (22%) were the leading etiologies. CTSI score of 10 was seen in 54% of patients, and 30% had >50% necrosis. Infection was documented in 36% of patients, with Staphylococcus aureus being the most frequent isolate. Initial management was conservative in 66%, followed by laparoscopic necrosectomy (22%) and pigtail drainage (12%). The overall mortality rate was 8%, and complications included pseudocysts (10%), recurrent pancreatitis (14%), and walled-off necrosis (8%). Conclusions: ANP commonly affects young adult males, with alcohol being the predominant cause. A CTSI score ≥10 and >50% necrosis were significantly associated with infected necrosis and adverse outcomes. Timely conservative management followed by minimally invasive interventions where needed can result in favorable outcomes.