ISSN 2490-3329 (Print)
ISSN 2303-7954 (Online)

Volume 49, Issue 1, Article 5

(Scr Med 2018:49:30-36)

Complications of Treatment of Acute Pancreatitis

Božo Krivokuća1, Milica Latinović2, Svetozar Krivokuća1

1 University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
2 Primary Health Care Centre, Banja Luka, Bosnia and Herzegovina

doi: 10.18575/
UDC: 616.37-002.1-07


Introduction: Acute pancreatitis is non specific inflammation of the pancreas due to the intrapancreatic activation of its proteolytic and lipolytic enzymes - enzyme lesions. The enzymes normally excreted by the pancreas are activated in the pancreas and destroy its tissue, leading to an autolysis process that causes bleeding and damage to the blood vessels. Enzyme autodigestion begins with local inflammation, edema, bleeding and necrosis.

Aim of the Study: The aim of this paper is to determine the incidence and complications in patients with acute pancreatitis and on the basis of the results obtained define specific health care measures for prevention and suppression of complications.

Patients and Methods: This study included patients, suffering from acute pancreatitis, treated at the Clinic for General and Abdominal Surgery of UCCof the Republic of Srpska in Banja Luka, in the period from January 1st, 2015 until April 30th, 2017. The total number of patients treated in this period is 147. Diagnosis of the disease is based on a detailed anamnesis at the entrance (acute abdominal pain in all patients), laboratory examinations (complete blood images, C-reactive protein, amylase, and lipase) and diagnostic procedures (abdominal ultrasound examination, chest RTG, CT, ERCP, NMR and ECG).
Based on the data obtained from the history of the disease, protocols and release lists, the following statistical analyses were performed: frequency of complications was established as well as mortality in billiary, alcoholic and idiopathic types of acute pancreatitis.

Results: The examinations performed determined the minimum number of laboratory and diagnostic procedures that confirm the acute pancreatitis diagnosis within a short period of time. The leading symptom of admission was a strong abdominal pain, present in all patients. Laboratory trials are dominated in elevated values of the total number leukocytes, C-reactive protein (CRP), and serum levels of amylase, lipase and bilirubin. Early diagnostic procedures, within the first 48 hours, significantly contribute to the reduction of acute pancreatitis complications. Out of a total of 147 patients with this diagnosis, 110 patients were treated conservatively and 27 operatively. Eight patients had a mortal outcome. By type of acute pancreatitis, billiary form is in the first, idiopathic second and alcoholic form in the third place. The light clinical form of acute pancreatitis was present in 124 patients and severe in 23. Mortality rate was 5.44% in all three clinical forms.

Conclusion: Early confirmation of acute pancreatitis diagnosis is the basic prerequisite of disease progression, reduction of possible complications, and death as an outcome of the disease. Patients who were treated conservatively had a lower rate of complications, shorter hospital stay, faster recovery and better quality of life in the later period. Multidisciplinary approach to diagnosis and treatment patients suffering from acute pancreatitis significantly reduces morbidity and mortality. Quality and comprehensive health care, as part of multidisciplinary team work, contributes to reducing disease complications and faster recovery of the patient. The results of treatment of acute pancreatitis patients at UCC RS do not differ significantly from the results of treatment in similar institutions in the region and the world.

Key words: acute pancreatitis, therapy, complications

Pdf version of article

1.Vlajnić Z. Njega hiruških bolesnika sa osnovama hirurgije. Banjaluka: Panevropski Univerzitet Apeiron; 2007;75-82 p. PMid:17392540
2. Uhl W, Warshaw A, Imrie C, Bassi C, McKay C, Lankisch P et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002;14(2):565-73.
3. Gulanick M, Myers J. Nursing care plans. 8th edition. Philadelphia:Mosby; 2014;974 p.
4. Bilić A. Bolesti gušterače. Zagreb: Medicinska naklada;1993;101 p.
5. Dominguez-Mufioz JE. Diagnosis of acute pancreatitis: any news or still amylase? In: Buchler M, Uhl E. Acute Pancreatitis:Novel Concepts in Biology and Therapy. London:Blackwell Science; 1999; 171 p.
6. Vucelić B. Amilaza-kliničko značenje i interpretacija hiperamilazemije i hiperamilazurije. Liječ Vjes. 1979;101:148-52. PMid:449592
7. Tenner S, Steinberg W. The addmission serum lipase. Amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis. Am J Gastroenterol. 1992; 87(12):1775-8.
8. Barauskas G, Svagzdys S, Maleckas A. C-reactive protein in early prediction of pancreatic necrosis. Medicina. 2004;40(2):135-40.
9. Naumovski-Mihalić S, Papa B, Colic-Cvrlje V, Katicic M, Prskalo M, Sabaric B et al. Ultrasonographic parameters-prognostic value in acute pancreatitis. Neurol Croatica. 1999;48(1):91-6.
10. Naumovski-Mihalić S, Prkacin I, Scrbec B, Colic-Cvrlje V, Sabaric B, Cetinic N et al. Current management of pancreatic pseudocysts. Neurol Croatica. 2000;49(1):175-9.
11. Balthazar EJ, Freeny PC. Contrast enchanced computed tomography in acute pancreatitis. Is it beneficial or harmful? Gastroenterol. 1994;106:152-9.
12. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-6.  PMid:2296641
13. Čolović RB. Akutni pankreatitis. In: Hirurgija pankreasa. Čolović RB, editor. Beograd: Zavod za udžbenike i nastavna sredstva Beograd; 1998. 117-141 p.
14. Arvanitakis M, Koustiani G, Gantzarou A. Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging-a comparative study. Dig Liv Dis. 2007;39:473-82.  PMid:17363349
15. Büchler MW, Uhl W, Maltfertheiner P, Sarr MG. Acute pancreatitis. Basel: Karger; 2004;1-58 p.
16. NIH-state of the science statement on endoscopic retrograde holangiopancreatography (ERCP) for diagnosis and therapy. NIH Consensens State Sci Statements 2002; 14-16;19(1):1-26.
17. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004; 53(9):1340-44.  PMid:15306596 PMCid:PMC1774183
18. Mithofer K, Mueller PR, Warshaw AL. Interventional and surgical treatment of pancreatic abscess. World J Surg. 1997;21(2):162-8.  PMid:8995072
19. Tenner S. Initial management of acute pancreatitis:critical issues during the first 72 hours. Am J Gastroenterol. 2004;99(12):2489-94.  PMid:15571599
20. Greenberg AJ, Hsu J, Bawazeer M, Marshall J, Friedrich OJ, Nathens A et al. Clinical practice guideline:management of acute pancreatitis. Can J Surg. 2016;59(2):128-140.  PMid:27007094 PMCid:PMC4814287
21. Phillip V, Steiner MJ, Algul H. Early phase of acute pancreatitis:Assessment and management. World J Gastrointest Pathophysiol. 2014; 15;5(3):158-68.
22. Karakayali F. Surgical and interventional management of complications caused by acute pancreatitis. World J Gastroenterol. 2014 Oct 7;20(37):13412-423.  PMid:25309073 PMCid:PMC4188894
23. Lowe ME, Sevilla WA. Nutritional advice for prevention of acute pancreatitis: review of current opinion. Nutrition and Dietary Supplements 2012;4:71-81.
24. Buchman AL. Glutamine: commercially essential or conditionally essential? A critical appraisal of the human data. Am J Clin Nutr. 2001;74(1):25-32.  PMid:11451714
25. Moraes JM, Felga GE, Chebli LA, Franco MB, Gomes CA, Gaburi PD et al. A full solid diet as the initial meal in mild acute pancreatitis is safe and result in a shorter length of hospitalization: results from a prospective, randomized, controlled, double-blind clinical trial. J Clin Gastroenterol 2010;44(7):517-22.
26. Gronroos JM, Nylamol EI. Mortality in acute pancreatitis in Turku University Central Hospital 1971-1995. Hepatogastroenterol 1999;46:2572-74.
27. Brown A, Baillargeon JD, Hughes M, Banks P. Can fluid resustitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology. 2002;2:104-7.  PMid:12123089

Contact address:
Božo Krivokuća,
Street address: Kolubarska 17,
78 000 Banjaluka
Republic of Srpska
Bosnia and Herzegovina
e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
phone number: +387-65-516-859

Submitted: March 13th, 2018
Accepted: March 19th, 2018