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Acute pancreatitis in the elderly - Can we perform better?
MedLine Citation:
PMID:  22041641     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Despite age traditionally being a criterion for stratification of severity in acute pancreatitis (AP), the condition is not common in the elderly population (>80 years) and very few studies have examined outcome in this cohort. The aim of this study was to evaluate our experience and outcome in this expanding population.
METHODS: A retrospective analysis was performed of all patients over 80 years of age who were admitted with AP (defined as a serum amylase >400 IU/L) between January 2004 and January 2007. The modified Glasgow score was used for severity stratification.
RESULTS: Forty patients with AP were admitted during the study period, of whom 23 were females. The mean age was 84 (SD 4.1) years. Fifteen patients (37%) had severe AP as indicated by a Glasgow score of 3 or more. The aetiologies were gallstones (n = 28; 70%), drug-induced (n = 4; 10%) and idiopathic (n = 8; 20%). Ten patients (25%) died during their initial admission to hospital, of whom 5 died before undergoing any form of imaging to determine the cause of AP. Six patients, 5 of whom had gallstones were subsequently readmitted with a further attack of AP. Eleven patients underwent an ERCP during their initial admission and a further 4 patients underwent ERCP during their subsequent admission. Only 3 patients with gallstone-induced AP underwent a cholecystectomy, all performed laparoscopically.
CONCLUSIONS: AP in octogenarians is a significant problem and carries a high mortality irrespective of the Glasgow severity score. Early intervention by means of ERCP is indicated to try and improve outcome in this group with biliary pancreatitis. Laparoscopic cholecystectomy must be considered as a definitive treatment in these patients as available evidence suggests that this can be performed with acceptable morbidity and mortality in this group.
Authors:
K Somasekar; R Foulkes; G Morris-Stiff; A Hassn
Publication Detail:
Type:  Journal Article     Date:  2010-12-24
Journal Detail:
Title:  The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland     Volume:  9     ISSN:  1479-666X     ISO Abbreviation:  Surgeon     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101168329     Medline TA:  Surgeon     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  305-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Nevill Hall Hospital, Abergavenny, Wales NP7 7EW, United Kingdom.
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