EC Emergency Medicine and Critical Care

Acute necrotizing haemorrhagic pancreatitis (ANHP) represents 10 to 25% of all forms of acute pancreatitis (AP). Their high mortality and morbidity are related to the onset of multiple organ dysfunction syndrome (MODS) and superinfection of necrosis. The principal aetiologies are gallstones (45%) and ethyl poisoning (35%).We analysed 204 cases of acute necrotizing haemorrhagic pancreatitis hospitalized in the intensive care unit for surgical emergencies of the Ibn Rochd University Hospital in Casablanca.The aim of this descriptive study is to analyse the epidemiological, clinical, radiological, therapeutic, and evolutionary data of ANHP. The severity of AP was defined by a Ranson score > 3 and APACHE II > 8, visceral failure and the presence of extensive necrosis.The average age was 52, with a female predominance. Biliary aetiologies remained the most frequent (81%). Pain and vomiting were present in 95% and 77% of cases, respectively. Abdominal ultrasound revealed gallbladder lithiasis in 60% of patients and abdominal CT scan revealed several necrosis casts in 49% of cases. Treatment was mainly symptomatic and the course was marked by 38% mortality.Several prognostic factors were found: female sex, haemodynamic and/or respiratory distress, high severity scores, infection, and length of hospitalization. 

Keywords: Acute Necrotizing Haemorrhagic Pancreatitis (ANHP); Acute Pancreatitis (AP); Multiple Organ Dysfunction Syndrome (MODS)

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