The Burden of Acute severe pancreatitis and early experience of Step-up approach for acute necrotizing pancreatitis at Military Hospital

  • Sushil Bahadur Rawal Nepalese Army Institute of Health Sciences
  • Uttam Laudari Kathmandu medical college
  • Basanta Khatiwada Nepalese Army Institute of Health Sciences
  • Anup Thapa Nepalese Army Institute of Health Sciences
  • Manoj Kumar Jha Nepalese Army Institute of Health Sciences
  • Jyoti Rayamajhi Nepalese Army Institute of Health Sciences
  • Srijan Malla Nepalese Army Institute of Health Sciences


Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach.
A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied.
Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them,  three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy.
Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

Author Biography

Sushil Bahadur Rawal, Nepalese Army Institute of Health Sciences
Associate Professor, Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal


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How to Cite
RAWAL, Sushil Bahadur et al. The Burden of Acute severe pancreatitis and early experience of Step-up approach for acute necrotizing pancreatitis at Military Hospital. J Soc Surg Nep, [S.l.], v. 22, n. 2, p. 11-17, jan. 2020. ISSN 2392-4772. Available at: <>. Date accessed: 24 june 2021.