Acute Necrotic Haemorrhagic Pancreatitis (ANHP): Two Cases in a Hospital with Limited Resources (CHU de Conakry, Guinea), and a Review of the Literature

Introduction: Severe forms of acute pancreatitis are defined by the appearance of visceral failure or a local complication (necrosis, pseudocyst, abscess). Purpose: To discuss two cases of difficult diagnosis of acute necrotic-haemorrhagic pancreatitis (ANHP) discovered intraoperatively in a clinical context of acute generalised peritonitis. Observation 1: 23-year-old patient admitted with abdominal pain, vomiting, cessation of feces and gas, abdominal distension and fever. Course: 72 days. History: epigastralgia. No history of alcohol or tobacco intoxication. Examination: Painful symmetrical abdomen, maximum in the epigastrium. Generalized parietal defensiveness. Decreased tenderness of flanks. Rectal examination: Douglas bulging and painful. After median laparotomy: 3.5 litres of blackish liquid, ‘candle flows’ on the greater omentum and transverse colon. No gastric or duodenal perforation. Pancreatic necrotic-haemorrhagic lesions present. Omentectomy. Necrosectomy, cleansing, drainage. Follow-up: oedema of the lower limbs, parietal then deep suppuration, evisceration. Surgical revision: total necrosis of the pancreas. Necrosectomy, peritoneal cleansing. Death on the operating table. Observation 2: 60-year-old patient admitted with abdominal pain, nausea, cessation of bowel movements and gas, fever. Evolution 22 hours. Notion of chronic alcohol-smoking. Examination: Abdomen painful throughout, maximum in the umbilical region, epigastrium, parietal defence. Pre-hepatic fat retained. After median laparotomy. Aspiration of 200 ml of haematic fluid. No gastro-duodenal perforation. Presence of ‘candle stains’, necrotic and haemorrhagic zones in the pancreas. Necrosectomy. Peritoneal cleansing and drainage. Good post-operative outcome. Conclusion: Drainage of infected necrosis was achieved by surgical necrosectomy in our observations.