Acute pancreatitis is a sudden inflammation of the pancreas [1][2]. It is a medical emergency requiring rapid, multidisciplinary management to determine the prognosis [1]-[4]. Its incidence is steadily increasing worldwide [1]-[6]. In Africa, data are sparse but indicate its emergence with significant morbidity and mortality [7]-[9]. In Gabon, its incidence is high and associated with high mortality [10]. The dramatic nature of its onset and its postprandial context, in an environment where local myths and beliefs still hold considerable sway, can delay its management and lead to significant morbidity and mortality [10]. It is in this context that we undertook this study, the aim of which was to establish the care pathway for patients hospitalized for acute pancreatitis in our department.

This was a cross-sectional retrospective study that included all cases of acute pancreatitis hospitalized in the hepatogastroenterology department of the Libreville University Hospital between January 1, 2019, and December 31, 2023, based on the Atlanta criteria. Sociodemographic data, patient care pathway, severity of the flare-up, etiology, and outcome were collected. We excluded patients with an acute pancreatitis flare-up in the context of chronic pancreatitis, as well as acute pancreatitis flare-ups revealing pancreatic cancer. Institutional and academic authorisations were obtained from the various ethics committees. Statistical analysis was performed using Epi-Info 7.2.6.0 software. All explanatory variables with a p-value ≤ 0.05 in the univariate analysis were included in the multivariate logistic regression model. A p-value ≤ 0.05 in the multivariate analysis was considered statistically significant. The odds ratio with a 95% confidence interval was used to measure the strength of the association.

Acute pancreatitis accounted for 5.19% of hospitalizations. This frequency was close to that found in the Congo (3.7%) but appeared higher than that of West African countries such as Senegal (0.5%) and Burkina Faso (0.46%) [7][8][11]. It remained well below that of the Maghreb, notably 10% in Algeria [12][13]. These differences could reflect an epidemiological reality but could also be explained by methodological biases, as some studies were conducted in hepatogastroenterology departments and others in digestive surgery [7][8][11]-[13]. The mean age of 41.9 years was similar to data from sub-Saharan Africa, where it ranges from 37 years in South Africa to 44 years in Côte d’Ivoire [7][8][10][11][14]-[17]. The male predominance, already noted by Maganga et al. in Gabon, is observed in several African countries [7][8][10][11][14]-[17]. As in the literature as a whole, alcoholic and lithiasic etiologies accounted for more than 80% of the causes of acute pancreatitis [1]-[22].

We observed a high mortality rate of 12.63%, confirming the data from Maganga et al. in Gabon [10]. This high mortality rate appeared similar in African countries with a high prevalence of acute pancreatitis [12][13][15]-[17], while it was significantly lower in Europe and the United States [1]-[3][18]-[22]. This high mortality rate could be explained by the delay in treatment, with an average of nearly 5 days between visits. Indeed, James et al. demonstrated the importance of the first 72 days of care in the management of acute pancreatitis [3]. This delay in treatment was marked, in the patient’s care pathway, by recourse to traditional healers in 35.79% of cases and to places of worship in 10.53%, reflecting the influence of cultural beliefs in our context. Furthermore, this care pathway was complicated by difficulty accessing an intensive care unit for severe cases (11.43%), which could worsen the loss of opportunity as indicated by international guidelines [1][3][18][23][24].

Moreover, statistical analysis found a statistical link between the occurrence of death and a CRP value greater than 150 mg/L, as well as a CTSI greater than 7. This confirms the results of Xiaoli et al., for whom a high CRP value was a criterion for the severity of acute pancreatitis [25]. In addition, Liu et al. showed that bacterial translocation during acute pancreatitis was a poor prognostic complication associated with a high CRP value [26]. The CTSI is included in all international guidelines for the prognostic assessment of acute pancreatitis and appears to be an independent factor of poor prognosis [1][3][18][23][24].

Acute pancreatitis is an emergency affecting young adult males of all socioeconomic backgrounds, with alcohol and gallstones being the main causes. Its management is delayed and limited by a care pathway influenced by sociocultural factors and the scarcity of intensive care unit beds. Public education about this condition and the establishment of a hepatogastroenterology intensive care unit could reduce its mortality rate.