Management of acute pancreatitis: from surgery to interventional intensive care

Abstract

The management of acute pancreatitis has been controversial over the past decades, varying between a conservative medical approach on the one hand and an aggressive surgical approach on the other. There has been great improvement in knowledge of the natural course and pathophysiology of acute pancreatitis over the past decade.^{1– 4} The clinical course of acute pancreatitis varies from a mild transitory form to a severe necrotising disease. Most episodes of acute pancreatitis (80%) are mild and self limiting, subsiding spontaneously within 3–5 days. Patients with mild pancreatitis respond well to medical treatment, requiring little more than intravenous fluid resuscitation and analgesia.⁵ In contrast, severe pancreatitis is defined as pancreatitis associated with organ failure and/or local complications such as necrosis, abscess formation, or pseudocysts. Severe pancreatitis can be observed in 15–20% of all cases.^{6, 7}