Acute pancreatitis

review of concepts and management

Abstract

The guidelines for management of acute pancreatitis (AP) have changed significantly over the past 20 years, especially regarding the surgical treatment of severe cases. A review of the literature shows the importance of trying to assess the severity of AP as well as its early complications in order to plan the supportive care. Recent evidence has helped to clarify the roles of computerized tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance, prophylactic antibiotics, enteral feeding and fine-needle aspiration bacteriology in the management of acute pancreatitis. This has been a change away from the early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. The guidelines recommend the early detection and objective evaluation of complications by clinical and imaging techniques. A formal approach with the appropriate use of various non-surgical and surgical options can help the ongoing attempts at decreasing mortality and morbidity in AP.