Acute pancreatitis at the beginning of the 21st century: the state of the art

Abstract

Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.

Figure 1

Algorithm for management of mild acute pancreatitis. IOC: Intraoperative cholangiography; CBD: Common bile duct.

Figure 2

Algorithm for management of severe acute pancreatitis. ERCP: Endoscopic retrograde cholangiopancreatography; ES: ERCP with sphincterotomy; Pt: Patient; MODS: Multiple organ dysfunction score; SOFA: Sequential organ failure assessment; CECT: Contrast-enhanced computed tomography; FNA: Fine needle aspiration.