Acute Severe Necrotising Pancreatitis Is Really a Surgical Challenge: An Overview

Abstract

Necrotic pancreatitis is a severe form of acute pancreatitis where morbidity and mortality associated with this type of acute pancreatitis are comparatively higher especially when it is also infected. It is estimated to be around 10-24% whereas less than 1% is if in mild form. Despite relative less study, there has been a significant change in the management of acute necrotising pancreatitis over the past two decades. Although 75% to 80% of cases of acute pancreatitis is a mild disease without associate mortality it is important to identify the 20% to 25% of patients who are likely to develop severe disease associated with major complications and who would benefit from early intensive care monitoring and treatment. In recent years the treatment of acute necrotising pancreatitis has shifted away from early surgical debridement (Necrosectomy) to aggressive intensive medical care of multiple organ systems with specific criteria for operative and non-operative management. This review presents the current concepts with regards to diagnosis and management of acute necrotising pancreatitis including the variation of opinion in most critical aspects. Some of the issues addressed include the management of these patients in an intensive care/ therapy unit, the role of prophylactic antibiotics, requirement of nutrition, enteral and/or parenteral and pre-surgical resuscitative management, the role of CT scan and FNAC in diagnosing infection and finally the role of surgery.