Surgical management of acute pancreatitis: Indications, optimal timing and recommended approaches.

Abstract

Acute pancreatitis is defined as an inflammatory process of the pancreas with possible peripancreatic tissue and multiorgan involvement inducing multiorgan dysfunction syndrome ,with an increased mortality rate.AP is one of the most common gastrointestinal disorders requiring acute hospitalization worldwide, with a reported increased incidence The principle mechanism for it is premature activation of the pancreatic enzymes within the pancrease. The diagnosis of acute pancreatitisis based on the fulfillment of 2 out of 3 of the following criteria : clinical(upper abdominal pain) , laboratory (serum amylase or lipase >3x upper limit of normal) and/or imaging (CT, MRI, ultrasonography) criteria. The patient with acute pancreatitis is presented mainly with upper abdominal pain, nausea and vomiting associated with multiple signs that may vary from mild tenderness to generalized peritonitis up to multisystem organ failure. Multiple scoring systems for assessment of severity of acute pancreatitis are found, like Ranson's criteria, Glasgow criteria, APACHE scoring system, and BISAP scoring system. Atlanta 2012 and DBC systems represent a major advancement in the field of severity classification in AP and accurately predicted pertinent clinical outcomes. The Revised Atlanta Criteria now define organ failure as a score of 2 or more for one of these organ systems using the modified Marshall scoring system

Indications for intervention in necrotizing pancreatitis are: a) Clinical suspicion of, or documented infected necrotizing pancreatitis with clinical deterioration, preferably when the necrosis has become walled-off. b) In the absence of documented infected necrotizing pancreatitis, ongoing organ failure for several weeks after the onset of acute pancreatitis, preferably when the necrosis has become walled-off.