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Acute Pancreatitis: Nonoperative and Operative Management

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The Acute Management of Surgical Disease

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Abstract

Within the realm of acute care surgery, few disease processes exhibit as much variation in severity, complications, and therapeutics as acute pancreatitis. While most pancreatitis limits itself to causing self-limited epigastric pain for a few days, necrotizing pancreatitis may cause a panoply of infectious, gastrointestinal, and abdominal vascular complications, requiring multiple minimally and maximally invasive modalities to treat. Hospital practice patterns vary in whether the internal medicine or general surgery service is primarily responsible for the care of patients with pancreatitis, but severe pancreatitis requires a multidisciplinary approach, frequently incorporating critical care, surgery, gastroenterology, interventional radiology, and clinical nutrition. The modern acute care surgeon must have a thorough understanding of surgical critical care, as well as the indications, contraindications, and potential complications both of surgical therapies and of relevant endoscopic and angiographic therapies in order to appropriately manage the patient with severe pancreatitis.

The most widely accepted definition of acute pancreatitis comes from the revised Atlanta classification and requires two of the following three factors: (1) acute onset of persistent severe epigastric pain, “often radiating to the back,” (2) a serum lipase or amylase activity level at least three times greater than the upper limit of normal, and (3) characteristic inflammatory changes seen on imaging, typically an IV contrast-enhanced computed tomography (CECT) scan, but alternatively magnetic resonance imaging (MRI) or abdominal ultrasound (US).

This chapter will describe the work-up of pancreatitis, severity scoring systems, and its medical and surgical management. In-depth descriptions are given of the technique and decision-making for necrosectomy, pseudocyst drainage, and management of complications such as hemorrhage and bowel necrosis.

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Authors and Affiliations

  1. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Isaac W. Howley & Martin A. Croce

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Correspondence to Isaac W. Howley .

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Editors and Affiliations

  1. Trauma and Acute Care Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Martin D. Zielinski

  2. Trauma and Surgical Care Clinic, Vanderbilt University, Nashville, TN, USA

    Oscar Guillamondegui

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Howley, I.W., Croce, M.A. (2022). Acute Pancreatitis: Nonoperative and Operative Management. In: Zielinski, M.D., Guillamondegui, O. (eds) The Acute Management of Surgical Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-07881-1_20

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