Skip to main content
SpringerLink
Log in

Diagnosis, objective assessment of severity, and management of acute pancreatitis

Santorini consensus conference

  • Consensus document
  • Published:
International journal of pancreatology Aims and scope Submit manuscript

Summary

Background

The diagnosis, early assessment, and management of severe acute pancreatitis remain difficult clinical problems. This article presents the consensus obtained at a meeting convened to consider the evidence in these areas. The aim of the article is to provide outcome statements to guide clinical practice, with an assessment of the supporting evidence for each statement.

Method

Working groups considered the published evidence in the areas of diagnosis, assessment of severity, nonoperative treatment, and surgical treatment of severe acute pancreatitis. Outcome statements were defined to summarize the conclusions on each point considered. The findings were discussed and agreed on by all participants. A careful assessment was made of the strength of the available evidence (proven, probable, possible, unproven, or inappropriate).

Findings and Conclusions

There is reliable evidence to support much current practice. Clear guidance can be given in most areas examined, and several areas were identified where further investigation would be helpful. Diagnosis using plasma concentrations of pancreatic enzymes is reliable. Rapid advances are taking place in the assessment of severity. Several new therapeutic strategies show real promise for the reduction of morbidity and mortality rates. Surgical debridement is required for infected pancreatic necrosis, but is less often necessary for sterile necrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wilson C, Imrie CW. Deaths from acute pancreatitis. Why do we miss the diagnosis so frequently?Int J Pancreatol 1988; 3: 273–282.

    PubMed  CAS  Google Scholar 

  2. Lankish PG. Undetected fatal acute pancreatitis; why is the disease so frequently overlooked?Am J Gastroenterol 1991; 86: 322–326.

    Google Scholar 

  3. Williamson RCN. Early assessment of severity of acute pancreatitis.Gut 1984; 25: 1331–1339.

    PubMed  CAS  Google Scholar 

  4. Glazer G, Dudley HAF. The surgical managment of acute pancreatitis.Ann R Coll Surg Engl 1987; 69: 249, 250.

    PubMed  CAS  Google Scholar 

  5. Buchler M, Uhl W, Beger HG. Complications of acute pancreatitis and their management. Curr Opinion Gen Surg 1993; 282–286.

  6. Bradley EL. A clinically based classification system for acute pancreatitis: Summary of the Atlanta symposium.Arch Surg 1993; 128: 586–590.

    PubMed  Google Scholar 

  7. Hariri M. Slivka A, Carr-locke DL, Banks PA. Pseudocyst drainage predisposes to infection when pancreatic necrosis is undiagnosed.Am J Gastroenterol 1994, 89: 1781–1794.

    PubMed  CAS  Google Scholar 

  8. Buchler M, Uhl W, Malfertheiner P. Elastase 1 in acute pancreatitis, inAcute Pancreatitis, Beger HG, Buchler M. (eds.), Springer-Verlag Berlin, Heidelberg, 1987; pp. 110–117.

    Google Scholar 

  9. Saccetti L, Cavalcanti E, Cerasuolo S, et al. Evaluation of pancreatic amylase immunoassay in acute pancreatitis.Clin Chim Acta 1989; 183: 95–100.

    Google Scholar 

  10. Bowen M, Cooper EH, McMahon MJ. The diagnosis of acute pancreatitis enhanced sensitivity from an ELISA assay oflipase.Biomed Pharmacother 1983; 37: 395–398.

    PubMed  CAS  Google Scholar 

  11. Gullo L, Ventrucci M, Pezzilli R, Plate L, Naldoni P. Diagnostic value of serum elastase 1 in pancreatic disease.Br J Surg 1987; 74: 44–47.

    PubMed  CAS  Google Scholar 

  12. Ventrucci M, Pezzilli R, Gullo L, Plate L, Sprovieri G, Barbara L. Role of pancreatic enzyme assays in diagnosis of pancreatic disease.Dig Dis Sci 1989; 34: 39–45.

    PubMed  CAS  Google Scholar 

  13. Kazmierczak SC, Catron PG, VanLente F. Diagnostic accuracy of pancreatic enzymes evaluated by used of multivariate data analysis.Clin Chem 1993; 39: 1960–1965.

    PubMed  CAS  Google Scholar 

  14. Dominguez-Munoz JE, Malfertheiner P. Diagnosis of acute pancreatitis, inAdvances in Pancreatic Disease, Dervenis, CG (ed.), Thieme-Verlag Stuttgart, New York, 1996; pp. 124–131.

    Google Scholar 

  15. McKay AJ, Imrie CW, O’Neill J, Duncan JG. Is an early ultrasound scan of value in acute pancreatitis?Br J Surg 1982; 69: 369–372.

    PubMed  CAS  Google Scholar 

  16. Moosa AR. The impact of computer tomography and ultrasound on surgical practice.Bull Am Coll Surg 1982; 67: 10–4.

    Google Scholar 

  17. Freeny PC. Radiology of acute pancreatitis, inAcute Pancreatitis, Glazer G, Ranson JHC (eds.), Balliere Tindall, London 1988; pp. 275–302.

    Google Scholar 

  18. Balthazar EJ. CT diagnosis and staging of acute pancreatitis.Radiol Clin North Am 1989; 27: 19–37.

    PubMed  CAS  Google Scholar 

  19. McMahon MJ, Playforth MJ, Pickford IR. A comparative study of methods for the prediction of severity of attacks of acute pancreatitis.Br J Surg 1980; 69: 29–32.

    Google Scholar 

  20. Corfield AP, Cooper MJ, Williamson RCN, et al. Prediction of severity in acute pancreatitis: a prospective comparison of three prognostic indices.Lancet 1985; ii: 403–406.

    Google Scholar 

  21. Dickson AP, Imrie CW. The incidence and prognosis of body wall ecchymosis in acute pancreatitis.Surg Gynaecol Obstet 1984; 159:343–347.

    CAS  Google Scholar 

  22. Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis.Surg Gynaecol Obstet 1974; 139:69–81.

    CAS  Google Scholar 

  23. Ranson JHC. The timing of biliary surgery in acute pancreatitis.Ann Surg 1979; 189: 654–662.

    PubMed  CAS  Google Scholar 

  24. Imrie CW, Benjamin IS, McKay AJ, McKenzie I, O’Neill J, Blumgart LH. A single centre double blind trial of Trasylol therapy in primary acute pancreatitis.Br J Surg 1978; 65:337–341.

    PubMed  CAS  Google Scholar 

  25. Osbourne DH, Imrie CW, Carter DC. Biliary surgery in the same admission for gallstone associated acute pancreatitis.Br J Surg 1981; 68: 758–761.

    Google Scholar 

  26. Blarney SL, Imrie CW, O’Neill J, Gilmour WM, Carter DC. Prognostic factors in acute pancreatitis.Gut 1984; 25: 1340–1346.

    Google Scholar 

  27. Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis.Lancet 1989; 11:201–205.

    Google Scholar 

  28. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE-II clinical assessment and multiple factor scoring systems.Br J Surg 1990; 77: 1260–1264.

    PubMed  CAS  Google Scholar 

  29. Toh SKC, Walters J, Johnson CD. APACHE-O a new predictor of severity in acute pancreatitis.Gut 1996; 38(Suppl 1): A35.

    Google Scholar 

  30. Lankisch PG, Schirren CA. Increased body weight as a prognostic parameter for complications in the course of acute pancreatitis.Pancreas 1990; 5: 626–629.

    PubMed  CAS  Google Scholar 

  31. Porter KA, Banks PA. Obesity as a predictor of severity in acute pancreatitis.Int J Pancreatol 1991; 10: 247–252.

    PubMed  CAS  Google Scholar 

  32. Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis.Br J Surg 1993; 80: 484–486.

    PubMed  CAS  Google Scholar 

  33. Talamini G, Bassi C, Falconi M, et al. Risk of death from acute pancreatitis.Int J Pancreatol 1996; 19: 15–24.

    PubMed  CAS  Google Scholar 

  34. Pezzilli R, Billi P, Baraket P. Peripheral leukocyte count and chest X-ray in the early assessment of the severity of acute pancreatitis.Digestion 1996; 57: 25–32.

    Google Scholar 

  35. Talamini G, Uomo G, Pezzilli R, et al. Renal function and chest X-rays in the assessment of 539 acute pancreatitis patients.Gut 1997; 41: A136.

    Google Scholar 

  36. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing a diagnosis.Radiology 1990; 174: 331–336.

    PubMed  CAS  Google Scholar 

  37. Vesentini S, Bassi C, Talamini G, Cavaiini G, Campedilli A, Pederzoli P. Prospective comparison of C-reactive protein level, Ranson score and contrast enhanced computed tomography in the prediction of septic complications of acute pancreaitis.Br J Surg 1993; 80: 755–757.

    PubMed  CAS  Google Scholar 

  38. Kemppainen E, Sainio V, Haapiainen R, Kivisaari L, Kivilaakso E, Puolakkainen P. Early localisation of necrosis by contrast enhanced computed tomography can predict outcome in severe acute pancreatitis.Br J Surg 1996; 83: 924–929.

    PubMed  CAS  Google Scholar 

  39. Moulton IS. The radiologic assessment of acute pancreatitis and its complications.Pancreas 1991; 6(Suppt 1): 13–22.

    Google Scholar 

  40. Nuutinen, P, Kivisaari L, Schroder T. Contrast enhanced computed tomography and microangiography of the pancreas in acute human hemorrhagic/necrotizing pancreatitis.Pancreas 1988; 3: 53–60.

    PubMed  CAS  Google Scholar 

  41. London NJ, Leese T, Lavelle JM, et al. Rapid-bolus contrast enhanced dynamic computed tomography in acute pancreatitis: a prospective study.Br J Surg 1991; 78: 1452–1456.

    PubMed  CAS  Google Scholar 

  42. Bradley EL, Murphy F, Ferguson C. Prediction of pancreatic necrosis by dynamic pancreatography.Ann Surg 1989; 210:495–503.

    PubMed  Google Scholar 

  43. Larvin M, Chalmers AG, McMahon MJ. Dynamic contrast enhanced CT: A precise technique for the indetification of pancreatic necrosis.Br Med J 1990; 300: 1425–1428.

    CAS  Google Scholar 

  44. Pickford IR, Blackett RI, McMahon MJ. Early assessment of severity using peritoneal lavage.Br Med J 1977; ii: 1377–1379.

    Google Scholar 

  45. Sainio V, Puolakkainen P, Kempainnen E, et al. Serum trypsinogen-2 in the prediction of outcome in acute necrotizing pancreatitis.Scand J Gastroenterol 1996; 31: 818–824.

    PubMed  CAS  Google Scholar 

  46. Nevalainen TJ. The role of phospholipase A in acute pancreatitis.Scand J Gastroenterol 1980; 15: 641–650.

    Article  PubMed  CAS  Google Scholar 

  47. Büchler M, Malfertheiner P, Schädlich H, Nevalainen TJ, Freiss H, Beger HG. Role of phospholipase A2 in human acute pancreatitis.Gastroenterology 1989; 97: 1521–1526.

    PubMed  Google Scholar 

  48. Bird NC, Goodman AJ, Johnson AG. Serum phospholipase A2 activity in acute pancreatitis: an early guide to severity.Br J Surg 1989; 76: 731, 732.

    PubMed  CAS  Google Scholar 

  49. Pezzilli R, Billi P, Migliori M, Gullo L. Clinical value of pancreatitis associated protein in acute pancreatitis.Am J Gastroenterol 1997; 92: 1887–1890.

    PubMed  CAS  Google Scholar 

  50. Gudgeon M, Heath DI, Hurley P, et al. Trypsinogen activation peptide assay in the early severity prediction of acute pancreatitis.Lancet 1990; 335: 4–8.

    PubMed  CAS  Google Scholar 

  51. Tenner S, Fernandez-del-Castillo C, Warshaw A, et al. Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis.Int J Pancreatol 1997; 21: 105–110.

    PubMed  CAS  Google Scholar 

  52. Beechey Newman N, Rae D, Sumar N, Hermon Taylor J. Stratification of severity in acute pancreatitis by assay of trypsinogen and 1-prophospholipase A2 activation peptides.Digestion 1995; 56: 271.

    Google Scholar 

  53. Appelros S, Thim L, Borgstrom A. Activation peptide of carboxypeptidase B in serum and urine in acute pancreatitis.Gut 1998; 42: 97–102.

    PubMed  CAS  Google Scholar 

  54. Ton SKC, Johnson CD, Appelros S, Petersen U, Borgstrom A. Carboxypeptidase activation peptide and IR anionic trypsinogen as markers of severity in acute pancreatitis.Digestion 1997; 58 (Suppl 2): 34.

    Google Scholar 

  55. Gross H, Leser HG, Anderson RM, et al. Interleukin-8 and neutrophil activation in acute pancreatitis.Eur J Clin Invest 1992; 22:200–203.

    PubMed  CAS  Google Scholar 

  56. Pezzilli R, Billi P, Miniero R, et al. Serum interleukin 6, interleukin 8 and α2 microglobulin in early assessment of severity of acute pancreatitis. Comparison with C reactive protein.Dig Dis Sci 1995; 40: 2341–2348.

    PubMed  CAS  Google Scholar 

  57. Leser HG, Gross H, Scheibenbogen C, et al. Elevation of interleukin 6 concentration precedes acute phase response and reflects severity in acute pancreatitis.Gastroenterology 1991; 101: 782–785.

    PubMed  CAS  Google Scholar 

  58. Viedma JA, Perez-Mateo M, Dominguez JE, Carballo F. Role of interleukin 6 in acute pancreatitis.Gut 1992; 33: 1264–1267.

    PubMed  CAS  Google Scholar 

  59. Heath DI, Cruikshank A, Gudgeon M, Jehanli A, Shenkin A, Imrie CW. Role of interleukin 6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis.Gut 1993; 34: 41–45.

    PubMed  CAS  Google Scholar 

  60. Rau B, Steinbach G, Mayer J, Gansauge F, Grünert A, Beger HG. The role of interleukin-8 in the severity assessment of septic complications in necrotising pancreatitis.Digestion 1997; 58 (Suppl 2): 11.

    Google Scholar 

  61. Pezzilli R, Billi P, Miniero R, Barakat B. Serum interleukin- 10 in human acute pancreatitis.Dig Dis Sci 1997; 42: 1469–1472.

    PubMed  CAS  Google Scholar 

  62. Exley AR, Leese T, Holliday MP, Swann RA, Cohen J. Endotoxaemia and serum tumour necrosis factor as prognostic markers in severe pancreatitis.Gut 1992; 33: 1126–1128.

    PubMed  CAS  Google Scholar 

  63. Messmann H, Grune S. TNF and TNF receptors P55 and P75 in mild and severe acute pancreatitis.Gastroenterology 1997; 112: A464.

    Google Scholar 

  64. Paajainen H, Laato M, Jaakkola M, Pulkki A, Niinikoski J, Nordback I. Serum tumour necrosis factor compared with C-reactive protein in the assessment of severity of acute pancreatitis.Br J Surg 1995; 82: 271–273.

    Google Scholar 

  65. de Beaux AC, Goldie AS, Ross JA, Carter DC, Fearon KHC. Serum concentration of inflammatory mediators related to organ failure with acute pancreatitis.Br J Surg 1996; 83: 349–353.

    PubMed  Google Scholar 

  66. Gross V, Schölmerich J, Leser HG, et al. Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute phase protein C reactive protein, αl-antitrypsin and protease inhibitor α2-macroglobulin.Dig Dis Sci 1990; 35: 97–105.

    PubMed  CAS  Google Scholar 

  67. Uhl U, Büchler M, Malfertheiner P, Martini M, Beger HG. PMN elastase in comparison with CRP, antiproteases and LDH as indicators of necrosis in human acute pancreatitis.Pancreas 1991; 6: 253–259.

    PubMed  CAS  Google Scholar 

  68. Dominguez-Muñoz JE, Carballo F, Garcia MJ. Clinical usefulness of polymorphonuclearelastase in predicting the severity of acute pancreatitis: results of a multicentre study.Br J Surg 1991; 78: 1230–1234.

    PubMed  Google Scholar 

  69. Glazer G, Mann D. UK guidelines for the management of acute pancreatitis.Gut 1998; 42 (Suppl 2).

  70. Bassi C, Falconi M, Caldiron E, Salvia R, Bertazzoni Minelli E, Pederzoli P. Use of antibiotics in necrotizing pancreatitis.Problems Gen Surg 1997; 13: 80–85.

    Google Scholar 

  71. Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis withImpenem.Surg Gynecol Obstet 1993; 176:480–483.

    PubMed  CAS  Google Scholar 

  72. Saino V, Kemppainem E, Piolakkainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis.Lancet 1995; 346: 663–667.

    Google Scholar 

  73. Takeda K, Matsuno S, Sunamura M, Kakugawa Y. Cotinuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis.Am J Surg 1996; 171:394–398.

    PubMed  CAS  Google Scholar 

  74. Delcenserie R, Yzet T, Ducroix JP. Prophylactic antibiotic in treatment of severe acute alcoholic pancreatitis.Pancreas 1996; 13: 198–201.

    PubMed  CAS  Google Scholar 

  75. Luiten EJT, Hop WCJ, Lange JF, Bruining HA. Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.Ann Surg 1995; 222: 57–65.

    PubMed  CAS  Google Scholar 

  76. Schwarz M, Isenmann R, Meyer H, Beger HG. Antibiotic use in necrotizing pancreatitis. Results of a controlled study.Deutsche Medizinsche Wochenschrift 1997; 122: 356–361.

    Article  CAS  Google Scholar 

  77. Bassi C. Infected pancreatic necrosis.Int J Pancreatol 1994; 16: 1–10.

    PubMed  CAS  Google Scholar 

  78. Johnson CD. Antibiotic prophylaxis in severe acute pancreatitis.Br J Surg 1996; 83: 883, 884.

    PubMed  CAS  Google Scholar 

  79. Powell JJ, Miles R, Siriwardena A. Antibiotic prophylaxis in the initial management of severe acute pancreatitis.Br J Surg 1998; 85:582–587.

    PubMed  CAS  Google Scholar 

  80. Carr-Locke DL. Role of endoscopy in gallstone pancreatitis.Am J Surg 1993; 163: 519–521.

    Google Scholar 

  81. Fan ST, La SC, Mok FPT, Lo CH, Rheng SS, Wong J. Earlytreatment of acute biliary pancreatitis by endoscopic papillotomy.N Engl J Med 1993; 328: 228–232.

    PubMed  CAS  Google Scholar 

  82. Neoptolemos JP, London NJ, James D, Carr-Locke DL, Bailey IA, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conventional treatment for acute pancreatitis due to gallstones.Lancet 1988; 11: 979–983.

    Google Scholar 

  83. Nowak A, Nowakowsca-Dulawa E, Marek TA, Rybicka J. Final results of the prospective, randomized, controlled study on endoscopic sphinterotomy versus conventional management in acute biliary pancreatitis.Gastrenterology 1995; 108: (A380).

    Google Scholar 

  84. Folsch UR, Nitsche R, Ludtke R, Hilgers RA, Creutzfeldt W, the German Group on Acute Pancreatitis. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis.N Engl J Med 1997; 336: 237–242.

    PubMed  CAS  Google Scholar 

  85. Koretz R. Nutritional support in pancreatitis: feeding an organ that has eaten itself.Ann Gastmintest Dis 1993; 4: 99–115.

    Google Scholar 

  86. Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos CA. Enteral feeding is superior to parenterai nutrition in severe acute pancreatitis: results of a randomized propsective trial.Br J Surg 1997; 84: 1665–1669.

    PubMed  CAS  Google Scholar 

  87. Windsor AJC, Kanwar S, Li AJK, et al. Compared with parenterai nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis.Gut 1998; 42: 431–435.

    Article  PubMed  CAS  Google Scholar 

  88. Kingsnorth AN, Galloway SW, Formela LJ. Randomised double-blind phase 11 trial of lexipafant, a platelet-actvating factor antagonist, in human acute pancreatitis.Br J Surg 1995: 82: 1414–1420.

    PubMed  CAS  Google Scholar 

  89. McKay CJ, Curran F, Sharpies C, Baxter JN, Imrie CW. Prospective placebo-controlled randomized trial of lexipafant in predicted severe acute pancreatitis.Br J Surg 1997; 84: 1239–1243.

    PubMed  CAS  Google Scholar 

  90. Toh SKC (for the British Acute Pancreatitis Study Group). Lexipaphant, a platelet activation factor antagonist reduces mortality in a randomised placebo-controlled study in patients with severe acute pancreatitis.Gut 1997; 40 (Suppl 1): A12.

    Google Scholar 

  91. Buchler M, Malfertheiner P, Uhl W, Scholmerich J, Stock-mann F, Adler G, et al. Gabexate mesilate in human acute pancreatitis.Gastroenterology 1993; 104: 1165–1170.

    PubMed  CAS  Google Scholar 

  92. Pederzoli P, Cavallini G, Falconi M, Bassi C. Gabexate mesilate vs aprotinin in human acute pancreatitis (GA.ME.P.A.): A prospective randomized double-blind multicenter study.Int J Pancreatol 1993; 14: 117–124.

    PubMed  CAS  Google Scholar 

  93. Messori A, Rampazzo R, Scroccaro G, Olivato R, Bassi C, Falconi M et al. Effectiveness of gabexate mesilate in acute pancreatitis, a metaanaly sis.Dig Dis Sci 1995; 40:734–738.

    PubMed  CAS  Google Scholar 

  94. Carballo F, Domingues E, Fernandes-Calvet L, et al. Is somatostatin useful in the treatment of acute pancreatitis? A metaanalysis.Digestion 1994; 55: 16–19.

    Google Scholar 

  95. McKay CJ, Baxter JN, Imrie CW. A randomized, controlled trial of octreotide in moderate to severe acute pancreatitis.Int J Pancreatol 1997; 21: 13–21.

    PubMed  CAS  Google Scholar 

  96. Uhl W, Malfertheiner P, Adler G, et al. The role of octreotide in human acute pancreatitis. A multicenter study.Digestion 1997; 58: 9 (A32).

    Google Scholar 

  97. Cavallini G, Tittobello A, Frulloni L, Masci E, Mariani A, Di Francesco V, et al. Gabexate for the prevention of pancreatic damage related to endoscopic cholangiopancreatography.N Engl J Med 1996; 335: 919–923.

    PubMed  CAS  Google Scholar 

  98. Poston GJ, Wiliamson CN. Surgical managment of acute pancreatitis.Br J Surg 1990; 77; 5–12.

    PubMed  CAS  Google Scholar 

  99. D’Egidio A, Schein M. Surgical strategies in the treatment of pancreatitc necrosis and infection.Br J Surg 1991; 78: 133–137.

    PubMed  CAS  Google Scholar 

  100. Farthmann EH, Lausen M, Schoffel U. Indications for surgical treatment of acute pancreatitis.Hepatogastroenterology 1993; 40: 556–562.

    PubMed  CAS  Google Scholar 

  101. Uomo G, Visconti M, Manes G, et al. Nonsurgical treatment of acute necrotizing pancreatitis.Pancreas 1996; 12; 142–148.

    PubMed  CAS  Google Scholar 

  102. Bradley EL, Allen K. A prospective longitudinal study of observation versus surgical intervention in the managment of necrotizing pancreatitis.Am J Surg 1991; 161: 19–24.

    PubMed  Google Scholar 

  103. de Beaux AC, Palmer KR, Carter DC. Factors influecing morbidity and mortality in acute pancreatitis: an analysis of 279 cases.Gut 1995; 37: 121–126.

    PubMed  Google Scholar 

  104. Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R. Necrosectomy and postoperative local lavage in necrotizing pancreatitis.Br J Surg 1988; 75: 207–212.

    PubMed  CAS  Google Scholar 

  105. Renner IG, Savage WT III, Pantoja JL. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases.Dig Dis Sci 1985; 30: 1005–1018.

    PubMed  CAS  Google Scholar 

  106. Karimagni I, Kathaleen A, Porter A, Langevin RE, Banks PA. Prognostic factors in sterile pancreatic necrosis.Gastroenterology 1992; 103: 1636–1640.

    Google Scholar 

  107. Foitzik T, Klar E, Buhr HJ, Herfarth C. Improved survival in acute necrotizing pancreatitis despite limiting the indications for surgical debvidement.Eur J Surg 1995; 161: 187–192.

    PubMed  CAS  Google Scholar 

  108. Pederzoli P, Cavallini G, Bassi C, Falconi M. Sterile necrosis: surgical indications? inFacing Pancreatic Dilemma, Pederzolli P, Bassi C, Cavallini G (eds.), Springer-Verlag, Heidelberg, 1994, pp. 43–65.

    Google Scholar 

  109. Fernandez-Cruz L, Navarro S, Valderama R, et al. Acute necrotizing pancreatitis: a multicentre study.Hepatogastroenterology 1994; 41: 185–189.

    PubMed  CAS  Google Scholar 

  110. Gerzof SG, Banks PA, Robbins AH, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration.Gastroenterology 1987; 93: 1315–1320.

    PubMed  CAS  Google Scholar 

  111. Banks PA, Gerzof SG, Langevin RE, Silverman SG, Sica GT, Hughes MD. CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome.Int J Pancreatol 1995; 18: 265–270.

    PubMed  CAS  Google Scholar 

  112. Rau B, Pralle U, Mayer JM, Beger HG. The role of fineneedle aspiration in the diagnosis of infected pancreatic necrosis: an 8 year experience.Br J Surg 1998; 85:179–184.

    PubMed  CAS  Google Scholar 

  113. Bradley EL. A fifteen year experience with open drainage for infected pancreatic necrosis.Surg Gynecol Obstet 1993; 177:215–222.

    PubMed  Google Scholar 

  114. Wilson C, McArdle CS, Carter DC, Imrie CW. Surgical treatment of acute necrotizing pancreatitis.Br J Surg 1988; 75:1119–1123.

    PubMed  CAS  Google Scholar 

  115. Farkas G, Marton J, Mandi Y, Szederkenyi E. Surgical strategy and managment of infected pancreatic necrosis.Br J Surg 1996; 83: 930–933.

    PubMed  CAS  Google Scholar 

  116. Teerenhovi O, Nordback I, Eskola J. High volume lesser sac lavage in acute necrotizing pancreatitis.Br J Surg 1989; 76:370–373.

    PubMed  CAS  Google Scholar 

  117. Johnson CD. Timing of intervention in acute pancreatitis. Postgrad Med J 1993; 69: 509–515.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 1st Department of Surgery, Konstantopoulion, “Agia Olga” Hospital, N. Ionia, Athens, Greece

    C. Dervenis

  2. Southampton General Hospital, Southampton, UK

    C. D. Johnson

  3. Borgo Roma Hospital, Verona, Italy

    C. Bassi

  4. The Buffalo General Hospital, Buffalo, NY

    E. Bradley

  5. Glasgow Royal Infirmary, Glasgow, UK

    C. W. Imrie

  6. The General Infirmary, Leeds, UK

    M. J. McMahon

  7. Yale Universtity, New Haven, CT

    I. Modlin

Authors
  1. C. Dervenis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. D. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Bassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. W. Imrie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. J. McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I. Modlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Dervenis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dervenis, C., Johnson, C.D., Bassi, C. et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Int J Pancreatol 25, 195–210 (1999). https://doi.org/10.1007/BF02925968

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02925968

Keywords

Search

Navigation