Opinion from the United Kingdom

Abstract

What is pancreatic necrosis? Whilst the diagnosis of acute and chronic pancreatitis have been carefully defined, descriptive terms to describe the local complications of acute pancreatitis, such as pseudocyst, abscess and necrosis, are usually employed without clear definitions. There is much confusion regarding the use of these terms. What is a phlegmon, and how is it differentiated from pancreatic necrosis? What is the difference between a pancreatic abscess and a infected pseudocyst or infected necrosis? Because of this confusion, a group of forty enthusiasts assembled in Atlanta between the 11th and 13th September 1992 to establish a clinically based classification system which would make the meaning of these terms clear [1]. The following definitions emerged:

• Acute fluid collections: In the setting of pancreatitis these occur early in the course of acute pancreatitis, are located in or near the pancreas and always lack a wall of granulation or fibrous tissue. These fluid collections are com- monly seen on ultrasound or CT scans of the pancreas during the first few days of an attack of pancreatitis.

• Pancreatic necrosis: Diffuse or focal area(s) of nonviable pancreatic parenchyma which is typically associated with peripancreatic fat necrosis. This term embraces both sterile and infected pancreatic necrosis.

• Pseudocyst: A collection of pancreatic juice enclosed by a non-epithelialized wall which arises as a consequence of acute pancreatitis, pancreatic trauma or chronic pancreatitis.

• Pancreatic abscess: A circumscribed intra-abdominal collection of pus, usually in proximity to the pancreas, containing little or no pancreatic necrosis, which arises as a consequence of acute pancreatitis or pancreatic trauma.