Complications of acute pancreatitis and their management.

Severe acute pancreatitis remains a disease with high hospital mortality. In the period from 1991 to 1992, several articles dealt with the complicated form of acute pancreatitis. There is no question that necrosis of the pancreas and fatty tissue in the peripancreatic spaces and particularly secondary infection of necrosis are the most important prognostic factors for these patients. Indications for surgery and the efficacy of conservative treatment of acute pancreatitis (including interventional measures) have not been clearly determined. Most surgeons would elect to operate on a patient with multiorgan failure caused by infected necrosis, however. Another major question is the type of surgery to be performed: closed continuous lavage of the lesser sac and retroperitoneal cavities, staged relaparotomy, or open packing. This review concentrates on articles pertaining to complicated acute pancreatitis in humans.