From the Research
Introduction to Severe Pancreatitis Management
Severe pancreatitis is a complex clinical syndrome associated with a high mortality rate, requiring early prediction, fluid resuscitation, organ support, enteral nutrition, and prevention of abdominal compartment syndrome as cornerstones of its management 1, 2.
Current Management Strategies
The current management of severe pancreatitis involves:
- Aggressive intravenous fluid resuscitation, with caution to prevent intra-abdominal hypertension and volume overload in patients with vascular leak syndrome 1, 2
- Enteral nutrition, considered a cornerstone in management, especially in patients with severe acute pancreatitis 1, 2
- Analgesic administration for pain control 2, 3
- Early identification and intervention to prevent patient morbidity and mortality 3
Role of Antibiotics and Infection Management
Antibiotics are no longer used for prophylaxis in severe acute pancreatitis unless infection is documented 1. In cases of suspected superimposed infection, antibiotics should be considered 4.
Management of Pancreatic Complications
Pancreatic fluid collections, including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis, can be managed with a progressive approach, starting with initial draining for infection, followed by less invasive techniques 5, 2, 4. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis 2, 4.
Surgical and Interventional Approaches
Surgery is no longer an early intervention and may not be needed, with interventional radiologic and endoscopic methods seeming to be safer with at least as good survival outcomes 5, 4. The acute care surgeon should maintain a skill set that includes minimally invasive techniques to successfully manage these patients 4.
Nutrition and Cholecystectomy
Optimal nutrition is crucial, with early enteral nutrition recommended 1, 2, 4. In biliary pancreatitis, cholecystectomy prior to discharge is recommended in mild disease and within 8 weeks of necrotizing pancreatitis 4.
Conclusion
The management of severe pancreatitis requires a multidisciplinary approach, with a strong understanding of clinical decisions and options for intervention. Early prediction, fluid resuscitation, organ support, enteral nutrition, and prevention of abdominal compartment syndrome are essential components of management, along with a progressive approach to managing pancreatic complications and a skill set that includes minimally invasive techniques 1, 5, 2, 3, 4.