What is edematous pancreatitis?

From the Guidelines

Edematous pancreatitis is a mild form of acute pancreatitis characterized by inflammation and swelling of the pancreas, with no organ failure, local or systemic complications, and usually resolves in the first week 1. This condition is also known as interstitial edematous pancreatitis, and it is the most common form of acute pancreatitis.

• The pancreas becomes inflamed due to premature activation of digestive enzymes within the organ itself, causing self-digestion of pancreatic tissue.
• The inflammation leads to fluid accumulation in and around the pancreas, resulting in edema.
• Common causes include gallstones, alcohol consumption, certain medications, high triglyceride levels, and some infections.
• Symptoms typically include severe upper abdominal pain that may radiate to the back, nausea, vomiting, fever, and elevated pancreatic enzyme levels in the blood (amylase and lipase).
• Treatment is primarily supportive, involving fasting to rest the pancreas, intravenous fluids, pain management with medications, and addressing the underlying cause.
• Most cases resolve within a few days with appropriate management, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1.
• Edematous pancreatitis is distinguished from the more severe necrotizing pancreatitis, which involves tissue death and carries a higher risk of complications such as infection, pseudocysts, or organ failure. According to the updated Atlanta classification 2012, the severity of acute pancreatitis is classified as mild, moderate, or severe, with edematous pancreatitis being the mild form 1.

From the Research

Definition and Characteristics of Edematous Pancreatitis

• Edematous pancreatitis, also known as interstitial-edematous pancreatitis, is a form of acute pancreatitis characterized by inflammation of the pancreas and parenchymal edema without necrosis 2, 3.
• It is a medical emergency that can be caused by various factors, including gallstones, alcohol consumption, medication, and rare cases of parasitic infections such as Fasciola hepatica 4.
• The disease spectrum of acute pancreatitis varies from mild edematous to severe disease with fatal complications 3.

Diagnosis and Treatment

• The diagnosis of edematous pancreatitis is primarily based on signs, symptoms, and laboratory test findings, as well as imaging findings such as computed tomography and magnetic resonance imaging 2, 5.
• Treatment priorities include intravenous fluid resuscitation, analgesia, and enteral nutrition, with critical care and organ support, parenteral nutrition, antibiotics, and pancreatic exocrine and endocrine replacement therapy as needed 6.
• Patients with local complications may require referral to specialist tertiary centers for further management, which may include drainage and/or necrosectomy 6.

Comparison with Necrotizing Pancreatitis

• Edematous pancreatitis has a lower mortality rate compared to necrotizing pancreatitis, with a hospital mortality rate of 5.5% versus 30% respectively 2.
• Necrotizing pancreatitis is a more severe form of acute pancreatitis characterized by necrosis in and around the pancreas, and is associated with high rates of morbidity and mortality 5.
• The diagnosis and severity assessment of necrotizing pancreatitis are based in large part on imaging findings, and treatment may involve a "step-up" approach using imaging-guided percutaneous catheter drainage of fluid collections prior to endoscopic or surgical necrosectomy 5.