Severe acute pancreatitis: a review.
BACKGROUND
Severe acute pancreatitis continues to be a difficult problem in clinical management. This paper provides a contemporary definition of the condition and explores the controversial issues that surround its diagnosis and management.


METHODS
Review of pertinent English language literature.


RESULTS
The use of various imaging techniques is discussed, with particular emphasis on the assessment of pancreatic necrosis and the evaluation of choledocholithiasis as a cause of the pancreatitis. Prophylactic antibiotics generally are discouraged and early and aggressive nutritional support is advocated. Delayed surgical intervention is recommended to avoid the severe consequences associated with prematurely early attempts at resection of the infarcted pancreas and adjacent retroperitoneal fat.


CONCLUSIONS
Better quality evidence, especially regarding the utility or lack thereof of antibiotic prophylaxis, is beginning to inform optimal management of patients with severe acute pancreatitis.
Charbonney
Emmanuel
E
Department of Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
Nathens
Avery B
AB
D019072:Antibiotic Prophylaxis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003646:Debridement; D042882:Gallstones / Q000150:complications / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D020535:Video-Assisted Surgery