Acute Pancreatitis

  • Carlo Staudacher
  • Gianpaolo Balzano
  • Nicolò Pecorelli
  • Vincenzo Mandalà
Part of the Updates in Surgery book series (UPDATESSURG)


The incidence of acute pancreatitis (AP) has increased over the last two decades to become a growing problem both in the United States and Europe [1, 2]. Between 1994 and 2001, the incidence of first-time attack in California increased from 33 to 44 per 100,000 adults [2] and at present AP accounts for more than 200,000 hospital admissions every year in the USA [3]. Data from the Italian Ministry of Health register show a total of 20,174 admissions for AP in Italy in 2005.


Acute Pancreatitis Acute Pancreatitis Severe Acute Pancreatitis Pancreatic Necrosis Abdominal Compartment Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Yadav D, Lowenfels AB (2006) Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 33:323–330PubMedCrossRefGoogle Scholar
  2. 2.
    Frey CF, Zhou H, Harvey DJ, White RH (2006) The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas 33:336–344PubMedCrossRefGoogle Scholar
  3. 3.
    Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States. Part III: liver, biliary tract, and pancreas. Gastroenterology 136:1134–1144PubMedCrossRefGoogle Scholar
  4. 4.
    Lund H, Tonnesen H, Tonnesen MH, Olsen O (2006) Long-term recurrence and death rates after acute pancreatitis. Scand J Gastroenterol 41:234–238PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley EL 3rd (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 13 1992. Arch Surg 128: 586–590PubMedCrossRefGoogle Scholar
  6. 6.
    Uomo G, Pezzilli R, Gabbrielli A et al (2007) Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. Dig Liver Dis 39:829–837PubMedCrossRefGoogle Scholar
  7. 7.
    Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–613PubMedCrossRefGoogle Scholar
  8. 8.
    Pezzilli R, Zerbi A, Di Carlo V et al (2010) Working Group of the Italian Association for the Study of the Pancreas on Acute Pancreatitis (2010). Practical guidelines for acute pancreatitis. Pancreatology 10:523–535Google Scholar
  9. 9.
    Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland (2005) UK guidelines for the management of acute pancreatitis. Gut 54:1–9CrossRefGoogle Scholar
  10. 10.
    Sauerland S, Agresta F, Bergamaschi R et al (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29PubMedCrossRefGoogle Scholar
  11. 11.
    Aboulian A, Chan T, Yaghoubian A et al (2010) Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study. Ann Surg 251:615–619PubMedCrossRefGoogle Scholar
  12. 12.
    Sinha R (2008) Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice? HPB (Oxford) 10:332–335CrossRefGoogle Scholar
  13. 13.
    Nebiker CA, Frey DM, Hamel CT et al (2009) Early versus delayed cholecystectomy in patients with biliary acute pancreatitis. Surgery 145:260–264PubMedCrossRefGoogle Scholar
  14. 14.
    De Rai P, Zerbi A, Castoldi L et al (2010) Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study. HPB 12:597–604PubMedCrossRefGoogle Scholar
  15. 15.
    Petrov MS, Savides TJ (2009) Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. Br J Surg 96:967–974PubMedCrossRefGoogle Scholar
  16. 16.
    Acosta JM, Katkhouda N, Debian KA et al (2006) Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg 243:33–40PubMedCrossRefGoogle Scholar
  17. 17.
    Ayub K, Imada R, Slavin J (2010). Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. Cochrane Database Syst Rev 1:CD003630PubMedGoogle Scholar
  18. 18.
    Rogers SJ, Cello JP, Horn JK et al (2010) Prospective randomized trial of LC+LCBDE vs ERCP/ S+LC for common bile duct stone disease. Arch Surg 145:28–33PubMedCrossRefGoogle Scholar
  19. 19.
    Clayton ES, Connor S, Alexakis N, Leandros E (2006) Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 93:1185–1191PubMedCrossRefGoogle Scholar
  20. 20.
    Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2:CD003327PubMedGoogle Scholar
  21. 21.
    Uhl W, Warshaw A, Imrie C et al (2002) International Association of Pancreatology: IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573PubMedCrossRefGoogle Scholar
  22. 22.
    Kelly TR, Wagner DS (1988). Gallstone pancreatitis: a prospective randomized trial of the timing of surgery. Surgery 104:600–605PubMedGoogle Scholar
  23. 23.
    Petrov MS, van Santvoort HC, Besselink MG et al (2008) Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg 247:250–257PubMedCrossRefGoogle Scholar
  24. 24.
    Banks PA, Freeman ML, and the Practice Parameters Committee of the American College of Gastroenterology (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101:2379–2400PubMedCrossRefGoogle Scholar
  25. 25.
    van Santvoort HC, Besselink MG, de Vries AC et al (2009) Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study. Ann Surg 250:68–75PubMedCrossRefGoogle Scholar
  26. 26.
    Büchler MW, Gloor B, Müller CA et al (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232:619–626PubMedCrossRefGoogle Scholar
  27. 27.
    Besselink MG, van Santvoort HC, Boermeester MA et al (2009) Timing and impact of infections in acute pancreatitis. Br J Surg 96:267–273PubMedCrossRefGoogle Scholar
  28. 28.
    Banks P, Gerzof S, Langevin R et al (2005) CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. Int J Pancreatol 18:265–270Google Scholar
  29. 29.
    Bradley EL 3rd, Allen K (1991) A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg 161:19–24PubMedCrossRefGoogle Scholar
  30. 30.
    Mier J, Luque-de León E, Castillo A et al (1997) Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 173:71–75PubMedCrossRefGoogle Scholar
  31. 31.
    Besselink MG, Verwer TJ, Schoenmaeckers EJ et al (2007) Timing of surgical intervention in necrotizing pancreatitis. Arch Surg 142:1194–1201PubMedCrossRefGoogle Scholar
  32. 32.
    Fernandez-del Castillo C, Rattner DW, Makary MA et al (1998) Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 228:676–684CrossRefGoogle Scholar
  33. 33.
    Bradley EL III, Fulenwider JT (1984) Open treatment of pancreatic abscess. Surg Gynecol Obstet 159:509–513PubMedGoogle Scholar
  34. 34.
    Rodriguez JR, Razo AO, Targarona J et al (2008) Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 247:294–299PubMedCrossRefGoogle Scholar
  35. 35.
    Connor S, Alexakis N, Raraty MG et al (2005) Early and late complications after pancreatic necrosectomy. Surgery 137:499–505PubMedCrossRefGoogle Scholar
  36. 36.
    Tsiotos GG, Luque-de León E, Sarr MG (1998) Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg 85:1650–1653PubMedCrossRefGoogle Scholar
  37. 37.
    Howard TJ, Patel JB, Zyromski N et al (2007) Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg 11:43–49PubMedCrossRefGoogle Scholar
  38. 38.
    Werner J, Feuerbach S, Uhl W et al (2005) Management of acute pancreatitis: from surgery to interventional intensive care. Gut 54:426–436PubMedCrossRefGoogle Scholar
  39. 39.
    Jacobi CA, Zieren HU, Sabat R et al (1997) Local and systemic inflammation after laparotomy versus laparoscopy in a sepsis model in rats. Langenbecks Archiv Chirurgie 382[Suppl 1]:9–13CrossRefGoogle Scholar
  40. 40.
    Freeny P, Houptmann E, Althaus S et al (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol 170:969–975Google Scholar
  41. 41.
    Echenique AM, Sleeman D, Yrizarry J et al (1998) Percutaneous catheter directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Interv Radiol 9:565–571PubMedCrossRefGoogle Scholar
  42. 42.
    Papachristou GI, Takahashi N, Chahal P et al (2007) Per oral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245:943–951PubMedCrossRefGoogle Scholar
  43. 43.
    Gardner TB, Chahal P, Papachristou GI et al (2009) A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled off pancreatic necrosis. Gastrointest Endosc 69:1085–1094PubMedCrossRefGoogle Scholar
  44. 44.
    Navaneethan U, Vege SS, Chari ST, Baron TH (2009) Minimally invasive techniques in pancreatic necrosis. Pancreas 38:867–875PubMedCrossRefGoogle Scholar
  45. 45.
    Gagner M (1996) Laparoscopic treatment of acute necrotizing pancreatitis. Semin Laparosc Surg 3:21–28PubMedGoogle Scholar
  46. 46.
    Zhu J, Fan X, Zhang X (2001) Laparoscopic treatment of severe acute pancreatitis. Surg Endosc 15:146–148PubMedCrossRefGoogle Scholar
  47. 47.
    Parekh D (2006) Laparoscopic-assisted pancreatic necrosectomy: a new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg 141:895–902PubMedCrossRefGoogle Scholar
  48. 48.
    Cuschieri A (2002) Pancreatic necrosis: pathogenesis and endoscopic management. Semin Laparosc Surg 9:54–63PubMedCrossRefGoogle Scholar
  49. 49.
    Bucher P, Pugin F, Morel P (2008) Minimally invasive necrosectomy for infected necrotizing pancreatitis. Pancreas 36:113–119PubMedCrossRefGoogle Scholar
  50. 50.
    Gambiez LP, Denimal FA, Porte HL et al (1998) Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections. Arch Surg 133:66–72PubMedCrossRefGoogle Scholar
  51. 51.
    Carter R (2003) Management of infected necrosis secondary to acute pancreatitis: a balanced role for minimal access techniques. Pancreatology 3:133–138PubMedCrossRefGoogle Scholar
  52. 52.
    Connor S, Ghaneh P, Raraty M et al (2003) Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 20:270–277PubMedCrossRefGoogle Scholar
  53. 53.
    Horvath K, Koo L, Ali A et al (2001) Laparoscopic assisted percutaneous drainage of infected necrosis. Surg Endosc 15:677–682PubMedCrossRefGoogle Scholar
  54. 54.
    Van Santvoort HC, Besselink MG, Horvath KD et al (2007) Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB (Oxford) 9:156–159CrossRefGoogle Scholar
  55. 55.
    Horvath K, Freeny P, Escallon J et al (2010) Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg 145:817–825PubMedCrossRefGoogle Scholar
  56. 56.
    van Santvoort HC, Besselink MG, Bakker OJ et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502PubMedCrossRefGoogle Scholar
  57. 57.
    Cheatham ML, Malbrain ML, Kirkpatrick A et al (2007) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome, II: recommendations. Intensive Care Med 33:951–962PubMedCrossRefGoogle Scholar
  58. 58.
    McKay CJ, Evans S, Sinclair M et al (1999) High early mortality rate from acute pancreatitis in Scotland, 1984-1995. Br J Surg 86:1302–1305PubMedCrossRefGoogle Scholar

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Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Carlo Staudacher
    • 1
  • Gianpaolo Balzano
    • 1
  • Nicolò Pecorelli
    • 1
  • Vincenzo Mandalà
    • 1
  1. 1.San Raffaele Scientific InstituteMilanItaly

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