Review Article-Acute necrotising pancreatits: Current Concepts

Pancreatic necrosis represents a severe form of acute pancreatitis. The morbidity and mortality associated with acute pancreatitis are substantially higher when necrosis is present especially when the area of necrosis is also infected. Despite a relative shortage of randomized clinical trials, there has been a significant change in the management of acute necrotising pancreatitis over the past 20 years. In recent years the treatment of acute necrotising pancreatitis has shifted away from early surgical debridement (necrosectomy) to aggressive intensive medical care of multiple organ systems with specific criteria for operative and nonoperative management. This review presents the current concepts with regards to diagnosis and management of acute necrotising pancreatitis including the controversial aspects. Some of the issues addressed include the management of these patients in an intensive care/therapy unit, the role of prophylactic antibiotics, requirement of nutrition, either enteral and/or parenteral, the role of CT scan and FNAC in diagnosing infection and finally the role of surgery. An extensive review of the literature has been done for this purpose from the Ovid Medline search, pubmed and documented facts from standard text books has also been included along with certain landmark old articles.

Keywords
Severe acute pancreatitis, pancreatic necrosis, infected necrosis, sterile necrosis, intensive care unit, necrosectomy