Conservative management

Since there is no specific pharmacotherapy for acute pancreatitis, initial treatment is based on the principles of intensive care unit (ICU) support with close monitoring of vital functions, adequate analgesia, and fluid replacement. Special attention must be paid to pulmonary, renal, and cardiocirculatory function.

The first step in management is transfer of the patient to the ICU. Acute interstitial edematous pancreatitis usually responds to basic treatment within days. Unless biliary tract stones are present there is no indication for surgery. However, necrotizing pancreatitis is associated with a high incidence of systemic and local complications, of which the most devastating is infection of intra- or extrapancreatic necrotic tissue. The prophylactic use of antibiotics able to penetrate into the pancreas is recommended for such patients. The supportive treatment of organ and systemic complications includes the whole spectrum of ICU measures ( T§b,!§..,.3).

Table 3 Definitions of organ complications and therapeutic measures in necrotizing pancreatitis

Conservative treatment should be applied over a minimum of 3 to 5 days unless a specific indication for surgery arises. There is ongoing controversy about the role of non-surgical management of clinically severe sterile necrotizing pancreatitis, unless there is documented infection with clinical signs of sepsis, as some of these patients can be successfully treated conservatively. In the absence of prospective randomized data, indications for surgical management of sterile necrosis require further investigation.

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