Key messages

• Acute pancreatitis can be classified into interstitial edematous pancreatitis, necrotizing pancreatitis, postacute pseudocyst, and pancreatic abscess.

• Discrimination between interstitial edematous and necrotizing pancreatitis is by contrast-enhanced CT and serum markers of necrosis.

• Initial management should be conservative in an intensive care environment.

• Indications for surgery include persisting pulmonary, renal, cardiocirculatory, or abdominal complications, sepsis, and proven infection of pancreatic necrosis. The timing for surgical management should be a preferably late intervention during the second week of the disease. The basic principle of surgical treatment is a combination of necrosectomy and an additional technique to manage the peripancreatic space.

• There are three different techniques of surgical management after initial necrosectomy: conventional treatment with sump drainage; open procedures with open abdominal management (open packing) or temporary abdominal closure with scheduled reoperations; closed procedures with continuous closed lavage of the lesser sac.

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