Acute pancreatitis is often a mild, self-limiting illness that responds to simple supportive
therapy in the form of intravenous fluids and
analgesics. More severe attacks may result in organ failure or
pancreatic necrosis. Such patients should be identified early in the course of an attack and actively monitored within an intensive care unit or high dependency area. Supportive
therapy remains the basis of management. Attention to the adequacy of the fluid balance and oxygenation are of prime importance and supportive
therapy may include inotropic support, assisted ventilation and
renal dialysis.
Pancreatic necrosis should be sought by contrast-enhanced computed tomography (CT) scanning, and surgical intervention may be required if the patient's clinical condition continues to deteriorate. Surgery should ideally be delayed until the second or subsequent week when necrosectomy (
debridement of necrotic pancreatic tissue) may be possible rather than formal pancreatic resection. The role of various drugs to suppress pancreatic secretion and inhibit pancreatic
enzymes, although shown to be consistently effective in experimental
pancreatitis, has not been established by controlled clinical trials in humans. Recent controlled studies examining peritoneal lavage in humans have failed to confirm the beneficial results suggested in earlier studies. Early
endoscopic sphincterotomy for patients with severe
gallstone pancreatitis and ductal
calculi has been reported to reduce mortality and morbidity in one controlled clinical trial and may prove to be an important advance.