TREATMENT OF ACUTE PANCREATITIS: PROGRESSING FROM A DIAGNOSIS OF PANCREATITIS AND ITS FORMS TO ITS COMPLICATIONS

Abstract

This article presents an analysis of the literature concerning approaches of the surgical treatment of acute pancreatitis. The in-depth study of the problem of acute pancreatitis and the development of management tactics began in the late nineteenth century and underwent major modifi cations, which have continued until present today. The following basic stages of the evolution of indications leading to the surgical intervention of acute pancreatitis were identifi ed: the self-suffi ciency of the diagnosis of acute pancreatitis; doubts about the reliability of the diagnosis; necrosis of the pancreas; complications of acute pancreatitis in the form of peritonitis, manifestations of biliary pathology and infection of necrotic zones; and the absence of an effect on necrotic pancreatitis via conservative and minimally invasive treatments. Special attention was given to modern formulations and indications for surgical intervention, which are determined by the effectiveness of the initial methods of therapy. It is important to note that there remained a group of patients who underwent surgery outside of the “golden standard” of the time limits for the operative treatment of destructive pancreatitis. Those groups were characterized by an early decompensation and a fulminant form of the disease or by late complications, which appeared at a much later date, after temporary improvement and after discharge from the surgical ward. Based on the analyzed data, the following conclusions were made: tactics of the management of acute destructive pancreatitis were accompanied by the evolution of surgical indications – from a diagnosis of pancreatitis and its forms to clinically controlled late complications; modern standards and indications for surgical intervention are formulated in 3-4 weeks on the background of demarcating the zones of pancreatic and peripancreatic destruction; categories of patients remain with fulminant forms of destructive pancreatitis and complications, which manifest at late terms on the background of the asymptomatic period of pancreatitis and remain problematic in terms of control over the course of the disease after the patient’s discharge from the hospital.

Keywords

• pancreatic necrosis, complications of pancreatitis, abdominal surgery