[Respiratory complications in severe acute pancreatitis]

The two basic mechanisms underlying most of the pleuropulmonary complications of severe acute pancreatitis include pulmonary atelectasis and alveolar flooding. Like in any abdominal catastrophe, pleural effusion and limited diaphragmatic excursion due to pain and intestinal atony are the main factors responsible for alveolar collapse and secondary infection. Physical therapy and needle pleural evacuation are the cornerstones of management. Owing to its pathophysiologic mechanisms adult respiratory distress syndrome is peculiar to acute pancreatitis. Alveolar capillary membrane injury is related to pancreatic necrosis, to its regional extent and to the subsequent over-amplification of the inflammatory reaction. Diversion of those potential mediators of the syndrome either surgically or by thoracic duct drainage is essential in order to improve survival in these patients.