[Diagnostic and therapeutic strategy in acute pancreatitis]

The diagnostic and therapeutic management of acute pancreatitis (AP) is directly related to the severity of the initial attack. Mild AP usually subsides spontaneously. On the other hand, severe AP requires admission to an intensive care unit and supportive care for multiple organ failure. During the second phase of the disease, repeated CT scans with the routine use of percutaneous fine needle aspiration and drainage allows both diagnosis and treatment of pancreatic abscesses. However, infected necrosis usually requires surgical drainage. The treatment of acute biliary pancreatitis must be performed during the same admission for mild AP. In contrast, it seems better to postpone any kind of surgical treatment in the severe forms of gallstone pancreatitis. The efficacy of endoscopic sphincterotomy has not yet been demonstrated.