[Acute pancreatitis. 2: Treatment of the complicated course]

Owing to its tendency to produce severe local and systemic complications, the hemorrhagic necrotic form of acute pancreatitis is still associated with a high mortality rate. Major local complications are pseudocystic space-consuming masses, arterial bleeding and abscess formation. The major systemic complications include circulatory shock, metabolic disorders, renal failure, respiratory insufficiency and sepsis. Of decisive importance for the prognosis is prophylaxis, early detection, and suitable treatment of these threatening complications, which is achieved on the basis of a combination of standardized basic treatment with problem- and symptom-oriented supplementary treatment. In the present paper, the current prophylactic, diagnostic and therapeutic concepts are described. In addition, a number of invasive measures and the indications for surgery are discussed.