[Acute severe pancreatitis: limitations of medical treatment]

The natural course of severe acute pancreatitis can be divided into two successive phases. The initial phase is characterized by the systemic manifestations resulting from the acute inflammatory response that takes place in the pancreas. The second stage reflects the progression of pancreatic necrosis towards spontaneous resolution, pseudocyst formation or secondary infection. While the treatment of these latter complications mainly consists of surgery (drainage of pseudocyst/infected necrosis) prevention and management of the initial systemic complications of acute pancreatitis is essentially involves medical therapy (empirical treatment, percutaneous peritoneal dialysis and thoracic duct drainage). Only the simultaneous and appropriate use of these various therapeutic modalities can ensure a substantial reduction in the mortality of severe acute pancreatitis. The place of these therapeutic approaches is discussed.