Acute pancreatitis: pathogenesis, outcome and treatment

The aetiological associations and proposed pathogenesis of acute pancreatitis have been reviewed. Although 80 per cent of patients have underlying alcohol abuse or gallstones, the precise mechanism of induction and of progression of pancreatic injury remains uncertain. Our current approach to management is summarized in Table 8. At present, no measure designed to limit the severity of pancreatitis or to interrupt the genesis of complications has been of proven benefit. Treatment is therefore primarily supportive. Peritoneal lavage by catheters introduced under local anaesthesia appears to be a valuable adjunct to the treatment of the early cardiovascular and respiratory complications of severe pancreatitis and we continue to recommend this measure. The major unsolved problem in treatment of this disease is the prevention and treatment of infected peripancreatic abscesses.