[Changes in the diagnosis and therapy of acute pancreatitis]

Currently clinical diagnosis of acute pancreatitis is heavily supported by abdominal sonography and computed tomography. Imaging procedures do not only give direct information on parenchymal destruction of the pancreas but do also allow the extent of peripancreatic necrosis to be recognized. While indications for and extent of surgical treatment are more restrictive under the influence of imaging diagnostics, an early operation is required in case of acute hemorrhagic pancreatitis with organ complications (stage II-III). In view of complications after surviving the acute phase of disease, imaging diagnostics are of utmost importance for tactical considerations regarding surgical approach. In the postacute phase necrosectomy and drainage are preferable to the formerly more common but less radical resection. Localized septic complications due to remaining necrosis call for delayed operation. Timing of relaparotomy, more than once, if necessary, is of essential prognostic importance. A more restrictive indication is confined to an early operation and an intensive conservative treatment will lead to a decrease of mortality in severe hemorrhagic-necrotizing pancreatitis.