Acute pancreatitis. A review with an emphasis on new developments

Area of Science:

• Gastroenterology
• Abdominal Imaging
• Pancreatic Diseases

Background:

• Acute pancreatitis presents a spectrum from mild to fatal, with some aspects remaining poorly understood.
• Occult biliary microlithiasis may be an underrecognized cause of idiopathic acute pancreatitis.
• The precise mechanism of enzyme activation in acute pancreatitis is still under investigation, though lysosomal enzymes are implicated.

Purpose of the Study:

• To review recent advances in understanding and managing acute pancreatitis.
• To highlight the utility of advanced imaging techniques in assessing severity and complications.
• To discuss current strategies for diagnosis and treatment, including controversial aspects.

Main Methods:

• Review of recent literature on acute pancreatitis.
• Discussion of advancements in computed tomography (CT) techniques, specifically contrast-enhanced dynamic pancreatography.
• Evaluation of diagnostic methods like CT-guided percutaneous needle aspiration.

Main Results:

• Contrast-enhanced dynamic pancreatography is valuable for detecting pancreatic necrosis and its extent, correlating with severity.
• CT-guided percutaneous needle aspiration is a safe and reliable method for diagnosing infected pancreatic necrosis and related collections.
• While supportive care is standard, specific treatments to halt autodigestion have generally been ineffective; early endoscopic sphincterotomy in severe biliary pancreatitis is debated.

Conclusions:

• Recent advances have improved the understanding and management of acute pancreatitis.
• Advanced imaging, particularly contrast-enhanced CT, plays a crucial role in assessing severity and guiding interventions.
• Accurate diagnosis of complications like infected necrosis is vital for appropriate patient management.