ABSTRACT
The majority of patients with severe early organ dysfunction will have pancreatic necrosis on CT scan. There is an association between the development of necrosis and the severity of organ dysfunction ( 5 ), although patients with edematous pancreatitis may manifest clinical features of a severe attack. Clinical practice has changed rapidly over the last decades, and the previous focus on parenchymal necrosis and particularly the role of prevention/treatment of infection are now considered in a wider concept tending toward organ support and less aggressive intervention. Most patients who develop organ failure have evidence of this at the time of admission or very shortly thereafter ( 6 ), and worsening or persistent organ failure is associated with an adverse outcome, and/or the development of late complications. There is no evidence that aggressive early surgical intervention to address the necrosis has a beneficial effect on outcome and indeed is potentially harmful.
