ABSTRACT
Physiology of the pancreas was better understood by the 19th century and in the 1880s, Fitz demonstrated the clinical features of acute pancreatitis. Abdominal pain that radiates to the back, serum amylase/lipase level greater than three times the upper limit, and evidence of pancreatitis on abdominal imagining are the three most important diagnostic features. Contrast-enhanced computed tomographic (CT) is performed in patients with severe pancreatitis to rule out acute necrotizing pancreatitis. Use of MRI is emerging due to its ability to better identify gallstones and characterize the contents of fluid collections seen on CT. Endoscopic retrograde cholangiopancreatography with stent placement is useful in cases of biliary pancreatitis with concomitant cholangitis. A discord exists regarding the management of acute necrotizing pancreatitis which carries a high risk of death. In the 2010 PANTER trial, 88 patients from 19 hospitals of the Dutch Pancreatitis Study Group with infected necrotizing pancreatitis were randomized to primary open necrosectomy or the step-up approach.
