Skip to main content
Log in

Current therapeutic strategies in severe acute pancreatitis

  • Review Articles
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Conclusion

Further improvement in the outcome of the patient with SAP can be expected in the future by the timely application of a series of therapeutic means during the course of the disease. Therefore a better understanding of the pathogenesis of the initial event, knowledge of the natural history of SAP and its complications, accurate and early recognition of the specific phases of the disease are crucial to define both indication and timing of these different therapeutic interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mayer DA, McMahon MJ, Corfield AP (1985) Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis. N Engl J Med 312:399–404

    Google Scholar 

  2. Corfield AP, Cooper JM, Williamson RCN (1985) Prediction of severity in acute panceatitis: prospective conparison of three prognostic indices. Lancet II:403–407

    Google Scholar 

  3. Ranson JHC, Rifkind KM, Turner JW (1976) Prognostic signs and nonoperative peritoneal lavge in acute pancreatitis. Surg Gynecol Obstet 143:209–219

    Google Scholar 

  4. McMahon MJ, Playforth MJ, Pickford IR (1980) A comparative study of methods for the prediction of severity of attacks of acute pancreatitis. Br J Surg 67:22–25

    Google Scholar 

  5. Sostre CF, Flournoy JG, Bova JG, Goldstein HM, Schenker S (1985) Pancreatic phlegmon. Clinical features and cause. Dig Dis Sci 30:918–927

    Google Scholar 

  6. Kivilaasko E, Fraki O, Nikki P (1981) Resection of the pancreas for acuate fulminant pancreatitis. Surg Gynecol Obstet 152:493–498

    Google Scholar 

  7. Balldin G (1987) Release of vasoactive substances in ascites and blood in acute pancreatitis. In: Beger HG, Bücher M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 63–70

    Google Scholar 

  8. Warshaw AL, Lesser PB, Rie M, Cullen DJ (1975) The pathogenesis of pulmonary edema in acute pancreatitis. Ann Surg 182:505–510

    Google Scholar 

  9. Lungarella G, Gardi C, De Santi MM, Luzi P (1985) Pulmonary vascular injury in pancreatitis: evidence for a major role played by pancreatic elastase. Exp Mol Pathol 42:44–59

    Google Scholar 

  10. Horn JK, Ranson JHC, Goldstein IM, Weissler J, Ceratola D, Taylor R, Perez HD (1980) Evidence of complement catabolism in experimental acute pancreatitis. Am J Pathol 101:205–216

    Google Scholar 

  11. Zieve L, Vogel WC (1961) Measurement of lecithinase A in serum and other body fluids. Serum lecithinse in acute pancreatitis. J Lab Clin Med 57:586–599

    Google Scholar 

  12. Beger HG, Bittner R, Block S, Büchler M (1986) Bacterial contamination of pancreatic necrosis: a prospective clinical study. Gastroenterology 91:433–438

    Google Scholar 

  13. Beger HG, Büchler M, Bittner R, Oettinger W, Block S, Nevalainen TJ (1987) Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: results of a prospective clinical trial. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 335–344

    Google Scholar 

  14. Beger HG, Krautzberger W, Bittner R, Block S, Büchler M (1985) Results of surgical treatment of necrotizing pancreatitis. World J Surg 9:972–979

    Google Scholar 

  15. Aldridge MC, Urnstein M, Glazer G, Dudley HAF (1985) Pancreatic resection for severe acute pancreatitis. Br J Surg 7 2:796–800

    Google Scholar 

  16. Rattner DW, Warshaw AL (1988) Surgical intervention in acute pancreatitis. Crit Care Med 16:89–95

    Google Scholar 

  17. Levy E, Hannoun L, Parc R, Honiger J, Huguet C, Loygue J (1984) Le drainage actif prolongé des pancré des pancréatites aigues nécrotico-hémorragiques. Ann Chir 38:351–356

    Google Scholar 

  18. Ranson JHC (1981) Conservative surgical treatment of acute pancreatitis. World J Surg 5:351–359

    Google Scholar 

  19. Reynaert MS, Bshouty ZH, Otte JB, Kestens PJ, Trémouroux J (1985) Percutaneous peritoneal dialysis as an early treatment of acute necrotic hemorrhagic pancreatitis. Intensive Care Med 11:123–128

    Google Scholar 

  20. Bonnet F, Rotman N, Fagniez PL (1985) Changing concepts in the evaluation and treatment of acute severe pancreatitis. Intensive Care Med 11:107–109

    Google Scholar 

  21. Smadja C, Bismuth H (1986) Pancreatic debridement in acute necrotizing pancreatitis: an obsolete procedure? Br J Surg 73:408–412

    Google Scholar 

  22. Röher HD, Maroske D (1987) Timing and indication for surgical treatment in necrotizing pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 321–327

    Google Scholar 

  23. Balldin G, Ohlsson K (1979) Demonstration of pancreatic proteaseantiprotease complexes in the peritoneal fluid of patient with acute pancreatitis. Surgery 85:451–456

    Google Scholar 

  24. Bockman DE, Büchler M, Beger HJ (1987) Ultrastructure of human acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 12–22

    Google Scholar 

  25. Imrie CW, Benjamin IS, Ferguson JC (1978) A single-centre double-blind trial of trasylol therapy in primary acute pancreatitis. Br J Surg 65:337–341

    Google Scholar 

  26. Ranson JHC (1979) The timing of biliary surgery in acute pancreatitis. Ann Surg 189:654–663

    Google Scholar 

  27. Osborne DH, Imrie CW, Carter DC (1981) Biliary surgery in the same admission for galstone-associated acute pancreatitis. Br J Surg 68:758–761

    Google Scholar 

  28. Larvin M, McMahon MJ (1989) APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet II:201–205

    Google Scholar 

  29. Mayer DA, McMahon MJ (1985) The diagnostic and prognostic value of peritoneal lavage in patients with acute pancreatitis. Surg Gynecol Obstet 160:507–512

    Google Scholar 

  30. Cooper MJ, Williamson RCN, Pollock AV (1982) The role of peritoneal lavage in the prediction and treatment of severe acute pancreatitis. Ann R Coll Surg Engl 64:422–425

    Google Scholar 

  31. Warshaw AL, Lee KH (1979) Serum ribonuclease elevations and pancreatic necrosis in acute pancreatitis. Surgery 86:227–234

    Google Scholar 

  32. Lasson A, Ohlsson K (1984) Acute pancreatitis. The conrrelation between clinical course, pretease inhibitors, and complement and kinin activation. Scand J Gastroenterol 19:707–710

    Google Scholar 

  33. McMahon MJ, Bowen M, Mayer AD, Cooper EH (1984) Relation of α2 macroglobulin and other antiproteases to the clinical features of acute pancreatitis. Am J Surg 147:164–169

    Google Scholar 

  34. Büchler M, Uhl W, Malfertheimer P (1987) Biochemical staging of acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 143–153

    Google Scholar 

  35. Wilson C, Heads A, Shenkin A, Imrie CW (1989) C-reative protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg 76:177–181

    Google Scholar 

  36. Mayer AD, McMahon MJ, Bowen M, Cooper EH (1984) C-reactive protein: an aid to assessment and monitoring of acute pancreatitis. J Clin Pathol 37:207–211

    Google Scholar 

  37. Silverstein W, Isikoff MB, Hill MC, Barkin J (1981) Diagnostic imaging of acute pancreatitis: prospective study using CT and sonography. AJR 137:497–501

    Google Scholar 

  38. Ranson JHC, Balthazar E, Caccavale R, Cooper M (1985) Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. Ann Surg 201:656–665

    Google Scholar 

  39. Maier W (1987) Early objective diagnosis and staging of acute pancreatitis by contrast-enhanced computed tomography. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 132–140

    Google Scholar 

  40. Creutzfeldt W, Lankisch PG (1981) Intensive medical treatment of severe acute pancreatitis. Word J Surg 5: 341–350

    Google Scholar 

  41. Finch WT, Sawyers JL, Schenker S (1976) A prospective study to determine the efficacy of antibiotics on acute pancreatitis. Ann Surg 183:667–671

    Google Scholar 

  42. Buggy BP, Nostrant TT (1983) Lethal pancreatitis. Am J Gastroenterol 78:810–814

    Google Scholar 

  43. Wedgwood KR, Farmer RC, Reber HA (1986) A model of hemorrhgic pancreatitis in cats. Role of 16, 16-dimethlyl Prostaglandin E2. Gastroenterology 90:32–40

    Google Scholar 

  44. Nevalainen TJ (1980) The role of phospholipase A in acute pancreatitis. Scand J Gastroenterol 15:641–650

    Google Scholar 

  45. Rinderknecht H (1988) Fatal pancreatitis, a consequence of excessive leukocyte stimulation? Int J Pancreatol 3:105–112

    Google Scholar 

  46. Kivalaasko E, Valtonen VV, Malkamäki M (1984) Endotoxaeia and acute pancreatitis: correlation between the severity of the disease and the antienterobacterial common antigen antibody titre. Gut 25:1065–1070

    Google Scholar 

  47. MRC Mulcicentre Trial (1980) Morbidity of acute pancreatitis: the effect of aprotinin and glucagon. Gut 21:334–338

    Google Scholar 

  48. Martinez E, Navarete F (1984) A controlled trial of synthetic salmon calcitonin in the treatment of severe acute pancreatitis. World J Surg 8:354–359

    Google Scholar 

  49. De Rai P, Franciosi C, Confalonieri GM etal, (1988) Effects of somatostatin in acute pancreatitis induced in rats by injection of taurocholate and trypsin into a temporarily closed duodenal loop. Int J Pancreatol 3:367–374

    Google Scholar 

  50. Tykkä HT, Vaittinen EJ, Mahlbergh KL et al (1985) A randomized double-blind study using CaNA2 EDTA, a phospholipase A2 inhibitor, in the management of human acute pancreatitis. Scand J Gastroenterol 20:5–12

    Google Scholar 

  51. Steinberg WM, Schlesselman SE (1987) Treatment of acute pancreatitis. Comparison of animal and human studies. Gastroenterology 93:1420–1427

    Google Scholar 

  52. Ranson JHC, Spencer FC (1978) The role of peritoneal lavage in severe acute pancreatitis. Ann Surg 187:565–575

    Google Scholar 

  53. Stone HH, Fabian TC (1980) Peritoncal dialysis in the treatment of acute alcoholic pancreatitis. Surg Gynecol Obstet, 150:878–882

    Google Scholar 

  54. Niederau C, Crass RA, Silver G, Ferrell LD, Grendell JH (1988) Therapeutic regimens in acute experimental hemorrhagic pancreatitis. Effects of hydratation, oxygenation, peritoneal lavage, and a potent protease inhibitor. Gastroenterology 95:1648–1657

    Google Scholar 

  55. Alle JL, Reynaert MS, Azagra JS, Massaut J, Dive A, De Maeght S (1988) Experience belge de la dialyse péritonéale percutanée dans le traitement de la pancréatite aigue nécroticohémorragique alcoolique. Acta Gastroenterol Belge 51:23–31

    Google Scholar 

  56. McMahon MJ, Lankisch PG (1987) Peritoneal lavage and dialysis for the treatment of acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer Berlin Heidelberg New York, pp 278–284

    Google Scholar 

  57. Sim DN, Duprez A, Anderson MC (1966) Alterations of the lymphathic circulation during acute experimental pancreatitis. Surgery 60:1175–1182

    Google Scholar 

  58. Mayer AD, Hodgson M, McMahon MJ (1985) Enzyme transfer from pancreas to plasma during acute pancreatitis. The contribution of ascitic fluid and lymphatic drainage of the pancreas. Gut 26:876–881

    Google Scholar 

  59. Dugernier Th, Reynaert Ms, Deby-Dupont G (1989) Prospective evaluation of thoracic-duct drainage in the treatment of respiratory failure complicating severe acute pancreatitis. Intensive Care Med 15:372–378

    Google Scholar 

  60. Renner IG, Savage WT, Pantoja JL, Renner VJ (1985) Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig Dis Sci 30:1005–1018

    Google Scholar 

  61. Acosta JN, Pellegrini CA, Skinner DB (1980) Etiology and pathogenesis of acute biliary pancreatitis. Surgery 88:118–122

    Google Scholar 

  62. Kelly TR (1980) Gallstone pancreatitis: the timing of surgery. Surgery 88:345–350

    Google Scholar 

  63. Armstrong CP, Taylor TV, Jeacock J, Lucas S (1985) The biliary tract in patients with acute gallstone pancreatitis. Br J Surg 72:551–555

    Google Scholar 

  64. Heij HA, Veen HF, Eggink WF, Obertop H (1985) Timing of surgery for acute biliary pancreatitis. Am J Surg 149:371–374

    Google Scholar 

  65. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP (1988) Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet II:979–983

    Google Scholar 

  66. Waltman AC, Luers PR, Athanasoulis CA, Warshaw AL (1986) Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques. Arch Surg 121:439–443

    Google Scholar 

  67. Kivilaasko E, Lempinen N Makelaïnen A, Nikki P, Schröder T (1984) Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. Ann Surg 199:426–431

    Google Scholar 

  68. Gerzof SG, Banks PA, Spechler SJ (1984), Role of guided percutaneous aspiration in early diagnosis of pancreatic sepsis. Dig Dis Sci 29:950–976

    Google Scholar 

  69. Gerzof SG, Banks P, Robbins AH (1987) Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology 93:1315–1320

    Google Scholar 

  70. Bradley EL III (1987) Management of infected pancreatic necrosis by open drainage. Ann Surg 206:542–550

    Google Scholar 

  71. Beger HG, Bittner R, Büchler M (1986) Hemodynamic data pattern in patients with acute pancreatitis. Gastroenterology 90:74–79

    Google Scholar 

  72. Block S, Büchler M, Bittner R Beger HG (1987) Sepsis indicators in acute pancreatitis. Pancreas 2:499–505

    Google Scholar 

  73. Reber HA (1986) Surgical intervention in necrotizing pancreatitis. Gastroenterology 91:479–482

    Google Scholar 

  74. Hiatt JR, Fink AS, King W III, Pitt HA (1987) Percutaneous aspiration of peripancreatic fluid collections: a safe method to detect infection. Surgery 101:523–530

    Google Scholar 

  75. Reynaert MS (1988) Réanimation des pancréatites nécroticohémorragiques. In: Réanimation et médecine d'urgence. Expansion Scientifique Française, Paris VI, 87–95

    Google Scholar 

  76. Warschaw AL, Jin G (1985) Improved survival in 45 patients with pancreatic abscess. Ann Surg 202:408–417

    Google Scholar 

  77. Becker JM, Pemberton JH, Dimagno EP, Illstrup DM, McIlrath DC, Dozois RR (1984) Prognostic factors in pancreatic abscess. Surgery 96:455–461

    Google Scholar 

  78. Bradley EL, Clements JL, Gonzalez AC (1979) The natural history of pancreatic pseudocysts. A verified concept of management. Am J Surg 137:135–141

    Google Scholar 

  79. Van Vyve E, Reynaert M, Dardenne A, Pringot J, Kestens PJ (1988) Pancréatite aigue necrosante: place du drainage percutané dans le traitement des masses nécrotiques stériles et infectées?. Med Chir Dig 17:18–19

    Google Scholar 

  80. Van Vyve E, Reynaert MS, Passelecq E (1988) Pancréatite aigue necrosante. Traitement des masses nérotiques stériles et infectées. Acta Gastroenterol Belge 51:44–50

    Google Scholar 

  81. Karlson KB, Martin EC, Fankuchen EI, Mattern RF, Schultz RW, Casarella WJ (1982) Percutaneous, drainage of pancreatic pseudocysts and abscesses. Radiology 142:619–624

    Google Scholar 

  82. Bradley EL, Fulenwider JT (1984) Open treatment of pancreatic abscess. Surg Gynecol Obstet 159:509–513

    Google Scholar 

  83. Büchler, M, Block S, Krautzberger W (1984) Necrotizing pancreatitis: peritoneal lavage (PL) or local lavage (LL) of the lesser sac? Dig Dis Sci 29:944–976

    Google Scholar 

  84. Fagniez PL, Rotman N, Kracht M (1989) Direct retroperitoneal approach to necrosis in severe acute pancreatitis. Br J Surg 76:264–267

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reynaert, M.S., Dugernier, T. & Kestens, P.J. Current therapeutic strategies in severe acute pancreatitis. Intensive Care Med 16, 352–362 (1990). https://doi.org/10.1007/BF01735172

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01735172

Keywords

Navigation