Complicated Acute Pancreatitis.

The treatment of severe, complicated pancreatitis requires: Rapid assessment and recognition of severity, determined by using APACHE or equivalent scoring systems. Aggressive resuscitation with crystalloid and colloid solutions using central venous monitoring for guidance, and to help identify and treat early organ failure. Nutritional support including total parenteral feeding, which can assist in maintaining nutrition during the prolonged period that may ensue. Nasojejunal feedings, bypassing the duodenum, supply nutrition and may decrease infectious complications. Judicious use of imaging studies, mainly dynamic-bolus contrast computed tomography (CT) of the abdomen. These studies will identify necrosis and other local complications of pancreatitis that are treatable by endoscopic, radiological or surgical means. Antibiotics, whose role has evolved to that of prophylaxis to prevent infection of necrotizing pancreatitis. Other medications such as octreotide have a limited role in the management of certain specific complications such as fistulas and post-pancreatic surgery. A multidisciplinary approach, including the use of endoscopic techniques and surgery to treat complicated pancreatitis. This approach provides optimal care of this challenging group of patients.