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INTRODUCTION

A third of all patients with acute pancreatitis develop complications, and a quarter of those patients will not survive, but recovery is now expected for the remainder because of improvements in the diagnosis and management of acute pancreatitis.1 The complications of acute pancreatitis can be local, regional, and/or systemic. The most important determinants of the severity of acute pancreatitis are infected local complications and persistent organ dysfunction,2 which are the basis for classifying acute pancreatitis severity (Table 69-1).3,4 This chapter focuses on the diagnosis and management of these important complications of acute pancreatitis.

TABLE 69-1CLASSIFICATION OF ACUTE PANCREATITIS SEVERITY BASED ON LOCAL AND SYSTEMIC COMPLICATIONS, ACCORDING TO THE DETERMINANTS-BASED CLASSIFICATION3 AND THE REVISED ATLANTA CLASSIFICATION6

LOCAL COMPLICATIONS

The local complications of acute pancreatitis are related to fluid collections and tissue necrosis in and around the pancreas. These were defined by the Atlanta Symposium in 1992 by the terms pancreatic necrosis, pseudocyst, and abscess.5 However, these terms have been confusing and new terminology has been introduced in an attempt to reflect current understanding of the pathophysiology and CT scan morphology of the disease.6 Changes in the morphology of local collections can occur over time and these are now defined on the basis of their content, chronicity, and whether infection is present (Table 69-2).7

TABLE 69-2CLASSIFICATION OF LOCAL COMPLICATIONS OF ACUTE PANCREATITIS BASED ON CONTENT, CHRONICITY, AND INFECTION6,7

The revised Atlanta Classification uses a 4-week cutoff, and fluid collections present for less time are called either an acute pancreatic fluid collection (APFC) or acute necrotic collection (ANC).6 These acute collections can either spontaneously resolve or progress to become “walled-off” or encapsulated, which is a reaction ...

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