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Acute pancreatitis is the most common gastrointestinal disease for which patients are acutely hospitalized, and its incidence continues to rise.1 The majority of patients (approximately 80%) with acute pancreatitis have mild disease, and symptoms usually resolve within 1 week with basic supportive care.2,3 The other 20% of patients develop a severe form of pancreatitis with organ failure and necrotizing pancreatitis. Necrotizing pancreatitis is now defined as either pancreatic parenchymal necrosis and peripancreatic fat necrosis or peripancreatic fat necrosis alone.2,4 The clinical course of these patients is often characterized by a persisting systemic inflammatory response syndrome and/or (multiple) organ failure for the first 1 to 2 weeks. Despite maximal supportive care in the intensive care unit, mortality is up to 30% in patients with early persisting organ failure.5,6 Secondary infection of the necrosis develops in 30% of patients and carries a mortality risk of approximately 15%.7,8
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CLASSIFICATION OF ACUTE PANCREATITIS
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A better understanding of local and systemic complications, together with better imaging and new interventions in acute pancreatitis, led to the Revised Atlanta Classification.2 This revised classification aims to clarify terminology and stimulate the use of uniform definitions and standardized reporting in patients with acute pancreatitis. Based on the absence or presence of local or systemic complications, 3 categories were defined in acute pancreatitis: mild, moderate, and severe (Table 70-1). Acute pancreatitis itself is divided into interstitial edematous pancreatitis and necrotizing pancreatitis, where local complications are linked to 1 of the 2 subtypes. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (ie, sterile or infected), and walled-off necrosis (ie, sterile or infected) (Table 70-2).
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