Severe acute pancreatitis (SAP) is defined as associated with local and/or systemic complications. Development of persistent
organs failure within 72 hours of symptoms onset and/or of infected pancreatic, peripancreatic complications allows the
definition of the most severe forms, identified as critical or ESAP that are overlapping definitions. Critical forms (ESAP) are
characterized by a short course, progressive multiple organ dysfunction syndrome (MODS), early hypoxemia, high CT severity
index, increased incidence of pancreatic, peripancreatic necrosis, infection and ACS. Peripancreatic fluid collection suggests the
anatomical clinical scenario of necrotizing acute pancreatitis. Intrahepatic fluid collection is a rare occurrence. We have treated
two cases of intrahepatic fluid collection in two patients with acute biliary pancreatitis. Many systemic and/or chronic diseases
can be connected with a greater incidence of acute pancreatitis: e.g. systemic lupus erythematous, Sjogren-Gongerot syndrome,
sarcoidose, systemic vasculitis, antiphospholipides syndrome, metabolic diseases. The association of AP with the diabetes is
in evidence: the risk of acute pancreatitis is raised by diabetes, but also of severe acute pancreatitis and early severe and critical
forms. AP is a biphasic disease. In the first phase of the disease (1-2 weeks), pancreas pathological alteration (CT severity index),
multi-organ dysfunction and compartment syndrome are in evidence as discriminating data between severe and critical forms.
In the late phase of pancreatitis evolution, the septic complication of pancreatic and peripancreatic necrotic fluid collections
assumes a discriminating role. In summary there are critical or early severe acute pancreatitis characterized in the initial phase
by SIRS with multi-organ dysfunction and equally severe forms in the late phase (3-4 weeks), after resolution or at least control
of MODS which are instead characterized by septic complication of fluid-necrotic collections. The prolonged evolution of the
disease can be increased by metabolic disease as diabetes. Intrahepatic fluid collection in the course of acute biliary pancreatitis
is a rare occurrence. The therapeutic approach is the same as that for pancreatic and peripancreatic fluid collections. In case
of infection, the patient undergoes percutaneous US/CT guided drainage. This therapeutic procedure can be added to the
therapeutic program for necrotizing acute biliary pancreatitis together with ERCP/ES and videolaparocholecystectomy (VLC).
Treatment of SAP and ESAP is now more conservative and less invasive than in the past: intensive care, prevention of intestinal
failure and assure papillary patency in the first phase of the disease. In the later phase therapeutic procedure for fluid necrotic
collections, is US/CT percutaneous catheter drainage.
Vincenzo Neri was born in Bari, Italy, on 15
March, 1946. He graduated in 1970 in Medicine and Surgery from the University of Bari. He is a fulltime
Professor of General Surgery in the Medical School of the University of Foggia, Polyclinic. He is Director of the Residency School of General Surgery
and Department of General Surgery. He was President of the Course of Degree of Medicine and Surgery, University of Foggia, in the years from
1996 to 2002. He was Director of Department of Surgical Sciences, University of Foggia in the years from 2002 to 2008. He obtained the certificate of
?Maitrise Universitaire en Pedagogie des Sciences de la Sant? from the Universit? Paris ? Nord Bobigny. He is the author of more than 330 scientific
paper edited on national and international journals and chapters of books. His research interest is hepatobiliopancreatic surgery. He is a member of
scientific societies : SIC, IHPBA, AISP, EASL, NESA and SLS.
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