Surgery in Acute Pancreatitis?

While we get this site up and running, we’ll be posting old morning report pearls:
Report Pearls
1. Severity of Acute Pancreatitis (revised Atlanta classification system 2012)
  • Mild: Absence of organ failure and local systemic complications
  • Moderate: transient organ failure (resolves within 48 hours) and/or local or systemic complications without persistent organ failure (>48 hours)
  • Severe: Persistent organ failure (>48 hours) that may involve one or multiple organs
2. Indications for Surgery in Severe Acute Pancreatitis
  1. When the surgeon is concerned that the symptoms are the result of a disease other than pancreatitis for which operation is mandatory
  2. In persistent and severe biliary pancreatitis, when an obstructing gallstone that cannot be managed endoscopically is lodged at the ampulla of Vater
  3. In the presence of infected pancreatic necrosis
  4. To drain a pancreatic abscess if percutaneous drainage did not produce the desired result
Controversy exists around whether surgery should be performed when a patient’s condition is deteriorating, and this mostly involves clinical judgment.

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