Severe acute pancreatitis remains a life-threatening disease. The first phase (about 10-14 days) is characterized by formation of pancreatic and peripancreatic necrosis and development of a systemic inflammatory response syndrome. This systemic response to the pancreatic inflammation/necrosis causes early organ failure that necessitates intensive care therapy. In the second phase (after 2 weeks), the leading cause of morbidity and mortality is superinfection of necrosis with development of septic multiple organ failure. In the last 2 decades, treatment has evolved considerably, and with improved intensive care management, there is a worldwide trend toward a more conservative strategy with operative intervention initiated primarily because of the local and systemic manifestations of infected necrosis and less so for sterile necrosis. However, today, septic complications caused by pancreatic infection account for 80% of the mortality, and infected necrosis therefore usually remains an absolute indication for same form of invasive intervention.
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