[Acute pancreatitis -  new developments in treatment].

Acute pancreatitis continues to be a potentially very severe disease. According to new classification schemes, a severe pancreatitis (up to 20%) is conditioned by structural changes and organ failures. The first critical moment concerns a fast development of pancreatic necrosis, followed by delayed infection. The most common complications of pancreatitis include infections, bleeding, compartment syndrome and decompensation of comorbidities. At the early stage the most important measure concerns the active expansion of blood volume and treatment of organ dysfunction. General antibiotic prophylaxis has been rejected; it is indicated only if there are signs of persistent circular failure and inflammatory response syndrome. The choice of antibiotic regimens usually includes Ciprofloxacin plus Metronidazole, Imipenem and Propene, administered for at least 10 to 14 days. After that the prophylaxis should be assessed and it may be continued under a changed regimen. The lab tests as well as imaging methods are continuously monitored and the administration of antibiotics is adequately adjusted. If infection is demonstrated antibiotics are indicated based on standard microbiological parameters and clinical relationships. Any surgical intervention (nephrectomy) is delayed as long as possible. Indication would concern impaired condition despite intensive care, e.g. newly developed sepsis, pains, food intake inability or other complications, such as bleeding. Recently the open surgical nephrectomy is confronted with derivations of infected necrosis via mini-invasive procedures, such as transcutaneous drainage, laparoscopic video-assisted nephrectomy or endoscopic transgastric nephrectomy. The methods may be combined. Mortality and morbidity of mini-invasive procedures are comparably significantly lower.