Necrotizing Pancreatitis: Update and When to Operate

About 20% of the cases of acute pancreatitis present in a severe form, known as necrotizing pancreatitis. Although this entity was first described centuries ago, many questions about it remain open and as a consequence, many studies are currently published addressing this subject nowadays. We performed a throughout research in the literature, with special attention to the articles published in the last five years and indexed to the PubMed. The following headings were used: Pancreatitis, Surgical procedures, Necrosis. The initial research rendered about 1800 articles, and the ones published in the last five years were evaluated. Some older, but remarkable articles were also included given their importance to this matter. As we further describe, treatment of acute pancreatitis involves a great number of questions, among which the most important are the ones related to the terminology of pancreatic collections, prognostic markers, use of antibiotics, type of diet employed and the approach to infected necrosis. Many radical changes could be seen over the last years on all these topics and a constant updating must be necessarily done by the ones involved in the treatment of this disease.