Radiol Clin N Am 40 (2002) 1211-1227.
Balthazar EJ.
Complications that occur during and after an episode of acute pancreatitis are responsible for the 2% to 10% mortality reported in this disease [1-9]. The early detection of these complications by clinical, laboratory means or imaging studies is essential for the proper management of these patients.
During the last 10 years it has been established that most life-threatening complications develop almost exclusively in patients with pancreatic necrosis [10-16]. The complex pathophysiologic process that trig-'gers the development of pancreatic necrosis is still poorly understood. Extensive investigations and recent developments, however, have been able to better explain the nature and etiology of complications and have focused on the best means to accurately predict, diagnose, and weigh their clinical relevance.
The purposes of this article are to describe clinically pertinent complications associated with acute pancreatitis, and review their pathophysiology and the diagnostic means by which complications are detected and assessed.
It is useful to remember that grave, potentially lethal complications can coexist and can occur at any time during the natural history of acute pancreatitis. These complications can exhibit systemic toxic manifestations associated with multiorgan failure or they may reflect local pathologic phenomena confined mainly to the pancreas and peripancreatic tissues. A temporal classification of complications into early, intermediate, and late can be useful in clinical practice, because they tend to occur in different time frames after the onset of acute pancreatitis. Although there is some overlap in the timing of their occurence, early complications that develop at the onset or within the first 2 to 3 days of an acute attack are mostly systemic in nature. Local pancreatic and abdominal complications usually develop later—within a few weeks or, with decreasing frequency, very late over several months or years following an acute episode of pancreatitis (Table 1).