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Necrosectomy and drainage, mostly surgically performed, are indicated in front of superinfection of pancreatic necrosis proven by percutaneous bacteriological puncture or when the clinical status of the patient deteriorates despite maximal intensive care, without proven infection of necrosis. Early necrosectomy (within the first two or three weeks) carries a risk of postoperative mortality around 50%. To delay further the necrosectomy is advisable when it is compatible with patient's status.

Mortality rate of acute pancreatitis is 5% but can reach 47% in necrotizing pancreatitis with multiorgan failure. Prediction of an unfavourable outcome is based on bioclinical scoring systems either specific of pancreatitis or not, single biological prognostic criteria as CRP and procalciton levels measured during the first 48 h and abdominal CT-scan. Medical treatment of acute pancreatitis is symptomatic and requires intensive care in severe forms of the disease.

The diagnosis of acute pancreatitis is based on the association of an acute abdominal pain with raised level of seric lipase exceeding three fold the normal value during the first 48 h following pain occurrence. The main causes are biliary lithiasis and chronic alcoholism. Oedematous pancreatitis resume in a few days whereas severe necrotizing pancreatitis may require long staining and complex medico-surgical management.

The diagnosis of acute pancreatitis is based on the association of acute upper abdominal pain and hyper lipasemia. The CT scan confirms the diagnosis and assess the severity of the pancreatitis, as do several bioclinical indexes. Alcohol and biliary lithiasis, seeked by ultrasound, are the two main causes of acute pancreatitis. Most of acute pancreatitis are oedematous and resolve spontaneously without sequella. Severe necrotizing pancreatitis lead to death in 10 to 20% of cases, because of multiple organ failure or intra-abdominal complications of necrosis. Treatment of severe acute pancreatitis involves intensivists, radiologists and surgeons. Surgery is restricted to drainage of super-infected necrosis and treatment of causative biliary lithiasis.