Total Necrosis of the Pancreas with Peripancreatic Necrosis: An Absolute Indication for Laparostomy?

Despite extensive clinical trials, acute necrotizing pancreatitis remains a poorly understood clinical entity, partly because of the difficulty of diagnosing its presence and assessing its severity, and also to marked variability in its natural history. Studies published to date have shown significant improvement in the clinical and morphological staging of necrotizing pancreatitis [1, 3, 4, 6], but indication for surgery according to either clinical or morphological staging alone remains a controversial issue [7].