Abstract
Therapeutic strategy for severe acute pancreatitis was reviewed based on the Japanese guidelines for acute pancreatitis. Aggressive fluid resuscitation with intensive medical care is crucial as an initial step of the management of severe acute pancreatitis. Urgent endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy (ERCP/ES) should be indicated for the patients with severe gallstone pancreatitis, in whom biliary obstruction or cholangitis is suspected. CT-guided fine needle aspiration is recommended for the diagnosis of infected pancreatic necrosis. Necrosectomy with continuous closed lavage or open drainage should be mandatory for surgical management of infected pancreatic necrosis.
