Pancreatitis is inflammation of the pancreas. In the acute form, the commonest causes are gallstones and alcohol; it is treated mainly with supportive care in hospital. The surgical role is twofold: treating the cause (cholecystectomy in the gallstone form, to prevent recurrence) and managing complications (necrosis, pseudocyst). The chronic form is a progressive damage with pain and malabsorption.
What is pancreatitis?
Pancreatitis is inflammation of the pancreas, the organ that produces digestive enzymes and insulin. There are two forms. Acute pancreatitis is a sudden inflammation, usually reversible, ranging from mild (the majority) to severe with necrosis. Chronic pancreatitis is a progressive, irreversible damage with fibrosis and a gradual loss of the organ's function.
In the acute form, the digestive enzymes are activated prematurely within the pancreas itself and cause "auto-digestion" — inflammation of its own tissue. Treating the underlying cause is decisive for the course.
How common is it?
Acute pancreatitis is one of the commonest causes of emergency admission for abdominal disease. Gallstones and alcohol together account for the majority of cases.
In the great majority the disease is mild and settles, but a proportion progresses to a severe form requiring intensive monitoring. Chronic pancreatitis is less common and is linked mainly to long-term alcohol use.
How does it present?
In acute pancreatitis the dominant symptom is severe pain:
- Intense, constant pain in the upper abdomen, often radiating to the back (a "band-like" pain).
- Nausea and vomiting, worse after eating.
- Abdominal tenderness and distension.
- In severe forms: fever, tachycardia and signs of systemic involvement.
In the chronic form, chronic or recurrent pain, weight loss, fatty stools (malabsorption) and, often, diabetes predominate.
How is it diagnosed?
The diagnosis of acute pancreatitis is based on the combination of the clinical picture, laboratory and imaging findings:
- Clinical assessment of the characteristic pain and the history.
- Laboratory tests — a rise in blood lipase (and amylase), at least three times the upper limit of normal.
- Upper-abdominal ultrasound to detect gallstones as the cause.
- CT to assess severity and any necrosis; MR cholangiopancreatography (MRCP) or endoscopic ultrasound for the biliary tree.
What are the causes?
Identifying the cause also determines the treatment — particularly the prevention of a new episode:
- Gallstones — stones that transiently obstruct the common bile/pancreatic duct (the commonest treatable cause).
- Alcohol — acute and, especially, chronic pancreatitis.
- High triglycerides and, more rarely, high blood calcium.
- Certain drugs and endoscopic cholangiopancreatography (ERCP).
- Genetic, autoimmune and obstructive factors; smoking in the chronic form.
Modern treatment options
Acute pancreatitis itself is treated mainly conservatively. The surgeon contributes decisively to treating the cause and to managing complications.
For details of the techniques, see the Surgical Services page and the Gallstones page.
Supportive Management
The cornerstone in the acute phase: intravenous hydration, pain control, early nutritional support and close monitoring in hospital. Most mild episodes settle with this care.
Cholecystectomy
In gallstone pancreatitis, removing the gallbladder prevents recurrence. In mild cases it is usually advised during the same admission, once the episode has settled; laparoscopically or robotically.
Treatment of Complications
For infected necrosis, a pseudocyst or walled-off necrosis, a step-up approach is used: drainage and minimally invasive necrosectomy as a priority, rather than extensive open surgery.
Frequently asked questions
Is pancreatitis dangerous?
Most cases of acute pancreatitis are mild and settle with supportive care in hospital. A minority, however, progress to severe disease with necrosis and life-threatening complications. This is why every episode needs prompt assessment and admission.
What is the commonest cause?
The two commonest causes are gallstones (stones that transiently obstruct the common duct) and alcohol. When the cause is gallstones, removing the gallbladder is decisive in preventing a new episode.
Does pancreatitis need surgery?
Acute pancreatitis itself is treated mainly conservatively (hydration, pain control, nutritional support). The surgical role is to treat the cause — chiefly cholecystectomy in the gallstone form — and to manage complications, such as infected necrosis or a pseudocyst.
When is the gallbladder removed after pancreatitis?
In gallstone pancreatitis, cholecystectomy prevents recurrence. In mild cases it is usually advised during the same admission, once the episode has settled. In severe cases it may be deferred until the situation has stabilised.
What is chronic pancreatitis?
It is a progressive, irreversible damage of the pancreas with fibrosis, presenting with chronic pain, malabsorption (fatty stools, weight loss) and, often, diabetes. The commonest cause is long-term alcohol use. Management includes pain control, enzyme replacement and, in selected cases, surgery.