112 Mihai C. et al.<strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong> (Iaşi), 2013, Vol. 9, Nr. 2
ARTICOLE DE SINTEZĂ 113<strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong> (Iaşi), 2013, Vol. 9, Nr. 2NECESITATEA REVIZUIRII CLASIFICĂRII ATLANTAA PANCREATITEI ACUTEV. Păunescu Clinica chirurgicală, Spitalul Clinic <strong>de</strong> Urgenţă „Bagdasar-Arseni”, BucureştiUniversitatea <strong>de</strong> Medicină şi Farmacie „Carol Davila” BucureştiNECESSITY TO REVIEW ATLANTA CLASSIFICATION OF ACUTE PANCREATITIS(Abstract): The universal credit of the acute pancreatitis <strong>de</strong>scription goes to Reginald Fitz Huber,who in 1889 classified acute pancreatitis in: hemorrhagic, gangrenous and suppurative, followingsurgical and autopsy findings. Over time were used different criteria for classification of acutepancreatitis. Classification of acute pancreatitis in 1992 in Atlanta introduced a uniform systemfor assessing clinical severity and various complications of the disease, wi<strong>de</strong>ly acceptedclassification. In this classification, acute pancreatitis is presented in two forms: mild and severe.Mild pancreatitis is associated with minimal dysfunction of organs and, eventually, it heals.Severe form is associated with organ failure and/or local complications, such as necrosis, abscessand pseudocyst. The increase of knowledge of pathophysiology in acute pancreatitis, theintroduction of advanced diagnostic and treatment means showed that some <strong>de</strong>finitions havecreated confusion and ma<strong>de</strong> absolutely necessary the revision of Atlanta classification. Thereview inclu<strong>de</strong>s criteria for assessing the severity and <strong>de</strong>scription of local complications. Therevised classification of acute pancreatitis in 2012 i<strong>de</strong>ntifies in the dynamic evolution of thedisease, early stage and late stage, and classifies severity as: mild, mo<strong>de</strong>rate and severe, based onthe presence or absence of multiple organ failure and local complications in the two forms ofacute pancreatitis: interstitial e<strong>de</strong>matous pancreatitis and necrotizing pancreatitis. Localcomplications are: acute peripancreatic fluid complications, pancreatic pseudocyst, acute necroticcollections and wall formed necrosis. CONCLUSION: This review <strong>de</strong>monstrates that revisedAtlanta classification is an useful tool for the management of acute pancreatitis and will allow to<strong>de</strong>crease the morbidity and mortality of severe pancreatitis.KEY WORDS: ACUTE PANCREATITIS; ATLANTA CLASSIFICATIONSHORT TITLE: Pancreatita acută – clasificarea Atlanta revizuităAcute pancreatitis – revised Atlanta classificationHOW TO CITE: Păunescu V. [Necessity to review Atlanta classification of acute pancreatitis] <strong>Jurnalul</strong> <strong>de</strong> chirurgie (Iaşi).2013; 9(2): 113-126. DOI: 10.7438/1584-9341-9-2-2.Pancreatita acută este o boalăinflamatorie a pancreasului exocrin, care,frecvent interesează şi ţesuturileperipancreatice şi sisteme <strong>de</strong> organe <strong>de</strong> ladistanţă, cu o patologie complexă, cu oevoluţie a<strong>de</strong>sea imprevizibilă, cu consecinţe<strong>de</strong>zastruoase, <strong>de</strong>spre care Sir BerkeleyMoynihan spunea în articolul Acutepancreatitis, publicat în Annals of Surgery,în 1925 [1], că este „cea mai teribilă dintretoate calamităţile ce survin în legătură cu unviscer abdominal. Debutul ei brusc, agonianelimitată care o acompaniază şi mortalitateaei crescută, toate împreună o fac să fie ceaReceived date: 28.11.2012Accepted date: 20.02.2013mai formidabilă dintre catastrofe”; GeorgeDieulafoy în Manuel <strong>de</strong> Pathologie Interne,o numea „drama pancreatică”. HenriMondor, în Diagnostic urgents. Abdomen,[31] o <strong>de</strong>scrie ca „o catastrofă abdominalăcaracterizată prin intensitatea semnelorfuncţionale, precocitatea semnelor generaleşi sărăcia relativă a semnelor fizice”.Mai recent, Lucien Leger, în articolulLes pancreatites aigues, o <strong>de</strong>scrie ca „oexplozie într-o uzină <strong>de</strong> armament” [5]Creditul universal al <strong>de</strong>scrieriisistematice a pancreatitei acute i se acordălui Reginald Huber Fitz (1843-1913), care aAdresa <strong>de</strong> corespon<strong>de</strong>nţă: Prof. Dr. Virgil PăunescuStr. Plutonier Petre Ionescu Nr. 12, Bloc 15, Scara A, etaj IV, Apartament 22, sector 3, Cod 032392, BucureştiTel.: 0040 (0) 724 39 58 53E-mail: validor2004@yahoo.com