P. De Rai

Diagnosis and treatment of acute pancreatitis: the position statement of the Italian Association for the study of the pancreas.

This medical position statement has been developed by the board of ProInf AISP (Computerized Project on Acute Pancreatitis) Study Group. The evidence and key recommendations were discussed at a dedicated meeting held in Milan on September 2007 and during this meeting the main clinical and therapeutic medical topics were extensively discussed. Each of the proposed recommendations was discussed and an initial consensus was reached. Acute pancreatitis in Italy is a disease of increasing annual incidence. The diagnosis of the disease should be established within 48hours of admission. Early identification of patients at risk of developing a severe attack of acute pancreatitis is of great importance because rapid therapeutic interventions improve outcome. The endoscopic approach seems to be most beneficial measure in patients with acute pancreatitis with jaundice and in those with cholangitis. The development of infected necrosis should be assessed using fine-needle aspiration and the sample should be cultured for germ isolation and characterization. The role of early ERCP in all patients with severe acute pancreatitis of biliary origin is still controversial. The data supporting the efficacy of antibiotic prophylaxis to prevent infection of necrosis are conflicting. The refeeding is a crucial topic in patients who have recovered from an acute episode of mild acute pancreatitis, but there are very few studies on this issue.

Pseudomembranous Colitis: Review of a Teaching Hospital Series

We present a critical review of a series of 23 patients with pseudomembranous colitis observed in a teaching hospital of Milan. The main role of morphologic and microbiologic findings in making a correct diagnosis is underlined; nevertheless, pseudomembranous colitis was sometimes associated with a clinical picture resembling that of peritonitis and apparently warranting emergency surgical treatment. Plain films of the abdomen may be misleading in these cases, whereas barium enema and exploratory puncture are contraindicated or risky; rectosigmoidoscopy performed without air insufflation and biopsies may be diagnostic, while awaiting the culture results. A 10-day medical treatment with vancomycin or metronidazole was effective in the great majority of the cases. Four patients died (17.3%).