ACUTE PANCREATITIS

Acute pancreatitisis about one-fifth as common as perforated peptic ulcer (Figure I). The necessityfor early exploration in the latter more frequently encounteredcondition overshadowsthe diagnosis of pancreatitis ("We'll just make sure"), and accounts for the frequency with which the abdomensof patients with acute pancreatitis were explored. AVERY JONES wrote in the introduction to "Modern Trendsin Gastroenterology"(1952): "Gastroenterologyhas a greater number of unsolved retiological problems than any other systemof the body." In truth, it could be added that in gastroenterologythere is no field at the present date with a greater number of unsolved problems than pancreatitis. Since Opie's classical paper on pancreatitis complicating calculous impaction of the ampulla of Vater (1901), therehasbeena tendency,amongstsurgeonsat all events, to relate pancreatitisexclusively to diseaseof the biliary tract. While it is undeniably true that patients with biliary calculi are as a group more prone to develop pancreatitis than others, careful clinical observation indicatesthat other quite unrelatedfactors may be of considerableimportancein pathogenesis, the appreciationand understandingof which have a material bearing on the diagnosisand managementof the condition.