Case of the Month #13 - pancreatitis

Published 02/02/2022

Specific Considerations

1. Nutrition (ESPEN Guidelines 2020)3

Early v Late

  • Early feeding (<48 hours) has shown a reduction in infected necrosis, organ failure and need for invasive intervention
  • Those with mild pancreatitis can eat and drink as soon as able. The majority can tolerate diet and do not require gut rest
  • Enteral Support should be considered within 24-72 hours if oral diet is not possible

Route of Delivery

  • Parenteral Nutrition was once thought to be beneficial as it could potentially limit activation of the pancreatic exocrine system, but parenteral nutrition is not without its own risks and complications
  • Enteral feeding has beneficial effects on maintenance of both function and structure of the gut mucosa, particularly with respect to prevention of bacterial translocation
  • There is consistent evidence that enteral feeding reduces mortality and infective complications.
  • When enteral feeding is indicated NG feed should be the first line. NJ feeding is reserved for those who fail to establish feed via the NG route.


  • Elemental feeds have been suggested as a way of reducing pancreatic stimulation. There is inadequate evidence to support the use of these at present. This also applies to probiotics and immune-nutrition

2. Gallstones

  • Mild Pancreatitis – Consider cholecystectomy before discharge

3. Antibiotics

  • The role of prophylactic antibiotics to prevent infection in pancreatitis has been long debated
  • The most recent literature appears to suggest no benefit in mortality or morbidity with prophylactic antibiotic therapy
  • Antibiotics should be used where evidence of infected pancreatic necrosis exists (or signs of extra-pancreatic infection)4
  • Detecting evidence of infected necrosis can often be clinically challenging
  • Procalcitonin (PCT) may be a useful tool when suspecting infected necrosis

4.Involvement of Local HPB Team

  • The following patients should be referred:
    • Severe acute pancreatitis or inpatient for >2 Weeks 5
    • Presence of any local complication