A súlyos acut pancreatitist gyakran kíséri hasűri nyomásfokozódás és annak súlyos formája, az abdominalis compartment-syndroma, ezért a betegség kezelésekor gondolni kell a kialakulására. Mivel a betegség korai stádiumában végzett műtétek morbiditása és mortalitása magas, csak a konzervatív kezelés eredménytelensége esetén, de mielőbb el kell végezni a dekompressziós műtétet. A műtéti dekompresszióra általában median laparotomiát alkalmaznak, de a haránt laparotomia is hasonlóan eredményes. A subcutan linea alba vagy a kétoldali anterior rectus fasciotomia is jó eredménynyel végezhető, azonban ennek eredménytelensége esetén dekompressziós laparotomia javasolt. A nyitotthas-kezelés a gyakori szövődmények miatt nem ajánlott. Törekedni kell a hasfal mielőbbi végleges zárására.
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