Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

Acute necrotizing pancreatitis (ANP), characterized by necrosis of pancreatic and/or peripancreatic tissues, is a potentially severe and life-threatening complication of acute pancreatitis, exhibiting a considerable mortality rate, particularly in the presence of infection, with rates ascending to 20–30%. Contrast-enhanced computed tomography is the definitive diagnostic standard, although treatment is determined by illness severity and the presence of secondary infection. The management of this condition has undergone considerable evolution, transitioning from initial surgical intervention to a more progressive, minimally invasive strategy. Initial management emphasizes aggressive fluid resuscitation, nutritional support, and monitoring of organ dysfunction. Infected necrosis is a critical factor influencing prognosis and requires intervention, typically starting with percutaneous drainage or endoscopic necrosectomy prior to evaluating surgical debridement. Recent advancements, such as the implementation of endoscopic and minimally invasive techniques, have enhanced outcomes by decreasing morbidity and mortality linked to open surgery. Despite these advancements, optimal treatment strategies are patient-specific and necessitate a multidisciplinary approach. Additional research is necessary to enhance guidelines and optimize patient outcomes.

Gallstones and colorectal cancer (CRC) are two common disorders that may develop simultaneously. In such situations, there is a significant chance of missing one of the conditions due to the primary clinical presentation. Late detection, diagnosis and treatment can be especially problematic in the case of unrecognized CRC. In the present study, the medical charts were retrospectively reviewed for all consecutive patients who were treated in the Second Department of Surgery, University Emergency Hospital Bucharest (Romania) between February 2015 and December 2017 following a diagnosis of CRC and/or biliary stones. There were 203 patients with CRC, 433 with biliary gallstones and 19 patients with both conditions. There were 125 men (61.6%) in the CRC group and 138 men (31.9%) in the gallstone group. The average age was 54.1±15.9 years in the gallstone group and 66.1±11.6 years in the CRC group. Obesity was observed in 96 patients (22.2%) with gallstones and in 14 (6.9%) patients in the CRC group. In the CRC group, 80 patients had medical comorbidities (39.4%), while in the gallstone group 126 patients (29.1%) had medical comorbidities. Bivariate analysis comparing gallstone only vs. gallstone and CRC identified age (P=0.001), male sex (P=0.001) and thyroid disease (P=0.001) as significant factors associated with synchronous diagnosis. The multivariable logistic regression of factors predicting CRC in patients with gallstones identified age (OR, 1.06; 95% CI, 1.023‑1.105; P=0.002) and thyroid diseases (OR, 11.15; 95% CI, 2.532‑49.06; P=0.001) as independent factors. There were significant differences regarding the location of the tumor between the CRC‑only group and the gallstone and CRC group (P=0.001): Rectum (39.7 vs. 5.3%), left colon (26.6 vs. 21.1%), transverse colon (13 vs. 26.3%) and right colon (20.7 vs. 47.4%). The study concluded that, in patients with gallstones, age and thyroid conditions were significantly associated with CRC. Patients with a synchronous diagnosis of gallstones and CRC had significantly more right‑sided CRC compared with regular CRC.

Acute pancreatitis is a common inflammatory digestive disease with an unpredictable clinical course, ranging from self-limited forms to severe forms, associated with complications and increased mortality. Early identification of patients at risk of severe disease is particularly important from a surgical perspective, as it has a significant impact on subsequent management. Traditional severity scores, such as APACHE (Acute Physiology And Chronic Health Evaluation) II and BISAP (Bedside Index for Severity in Acute Pancreatitis), remain widely used, but their rigid structure and delayed applicability may limit initial risk assessment. In this review we highlight the evolving role of artificial intelligence in predicting the severity of acute pancreatitis and supporting clinical decision-making, with a focus on surgical management. Recent advances show that data-driven models could improve early risk assessment compared to traditional methods. Although their potential clinical benefits are becoming increasingly clear, real-world implementation remains limited. Initial results are encouraging, but important questions regarding reliability, safety, and integration into clinical practice still need to be addressed.