Abstract

Acute Pancreatitis (AP) is one of the most common pancreatic diseases leading to hospital admissions worldwide, with a clinical course that is often unpredictable. In the context of a rapidly aging global population, the incidence of AP in the elderly is increasing, depending on the age group studied. Compared to younger individuals, AP in this population typically presents with a more severe clinical picture, a higher frequency of systemic complications, and a significantly higher mortality rate. Regarding etiology, gallstones are the leading cause in the elderly (accounting for up to 75% of cases), while alcohol—the primary cause in younger people—accounts for only about 5%. Other factors such as medications (due to polypharmacy in the elderly), pancreatic cancer, and metabolic issues like hypertriglyceridemia should also be considered. Diagnosing AP in the elderly faces many challenges due to age-related structural changes in the pancreas and biliary tract, which can easily be confused with chronic conditions on imaging. Notably, clinical manifestations in this group are often atypical; abdominal pain may be mild or unclear in more than 50% of cases, and classic symptoms such as fever or leukocytosis are frequently not prominent. Instead, patients can rapidly fall into a state of consciousness disorders and progressive shock. Regarding prognosis, traditional scoring systems such as Ranson, APACHE II, or BISAP sometimes have limitations in accurately predicting mortality in the elderly due to differences in age thresholds and physiological reserves. Therefore, combining new biomarkers (such as IL-6, Procalcitonin) and assessing frailty (Clinical Frailty Scale - CFS) is recommended for more accurate risk stratification. Modern treatment strategies emphasize early but cautious fluid resuscitation to avoid circulatory overload, along with minimally invasive intervention for necrotic complications and a focus on enteral nutrition to improve clinical outcomes for patients.