Letalitätsbestimmende Faktoren bei schwerer akuter Pankreatitis unter besonderer Berücksichtigung des Therapiewandels / Mortality Factors in Severe Acute Pancreatitis with Special Reference to a Conservative Treatment Strategy

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent. Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed. Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment. Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity. CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

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Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

Gastroenterology Research and Practice ◽

10.1155/2016/5251806 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Dejan V. Radenkovic ◽

Colin D. Johnson ◽

Natasa Milic ◽

Pavle Gregoric ◽

Nenad Ivancevic ◽

...

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Severe Acute Pancreatitis ◽

Fluid Resuscitation ◽

Interventional Treatment ◽

Invasive Approach ◽

Aggressive Fluid Resuscitation ◽

Abdominal Compartment

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

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Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1080 ◽

2019 ◽

Vol 74 (3) ◽

pp. 210-215

Author(s):

Vil M. Timerbulatov ◽

Shamil V. Timerbulatov ◽

Radik R. Fayazov ◽

Mahmud V. Timerbulatov ◽

Elza N. Gaynullina ◽

...

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Early Diagnosis ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Severe Acute Pancreatitis ◽

Abdominal Pressure ◽

Decompressive Laparotomy ◽

Abdominal Hypertension ◽

Abdominal Compartment

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment. AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction. MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs). RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 46 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree surgical treatment, with IV degree IAH emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p0.05), at SAP 37.5% and 80% (p0.01), respectively, at IV degree IAH for AOOC 75% and 90% (p0.05), with SAP 75% and 88,8% (p0.05) respectively. CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH IIII degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.

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The criterion for patients' transfer with severe acute pancreatitis; special reference to overseas guidelines, the concept for criterion, and its problems to be solved

Suizo ◽

10.2958/suizo.21.500 ◽

2006 ◽

Vol 21 (6) ◽

pp. 500-503 ◽

Cited By ~ 1

Author(s):

Yasutoshi KIMURA ◽

Kouichi HIRATA

Keyword(s):

Acute Pancreatitis ◽

Special Reference ◽

Severe Acute Pancreatitis

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ACUTE PANCREATITIS IN CHILDHOOD - RESULTS OF A CONSERVATIVE TREATMENT STRATEGY.

Pancreas ◽

10.1097/00006676-200411000-00103 ◽

2004 ◽

Vol 29 (4) ◽

pp. 352

Author(s):

M. Bottländer ◽

M. Melter ◽

R. Nustede ◽

B.M. Ure

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Treatment Strategy

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Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis

Journal of Gastroenterology ◽

10.1007/s00535-007-2081-5 ◽

2007 ◽

Vol 42 (8) ◽

pp. 681-689 ◽

Cited By ~ 17

Author(s):

Takeo Yasuda ◽

Takashi Ueda ◽

Yoshifumi Takeyama ◽

Makoto Shinzeki ◽

Hidehiro Sawa ◽

...

Keyword(s):

Acute Pancreatitis ◽

Clinical Outcome ◽

Enteral Nutrition ◽

Severe Acute Pancreatitis ◽

Treatment Strategy ◽

Arterial Infusion ◽

Continuous Regional Arterial Infusion

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The Choice of Treatment Tactics in Patients with Severe Acute Pancreatitis Taking Into Account the Factor of Intra-Abdominal Hypertension

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-3-400-409 ◽

2020 ◽

Vol 9 (3) ◽

pp. 400-409

Author(s):

B. M. Belik ◽

G. M. Chirkinyan ◽

R. S. Tenchurin ◽

Z. A. Abduragimov ◽

D. V. Mareyev ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Treatment Strategy ◽

Apache Ii ◽

Abdominal Pressure ◽

Group I ◽

Abdominal Hypertension ◽

Choice Of Treatment ◽

Therapeutic Measures ◽

Severity Of The Disease

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.

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