scholarly journals Severe acute pancreatitis: surgical indications and treatment

2020 ◽  
Author(s):  
Max Heckler ◽  
Thilo Hackert ◽  
Kai Hu ◽  
Cristopher M. Halloran ◽  
Markus W. Büchler ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Organ Failure ◽  
Severe Disease ◽  
Intensive Therapy ◽  
Necrotizing Pancreatitis ◽  
Pancreatic Pseudocysts ◽  
Second Phase ◽  
Accurate Identification ◽  
Multi Organ Failure

Abstract Background Acute pancreatitis (AP) is defined as an acute inflammatory attack of the pancreas of sudden onset. Around 25% of patients have either moderately severe or severe disease with a mortality rate of 15–20%. Purpose The aim of this article was to summarize the advances being made in the understanding of this disease and the important role of surgery. Results and conclusions An accurate diagnosis should be made a soon as possible, initiating resuscitation with large volume intravenous fluids and oxygen by mask. Predicted severe disease will require intensive monitoring. Most deaths within the first week are due to multi-organ failure; thus, these patients will require intensive therapy unit management. During the second phase of the disease, death is due to local complications arising from the pancreatic inflammation, requiring accurate identification to determine the correct form of treatment. Acute peripancreatic fluid collections arise < 4 weeks after onset of interstitial edematous pancreatitis, not requiring any treatment. Most pancreatic pseudocysts arise > 4 weeks and largely resolve on conservative management. Necrotizing pancreatitis causing acute necrotic collections and later walled-off necrosis will require treatment if symptomatic or infected. Initial endoscopic transgastric or percutaneous drainage will resolve less serious collections but necrosectomy using minimally invasive approaches will be needed for more serious collections. To prevent recurrent attacks of AP, causative factors need to be removed where possible such as cholecystectomy and cessation of alcohol. Future progress requires improved management of multi-organ failure and more effective minimally invasive techniques for the removal of necrosis.

scholarly journals Glucocorticoids in acute pancreatitis: a propensity score matching analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meng Wang ◽  
Zongxing Jiang ◽  
Hongyin Liang
Keyword(s):  
Acute Pancreatitis ◽  
Propensity Score ◽  
Organ Failure ◽  
Propensity Score Matching ◽  
Fluid Intake ◽  
Final Analysis ◽  
Apache Ii ◽  
Propensity Score Matching Analysis ◽  
Multi Organ Failure ◽  
Positive Balance

Abstract Background There are few reports about the effect of glucocorticoids in the treatment of acute pancreatitis in humans. This study aims to evaluate the effect of glucocorticoids in the treatment of acute pancreatitis by propensity score matching analysis. Results Acute pancreatitis patients admitted between 2014 and 2019 were collected from the database and analyzed. Included patients were divided into the glucocorticoids-used group (GC group) and the non-glucocorticoids-used group (NGC group) according to whether glucocorticoids were used. A total of 818 eligible patients were included in the final analysis. Seventy-six patients were treated with glucocorticoids, and 742 patients were treated without glucocorticoids. Before propensity score matching, the triglyceride levels (38.2 ± 18.5 vs. 20.2 ± 16.8, P < 0.05) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (7.1 ± 2.5 vs. 4.5 ± 2.1, P < 0.05) at admission were significantly higher in the GC group than in the NGC group. The incidence of multi-organ failure (33.3% vs. 11.9%, P < 0.05) was significantly higher in the GC group than in the NGC group. Patients in the GC group showed a positive balance of fluid intake and output over 72 h. After 1:1 propensity score matching, 59 patients from each group (GC and NGC) were included in the analysis. There were no significant differences in age, sex, body mass index, triglycerides, or APACHE II scores between the two groups (P > 0.05), and the patients’ clinical outcomes were reversed. The proportion of patients with organ failure (40.7% vs. 52.5%, p < 0.05) and multi-organ failure (35.0% vs. 67.7%, P < 0.05) was significantly lower in the GC group than in the NGC group. Furthermore, patients in the GC group had significantly shorter lengths of hospital stay (12.9 ± 5.5 vs. 16.3 ± 7.7, P < 0.05) and costs (25,348.4 ± 2512.6vs. 32,421.7 ± 2813.3, P < 0.05) than those in the NGC group. Conclusions This study presents preliminary confirmation of the beneficial effect of glucocorticoids in the treatment of acute pancreatitis. More high-quality prospective studies are needed in the future.

scholarly journals Su1420 – Multi-Organ Failure is the Strongest Determinant of Poor Clinical Outcomes in Acute Pancreatitis. (Apprentice Study Group)

2019 ◽  
Vol 156 (6) ◽  
pp. S-541-S-542
Author(s):  
Amir Gougol ◽  
Pedram Paragomi ◽  
Xiaotian Gao ◽  
Rupjyoti Talukdar ◽  
Rakesh Kochhar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Study Group ◽  
Multi Organ Failure

A fatal case of healthcare associated Crimean-Congo haemorrhagic fever with severe disease and multi-organ failure

2016 ◽  
Vol 72 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Mustafa Sunbul ◽  
Saban Esen ◽  
Tom E. Fletcher ◽  
Ahmet Dilek ◽  
Nil Guler ◽  
...  
Keyword(s):  
Organ Failure ◽  
Severe Disease ◽  
Fatal Case ◽  
Haemorrhagic Fever ◽  
Multi Organ Failure ◽  
Crimean Congo Haemorrhagic Fever ◽  
Healthcare Associated

scholarly journals Rare Combinations of Late Complications of Acute Pancreatitis and Other Diseases

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
D. M. Bidiuk ◽  
A. I. Furtak ◽  
A. M. Mykush
Keyword(s):  
Acute Pancreatitis ◽  
Bowel Obstruction ◽  
Necrotizing Pancreatitis ◽  
Late Complications ◽  
Clinical Development ◽  
Pancreatic Pseudocysts ◽  
Peptic Ulcers ◽  
Surgical Department ◽  
Surgical Disease ◽  
Previously Treated

Acute pancreatitis is a severe surgical disease which can be accompanied by gastrointestinal bleeding and bleeding from pancreatic pseudocysts, bowel obstruction, and perforations of peptic ulcers. The cases in which the aforementioned pathological processes were the main cause of hospitalization and lesions of the pancreas (abscess, pseudocyst) were diagnosed during treatment as a background disease are noteworthy. Clinical development and treatment of the disease were analyzed in 5 patients with the following basic pathologies: perforations of peptic ulcers (2 patients), ulcerous bleeding (1 patient), adhesive bowel obstruction (1 patient), myelofibrosis, splenomegaly (1 patient). During treatment, all the patients developed symptoms of late complications of necrotizing pancreatitis in the form of pseudocysts and abscesses which were not diagnosed before hospitalization and were characterized by an asymptomatic course. Based on the anamnesis it was revealed that all the patients were previously treated in surgical department with the diagnosis of acute pancreatitis. The possibility of an uncontrolled asymptomatic development of late complications of acute pancreatitis which further manifest themselves as background pathology and aggravate the course of other diseases was emphasized.

scholarly journals Atlanta Classification for Acute Pancreatitis- A Study Protocol

2021 ◽  
pp. 61-68
Author(s):  
Varun Singh ◽  
Rajasbala Pradeep Dhande ◽  
Gaurav Mishra
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Scoring System ◽  
Necrotizing Pancreatitis ◽  
Classification Systems ◽  
Mortality And Morbidity ◽  
The Past ◽  
Edematous Pancreatitis ◽  
Acute Necrotic Collection

Background: Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen  and Atlanta Classification. Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure. Methodology: We will be carrying forward our study on   Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis. Results: Will be tabulated at the end of the study using SPSS version 26 software. Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.

D-DIMER - AN ESSENTIAL MARKER IN SEVERITY PREDICTION OF ACUTE PANCREATITIS

2021 ◽  
pp. 78-82
Author(s):  
Mrinal Talukdar ◽  
Prashanth K R ◽  
Ratnadeep Paul
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Receiver Operating Curve ◽  
Severity Prediction ◽  
Ranson Score ◽  
D Dimer

Introduction: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with severe forms but it remains a challenge to identify these poor prognosis cases especially in the rst 48 hours. This study will evaluate the efcacy of serum D-Dimer in prediction of severity and outcome of acute pancreatitis. A prospective observati Methods: onal study of 60 patients presenting with AP was done at st st Silchar Medical College from 1 June 2017 to 31 May 2018. APACHE-II, Ranson criteria, and CT severity index (CTSI) of all patients were calculated,. D-Dimer was done for all patients. The patients were stratied into categories of severe pancreatitis, organ failure and pancreatic necrosis, as well as the number of deaths. The comparison of D-Dimer with other scoring systems was done by area under the receiver-operating curve (AUC) to predict severity, organ failure, necrosis, and death. Of the 60 patie Result: nts, 15 (25%) developed SAP, 12 (20%) Organ failure (OF), 22 (36.7%) pancreatic necrosis and 3 (5%) died. ROC curves were generated and following cut-off were selected for comparison of severity, organ failure, necrosis and death; Ranson ≥ 3, APACHE II ≥ 8, CTSI ≥ 4. Cut-off of D-Dimer value for severity, organ failure, necrosis and death are ≥1397µg/L, ≥1886µg/L, ≥1890µg/L and ≥5769µg/L respectively. The AUC of D-Dimer (0.914) in predicting severity of disease is similar to that of Apache 2 (0.958) and Ranson (0.899). CTSI (0.715) had lowest AUC among them. The AUC of D-Dimer (0.833) in predicting of organ failure of disease is similar to that of Ranson (0.908) and lower than Apache 2 (0.980). CTSI (0.715) had lowest AUC among them. The AUC of CTSI (0.892) in predicting the necrosis was higher than Apache 2 (0.590), Ranson score (0.578) system and D-Dimer. The AUC of D-Dimer (0.953) in predicting of mortality of disease is similar to that of Apache 2 (0.933), CTSI (0.953) and lower than Ranson score (0.816). Conclusion: D-Dimer is an easy tool for assessment of severity and prognosis of acute pancreatitis. CTSI is best for predicting pancreatic necrosis.

scholarly journals Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

2019 ◽  
Vol 9 (1) ◽  
pp. 44-54
Author(s):  
Abdullah Al Mamun ◽  
Indrajit Kumar Datta ◽  
Md Anisur Rahman ◽  
Md Nazmul Hoque
Keyword(s):  
Acute Pancreatitis ◽  
General Hospital ◽  
Severe Acute Pancreatitis ◽  
Severe Disease ◽  
Necrotizing Pancreatitis ◽  
Early Management ◽  
Mild Disease ◽  
The Mean ◽  
The Difference ◽  
D Dimer

Background: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inflammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inflammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with the most severe forms but it remains a challenge to identify these poor prognosis cases specially in the first 48 hours. The objective of our study is to evaluate the efficacy of serum D-dimer in the prediction of severity and outcome of acute pancreatitis. Methods: This prospective and observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, Bangladesh from January, 2016 to September, 2017. Patients with acute pancreatitis admitted to Department of GHPD of BIRDEM General Hospital, Dhaka, were included in this study. Purposive type of non probability sampling technique was applied to enroll the patients. A predesigned structured questionnaire was used for recording the necessary information. Patients admitted with abdominal pain and fulfilling the diagnostic criteria of acute pancreatitis by clinical history, physical examination, biochemical tests and different imaging modalities and patients aged more than 18 years were included in this study. The patients were followed up on day 1, day 3 of admission and on the day before discharge. Results: Total 87 patients with acute pancreatitis, who fulfilled the inclusion criteria, were included in this study. This study found that 53(61.0%) had mild acute pancreatitis, 27(31.0%) patients had moderately severe acute pancreatitis and 7(8.0%) patients had severe acute pancreatitis. The mean serum D-dimer at day 1 of patients with mild disease was 2.31± 1.82(mean±SD) μg/ml, in patients with moderately severe disease was 4.67± 2.02(mean±SD) μg/ml and in severe acute pancreatitis it was 10.11±3.11 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). The mean serum D-dimer at day 3 of patients with mild disease was 0.8±0.51 (mean±SD) μg/ml, in patients with moderately severe disease was 1.86±2.22 (mean± SD) μg/ml and in severe acute pancreatitis it was 3.62±1.9 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). Thus serum D-dimer could predict disease severity early in the course of disease successfully. In the present study 55(63.2%) patients did not develop any kind of complications and serum D-dimer level at day 1 and day 3 were 2.4±1.73 and 0.81±0.49 respectively. On the other hand 32 (36.8%) patients developed complications and serum D-dimer level at day 1 and day 3 were 5.86±3.5 and 2.31±2.3 respectively. The difference among the groups were statistically significant (p<0.001).That reveals serum D-dimer is a predictor of outcome of acute pancreatitis. Sensitivity, specificity and accuracy was 77.8%, 76.5% and 77.0% respectively at day 1 (cut off value e”3.3 μg/ml) and it was 73.5%, 77.4% and 75.9% respectively at day 3 (cut off value e”1.05 μg/ml) in prediction outcome of AP. Conclusion: The difference of serum D-dimer levels between mild, moderately severe and severe acute pancreatitis was statistically significant and it was also higher in patients who developed complications following acute pancreatitis than those without complications. This simple, feasible and reproducible marker can be used in clinical practice to improve the early management of acute pancreatitis. Birdem Med J 2019; 9(1): 44-54

Sign in / Sign up

Export Citation Format

Share Document