scholarly journals O-BN05 The management of pancreatitis and complications that require intervention in a Benign Specialist Surgical Unit

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Helen Whitmore ◽  
Rola Salem ◽  
Matt Browning ◽  
Kirk Bowling ◽  
Petros Christopoulos ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Surgical Care ◽  
Pancreatic Pseudocysts ◽  
Specialist Centre ◽  
Operative Notes ◽  
Age Range ◽  
Surgical Unit

Abstract Background Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care. Methods A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period. Results Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality. Conclusions Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.

scholarly journals Neonatal intestinal obstruction: report

2000 ◽  
Vol 6 (1) ◽  
pp. 187-193
Author(s):  
G. A. Nasir ◽  
S. Rahma ◽  
A. H. Kadim
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Intestinal Obstruction ◽  
Imperforate Anus ◽  
Surgical Intervention ◽  
Duodenal Atresia ◽  
Colonic Atresia ◽  
Neonatal Intestinal Obstruction ◽  
Age Range ◽  
Surgical Unit

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction [27.8%] followed by duodenal atresia [13.9%] and colonic atresia and meconium ileus [11.1% each]. There were 8 deaths following surgery [22% mortality rate], the main causes being aspiration pneumonia, septicaemia and hypothermia

(Un) conventional complicated pancreatitis

2021 ◽  
Vol 75 (1) ◽  
pp. 61-67
Author(s):  
Michal Rybár ◽  
Ivo Horný
Keyword(s):  
Acute Pancreatitis ◽  
Multidisciplinary Approach ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Secondary Infection ◽  
Abdominal Ultrasound ◽  
Stent Migration ◽  
Endoscopic Extraction ◽  
Threatening Condition ◽  
Life Threatening

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

scholarly journals Endoscopic Drainage of Pancreatic Pseudocysts

1990 ◽  
Vol 4 (9) ◽  
pp. 568-571 ◽  
Author(s):  
Claude Liguory ◽  
Jean Francois Lefebvre ◽  
Gary C Vitale
Keyword(s):  
Pancreatic Duct ◽  
Surgical Intervention ◽  
The Body ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Acute Necrotizing ◽  
Head Of The Pancreas ◽  
Serial Scanning

Endoscopic drainage of pancreatic pseudocysts was attempted in 17 patients over an eight year period. There were nine cysts located in the head of the pancreas, six in the body and two in the tail. Endoscopic retrograde cholangiopancreatography was performed in all cases and the pancreatic duct satisfactorily opacified in 16 of the 17 patients. This study identified a communication with the pancreatic duct in seven cases. There were two cases in which multiple cysts were present; in each, one cyst was drained endoscopically and the others surgically. Endoscopic drainage of the cyst was immediately possible in 16 of 17 cases (94%). Late follow-up (mean 26 months) documented cyst disappearance in 11 cases (69%). None of the five patients with persistent cysts has required secondary surgical intervention, and the cysts are asymptomatic and stable or decreasing in size by serial scanning. There was one case (6%) in which a pseudocyst recurred following initial resolution. There were two complications (12%) requiring surgical intervention: gastrointestinal perforation with peritonitis in one patient and hemorrhage at the cyst margin from an arterial bleeder in another. There were no deaths at 30 days, but in one case a recurrent acute necrotizing pancrearitis occurred 36 days following endoscopic drainage and the patient died. This death was felt to be unrelated to the endoscopic procedure. In conclusion, internal drainage of pancreatic pseudocysts by endoscopic means can be proposed as an alternative to surgical drainage when the cyst can be identified as bulging into the stomach or duodenum. Immediate drainage is usually effective with a minimal long term recurrence rate.

scholarly journals Traumatic Orbital Subperiosteal Hematoma With Acute Visual Compromise: Role of the Head and Neck Surgeon

2019 ◽  
Vol 98 (10) ◽  
pp. 617-620
Author(s):  
Tom Shokri ◽  
Vijay A. Patel ◽  
Neerav Goyal
Keyword(s):  
Surgical Intervention ◽  
Ocular Injury ◽  
Optimal Method ◽  
Craniomaxillofacial Trauma ◽  
Institutional Experience ◽  
Sudden Blindness ◽  
Age Range

The primary goal was to report our institutional experience of a rare, vision-threatening complication following craniomaxillofacial trauma. A retrospective review was performed between January 2016 and January 2018 to identify 3 patients with traumatic orbital subperiosteal hematoma (OSPH). Visual acuity, intraocular pressures (IOPs), and the need for surgical intervention were abstracted. The age range was 36 to 88 years. Indications for surgical intervention include relative afferent pupillary defect, gaze restriction, visual impairment, and elevated IOP. Preoperatively, IOP range was 15.0 to 25.0. Two patients required OSPH evacuation via a medial brow approach. Follow-up after ocular injury ranged from 25 to 41 days, with IOP range of 13.0 to 16.0. Traumatic OSPH is an uncommon clinical finding; prompt assessment with consideration of surgical intervention may mitigate deleterious long-term morbidity, chiefly sudden blindness. Further research efforts may elucidate the optimal method in the management of this complex clinical entity.

scholarly journals Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study

2018 ◽  
Vol 41 (3) ◽  
pp. 20-30
Author(s):  
J. Tu ◽  
J. Zhang ◽  
L. Ke ◽  
Y. Yang ◽  
Q. Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Acute Pancreatitis ◽  
Blood Glucose ◽  
Pancreatic Necrosis ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Long Term Follow Up

Introduction. Patients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation. Methods. Follow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episodes. Oral Glucose Tolerance Test (OGTT) and faecal elastase-1(FE-1) test were used as primary parameters. Fasting blood-glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin HBA1c, 2-h postprandial blood glucose (2hPG), Homa beta cell function index (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR) and FE-1 were collected. Abdominal contrast-enhanced computed tomography (CECT) was performed to investigate the pancreatic morphology and the other related data during hospitalization was also collected. Results. One hundred thirteen patients were included in this study and 34 of whom (30.1%) developed diabetes mellitus (DM), 33 (29.2%) suffered impaired glucose tolerance (IGT). Moreover, 33 patients (29.2%) developed mild to moderate exocrine pancreatic insufficiency with 100μg/g<FE-1<200μg/g and 7 patients (6.2%) were diagnosed with severe exocrine pancreatic insufficiency with FE-1<100μg/g. The morbidity of DM and IGT in patients with pancreatic necrosis was significant higher than that in the non-pancreatic necrosis group (χ2 = 13.442,P = 0.001). The multiple logistic regression analysis showed that extent of pancreatic necrosis<30% (P = 0.012, OR = 0.061) were the protective factors of endocrine pancreatic insufficiency. HOMA-IR (P = 0.002, OR = 6.626), Wall-off necrosis (WON) (P = 0.013, OR = 184.772) were the risk factors. Conclusion. The integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis>50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.

scholarly journals Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts

2008 ◽  
Vol 45 (1) ◽  
pp. 17-21 ◽  
Author(s):  
César Vivian Lopes ◽  
Christian Pesenti ◽  
Erwan Bories ◽  
Fabrice Caillol ◽  
Marc Giovannini
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Pancreatic Pseudocysts ◽  
Ultrasound Guided ◽  
Traditional Treatment ◽  
Plastic Stent ◽  
Secondary Infections ◽  
Fluoroscopic Control ◽  
Transmural Drainage

BACKGROUND: Surgery is the traditional treatment for symptomatic pancreatic pseudocysts, but the morbidity is still too high. Minimally invasive endoscopic approaches have been encouraged. AIMS: To evaluate the efficacy of endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. METHODS: From January, 2003 to August, 2006, 31 consecutive symptomatic patients submitted to 37 procedures at the same endoscopic unit were retrospectively analysed. Chronic and acute pancreatitis were found in, respectively, 17 (54.8%) and 10 (32.3%) cases. Bulging was present in 14 (37.8%) cases. Cystogastrostomy or cystoduodenostomy were created with an interventional linear echoendoscope under endosonographic and fluoroscopic control. By protocol, only a single plastic stent, without nasocystic drain, was used. Straight or double pigtail stents were used in, respectively, 22 (59.5%) and 15 (40.5%) procedures. RESULTS: Endoscopic ultrasound-guided transmural drainage was successful in 29 (93.5%) patients. Two cases needed surgery, both due to procedure-related complications. There was no mortality related to the procedure. Twenty-four patients were followed-up longer than 4 weeks. During a mean follow-up of 12.6 months, there were six (25%) symptomatic recurrences due to stent clogging or migration, with two secondary infections. Median time for developing complications and recurrence of the collections was 3 weeks. These cases were successfully managed with new stents. Complications were more frequent in patients treated with straight stents and in those with a recent episode of acute pancreatitis. CONCLUSIONS: Endoscopic transmural drainage provides an effective approach to the management of pancreatic pseudocysts.

scholarly journals Ultrasound-guided drainage of walled-off pancreatic necrosis. Case report.

2015 ◽  
Vol 17 (2) ◽  
pp. 259
Author(s):  
Bogdan Popa ◽  
Madalina Ilie ◽  
Oana Plotogea ◽  
Ionut Olteanu ◽  
Claudiu Turculet ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Biliary Duct ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
The Common ◽  
The Right ◽  
Walled Off Necrosis

ERCP (endoscopic retrograde cholangiopancreatography) represents a safe endoscopic procedure and serious complica- tions (perforation, haemorrhage, and acute pancreatitis) are usually uncommon. We present the case of a 38-year-old patient with gallstones in the common biliary duct who developed acute pancreatitis after ERCP. One month later a huge fluid col- lection with necrotic tissue in the right paracolic gutter was found, the fluid being drained by percutaneous drainage under ultrasonographic guiding. The particularity of the case is the post-ERCP pancreatitis, complicated with walled-off necrosis, resolved without surgical intervention by using percutaneous drainage.

scholarly journals Mechanisms and Management of Acute Pancreatitis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ari Garber ◽  
Catherine Frakes ◽  
Zubin Arora ◽  
Prabhleen Chahal
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Outlet Obstruction ◽  
Gallstone Pancreatitis ◽  
Drainage Procedure ◽  
Endoscopic Techniques ◽  
Persistent Abdominal Pain ◽  
Fluid Collections ◽  
Walled Off Necrosis

Acute pancreatitis represents a disorder characterized by acute necroinflammatory changes of the pancreas and is histologically characterized by acinar cell destruction. Diagnosed clinically with the Revised Atlanta Criteria, and with alcohol and cholelithiasis/choledocholithiasis as the two most prominent antecedents, acute pancreatitis ranks first amongst gastrointestinal diagnoses requiring admission and 21st amongst all diagnoses requiring hospitalization with estimated costs approximating 2.6 billion dollars annually. Complications arising from acute pancreatitis follow a progression from pancreatic/peripancreatic fluid collections to pseudocysts and from pancreatic/peripancreatic necrosis to walled-off necrosis that typically occur over the course of a 4-week interval. Treatment relies heavily on fluid resuscitation and nutrition with advanced endoscopic techniques and cholecystectomy utilized in the setting of gallstone pancreatitis. When necessity dictates a drainage procedure (persistent abdominal pain, gastric or duodenal outlet obstruction, biliary obstruction, and infection), an endoscopic ultrasound with advanced endoscopic techniques and technology rather than surgical intervention is increasingly being utilized to manage symptomatic pseudocysts and walled-off pancreatic necrosis by performing a cystogastrostomy.

scholarly journals Minimally invasive surgery in the treatment of acute pancreatitis

2020 ◽  
Vol 11 (4) ◽  
pp. 75-80
Author(s):  
Eldar E. Topuzov ◽  
Bella G. Tsatinyan ◽  
Eskender G. Topuzov ◽  
Vyacheslav K. Balashov ◽  
Esma A. Arshba ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Medical Records ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Minimally Invasive Techniques ◽  
Severe Degree ◽  
Invasive Techniques ◽  
Positive Effect

Background. In recent years, the lethality from acute pancreatitis in Russia has not undergone significant changes and according to various data is from 15% to 25%. Purpose. The evaluation of the performing minimally invasive interventions in the treatment of patients with moderate to severe acute pancreatitis. Materials and methods. The authors retrospectively analyzed the medical records of 169 patients, the structure of mortality and complications depending on the choice of surgical intervention for the patients with acute pancreatitis of moderate and severe degree. Results. Lethal outcomes in the group of patients using minimally invasive interventions amounted to 11.5%, in the group of patients using traditional operations 37.5%, p 0.05. Laparoscopic interventions were effective in 88.8% of the cases, and drug therapy had a positive effect in 81.2% of the cases, p 0.05. Conclusion. It is shown that the use of minimally invasive techniques in the treatment of pancreatic necrosis significantly reduces the levels of mortality, postoperative complications, which improves the overall results of acute pancreatitis treatment.

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