scholarly journals Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Tiffany J. Patton ◽  
Timothy A. Sentongo ◽  
Grace Z. Mak ◽  
Stacy A. Kahn
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Fluid Collection ◽  
Initial Presentation ◽  
Metabolic Abnormalities ◽  
Pediatric Case ◽  
Severe Pancreatitis ◽  
Colonic Necrosis

Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

scholarly journals Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽  
2022 ◽  
pp. 1-9
Author(s):  
Daxin Guo ◽  
Wei Dai ◽  
Jingyi Shen ◽  
Mengting Zhang ◽  
Yetan Shi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Cochrane Library ◽  
Intensive Care Unit Treatment ◽  
Significant Difference ◽  
And Control

<b><i>Background:</i></b> The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. <b><i>Methods:</i></b> This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. <b><i>Results:</i></b> Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; <i>p</i> = 0.03) and complications (OR: 0.48; <i>p</i> = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; <i>p</i> = 0.24), mortality (OR: 0.69; <i>p</i> = 0.17), extrapancreatic infection (OR: 0.64, <i>p</i> = 0.54), pulmonary infection (OR: 1.23; <i>p</i> = 0.69), blood infection (OR: 0.60; <i>p</i> = 0.35), urinary tract infection (OR: 0.97; <i>p</i> = 0.97), pancreatic pseudocyst (OR: 0.59; <i>p</i> = 0.28), fluid collection (OR: 0.91; <i>p</i> = 0.76), organ failure (OR: 0.63; <i>p</i> = 0.19), acute respiratory distress syndrome (OR: 0.80; <i>p</i> = 0.61), surgical intervention (OR: 0.97; <i>p</i> = 0.93), dialysis (OR: 2.34; <i>p</i> = 0.57), use of respirator or ventilator (OR: 1.90; <i>p</i> = 0.40), intensive care unit treatment (OR: 2.97; <i>p</i> = 0.18), and additional antibiotics (OR: 0.59; <i>p</i> = 0.28) between the experimental and control groups. <b><i>Conclusions:</i></b> It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

ID: 36: PEGASPARGASE INDUCED SEVERE PANCREATITIS. FRIEND OR FOE?

2016 ◽  
Vol 64 (4) ◽  
pp. 942.1-942 ◽  
Author(s):  
N Vyas ◽  
H Alkhawam ◽  
R Sogomonian ◽  
RA Ching Companioni ◽  
M Tiba ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Lymphoblastic Leukemia ◽  
Kidney Injury ◽  
Leukemic Cells ◽  
Drug Induced ◽  
Severe Pancreatitis ◽  
Elevated Liver Enzymes ◽  
Wide Range

IntroductionPegaspargase (Oncaspar) is a modified version of L-asparaginase conjugated with polyethylene glycol. In leukemic cells, asparaginase hydrolyzes L- asparagine to ammonia and L-aspartic acid leading to depletion of asparagine. Despite its potential benefits there are a wide range of side effects. One rare but potentially deadly complication is severe pancreatitis.CaseThe patient was a 24 year old Mexican male with a history of Acute T-Cell Lymphoblastic Leukemia (ALL) on recent chemotherapy including pegaspargase, admitted for abdominal pain, found to have acute pancreatitis secondary to hypertriglyceridemia. Heart rate was 127 bpm, chest revealed decreased air entry in right lung bases, and a distended severely tender abdomen. Laboratory tests were remarkable for elevated liver enzymes ALP 360 U/L, AST 310 U/L, GGT 216 U/L, ALT 44 U/L, LDH 829 U/L, elevated lipase 228 U/L, and hypertriglyceridemia >3,000 mg/dL. Abdominal CT showed pancreatitis with necrosis; peripancreatic, intraperitoneal and extensive retroperitoneal fluid. Subsequently his severe pancreatitis was associated with acute kidney injury and respiratory failure which is illustrated by his (BUN 22 Creatinine 2.16, and persistent hypoxia.) According to the Atlanta Classification, patient is classified under severe acute pancreatitis.DiscussionPegaspargase is used for treatment of ALL and is gaining in popularity over Asparaginase therapy due to it having fewer incidences of hypersensitivity reactions and because of its long half life (367 hrs) allowing dosing every 14 days as opposed to Asparaginase which is dosed daily. Pegaspargase definitely has its benefits but we can't lose sight of one of its rare, but potentially deadly complications, pancreatitis. In one study nine of the 50 patients (18%) with ALL treated with pegaspargase were diagnosed to have pancreatitis. In contrast, only one out of 52 (1.9%) ALL patients who received native E. coli L-asparaginase during the same time period developed pancreatitis. One proposed mechanism of this drug-induced pancreatitis is hypertriglyceridemia, which is seen in our case. It is suggested that apolipoprotein E polymorphism may influence the development of hyperlipidemia in ALL patients receiving pegaspargase therapy.We report a case to increase the awareness of higher incidence of pegaspargase-induced pancreatitis, which is a rare but potentially deadly complication. Clinicians should monitor triglycerides while on treatment and suspect pancreatitis if patient develops abdominal pain. If pancreatitis occurs, therapy should be stopped and not reinstituted. For patients with hypertriglyceridemia without pancreatitis discontinuation of therapy should be considered.Abstract ID: 36 Figure 1Impression: Severe acute pancreatitis. Significant interval worsening.

scholarly journals Pancreatitis Is a Silent Killer in Peritoneal Dialysis With Difficult Diagnostic Approach

2018 ◽  
Vol 11 ◽  
pp. 117954761876576 ◽  
Author(s):  
Roberta Aliotta ◽  
Luca Zanoli ◽  
Itria Lauretta ◽  
Rosa Giunta ◽  
Silvia Ferrario ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Pancreatic Pseudocyst ◽  
Rate Condition ◽  
Severe Pancreatitis ◽  
Left Shift ◽  
Fungal Sepsis ◽  
Candida Peritonitis

Until 2018, 236 cases of acute pancreatitis have been reported in patients who underwent peritoneal dialysis. Here, we presented a patient with double renal transplantation with chronic renal failure, under renal replacement therapy by peritoneal dialysis, who developed acute pancreatitis with abdominal pain, nausea, vomiting, leukocytosis with neutrophil left shift which is complicated by pancreatic pseudocyst, candida peritonitis, fungal sepsis, overlapping of Acinetobacter baumannii sepsis, and pneumonitis. After the percutaneous cystogastrostomy drainage of pancreatic pseudocyst, changes from peritoneal dialysis to hemodialysis, various thoracentesis, and polyantibiotics therapy, the resolution of the sepsis state was seen. The particular aspect of our case is the various comorbidity risks, severe pancreatitis associated with candida and A baumannii sepsis, and treatment strategy that lead to heal this kind of the high mortality rate condition.

scholarly journals Development of Colonic Necrosis Following Severe Acute Pancreatitis.

2000 ◽  
Vol 39 (4) ◽  
pp. 305-308 ◽  
Author(s):  
Yoshikazu UMENO ◽  
Junji OTSUKA ◽  
Eizaburo SASATOMI ◽  
Koji IRIE
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Colonic Necrosis

scholarly journals Comparison of BISAP score with Ranson’s score in predicting severe acute pancreatitis

2016 ◽  
Vol 18 (3) ◽  
pp. 44
Author(s):  
D Karki ◽  
T Tamang ◽  
D Maharjan ◽  
P Thapa ◽  
S Shrestha
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Scoring System ◽  
Laboratory Data ◽  
P Value ◽  
Severe Pancreatitis ◽  
Common Etiology ◽  
Sensitivity Specificity

Objectives: To compare BISAP score with Ranson’s scoring in predicting severity of acute pancreatitisMethods: Extensive demographic, radiographic, and laboratory data from consecutive patients with AP admitted to our institution was collected between March 2014 to March 2015. Ranson’s and BISAP score was calculated. Severity of pancreatitis was defined according to Atlanta classification. Sensitivity, Specificity, PPV, NPV of both the scoring system was calculated and compared.Results: A total of 42 patients with diagnosis of acute pancreatitis were included during the study period. 21(50%) were male and 21(50%) were female. Mean age is 49.52 ± 17.37.Most common etiology was biliary (45%) followed by alcohol (31%). 20 (48%) patients were categorized as severe pancreatitis according to Atlanta classification. 21 (50%) patients had a Ranson’s score of ≥3 and 19 (45.24%) patients had a BISAP score of ≥3. Both Ranson’s and BISAP scoring system was statistically significant in determining SAP ( p-value = 0.002). Sensitivity, specificity, PPV and NPV of Ranson’s and BISAP score was calculated to be 75%, 72.72%, 71.43%, 76.19% and 70%, 77.27%, 73.68%, 73.91%. respectively. The AUC for SAP by Ranson’s score is 0.7386 ; 95%CI (0.602 - 0.874) and BISAP score is 0.7364 ; 95% CI ( 0.599 - 0.872).Conclusions: Both Ranson’s and BISAP scoring system is similar in predicting SAP. However BISAP has the advantage due to its simplicity.

scholarly journals Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

2020 ◽  
Vol 9 (1) ◽  
pp. 263 ◽  
Author(s):  
Biswajit Khatua ◽  
Jordan R. Yaron ◽  
Bara El-Kurdi ◽  
Sergiy Kostenko ◽  
Georgios I. Papachristou ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Systemic Inflammation ◽  
Normal Saline ◽  
Meta Analysis ◽  
Extracellular Calcium ◽  
Severe Pancreatitis ◽  
Ringer’S Lactate

Objective: Ringer’s lactate may improve early systemic inflammation during critical illnesses like severe acute pancreatitis, which are associated with hypocalcemia. Ringer’s lactate is buffered and contains lactate and calcium. We, thus analyzed extracellular calcium or lactate’s effects on the mechanisms, intermediary markers, and organ failure in models mimicking human disease with nonesterified fatty acid (NEFA) elevation. Methods: Meta-analyses and experimental studies were performed. Experimentally, extracellular calcium and lactate were compared in their interaction with linoleic acid (LA; a NEFA increased in human severe pancreatitis), and its subsequent effects on mitochondrial depolarization and cytosolic calcium signaling resulting in cell injury. In vivo, the effect of LA was studied on organ failure, along with the effect of calcium or lactate (pH 7.4) on severe acute pancreatitis-associated organ failure. A meta-analysis of human randomized control trials comparing Ringer’s lactate to normal saline was done, focusing on necrosis and organ failure. Results: Calcium reacted ionically with LA and reduced lipotoxic necrosis. In vivo, LA induced organ failure and hypocalcemia. During severe pancreatitis, calcium supplementation in saline pH 7.4, unlike lactate, prevented hypocalcemia, increased NEFA saponification, reduced circulating NEFA and C-reactive protein, reduced pancreatic necrosis adjacent to fat necrosis, and normalized shock (carotid pulse distension) and blood urea nitrogen elevation on day 1. This, however, did not prevent the later increase in serum NEFA which caused delayed organ failure. Meta-analysis showed Ringer’s lactate reduced necrosis, but not organ failure, compared with normal saline. Conclusion: Hypocalcemia occurs due to excess NEFA binding calcium during a critical illness. Ringer’s lactate’s early benefits in systemic inflammation are by the calcium it provides reacting ionically with NEFA. This, however, does not prevent later organ failure from sustained NEFA generation. Future studies comparing calcium supplemented saline resuscitation to Ringer’s lactate may provide insights to this pathophysiology.

scholarly journals Prognostic Indicator in Severe Acute Pancreatitis

2018 ◽  
Vol 3 (05) ◽  
Author(s):  
Dr. Ajay Khanolkar ◽  
Dr. Manish Khare
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Surgical Intervention ◽  
Financial Burden ◽  
Fluid Collection ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Management Decision ◽  
Apache Ii Score ◽  
Local Complication

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.

scholarly journals Successful drainage case of infected pancreatic pseudocyst after severe acute pancreatitis

2008 ◽  
Vol 73 (2) ◽  
pp. 190-191
Author(s):  
Shin Yasui ◽  
Takeshi Ishihara ◽  
Reiko Eto ◽  
Tatsuya Fujimoto ◽  
Koichiro Okitsu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst

scholarly journals Length of stay overestimates severity of post-ERCP pancreatitis: Is it time to revise the consensus definition?

2018 ◽  
Vol 06 (07) ◽  
pp. E838-E843 ◽  
Author(s):  
Mahya Faghih ◽  
Amitasha Sinha ◽  
Robert Moran ◽  
Elham Afghani ◽  
Yuval Patel ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Length Of Stay ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Important Determinant ◽  
Fluid Collection ◽  
Clinical Parameters ◽  
Surgical Drainage ◽  
Consensus Definition

Abstract Introduction Length of stay (LOS) is an important determinant of the severity of post-ERCP pancreatitis (PEP) in the consensus definition. The aim of our study was to evaluate and compare severity of PEP based on the revised Atlanta classification (RAC) and the consensus definition. Patients and methods Between 1/2000 and 12/2011, all adult patients admitted with suspicion of PEP after outpatient ERCP were evaluated. PEP was defined using the RAC, but the severity of PEP was defined using both revised Atlanta and consensus definitions. Results A total of 341 patients (mean age 49 years and 75 % females) were diagnosed with PEP. The consensus definition classified 57 %, 37 %, and 8 % of patients with mild, moderate, and severe PEP, respectively. The RAC diagnosed 94 %, 6 %, and 0 % with mild, moderate, and severe acute pancreatitis, respectively. Of the patients diagnosed with moderate-severe PEP by consensus definition, only 12.5 % had clinical parameters of pancreatitis severity, such as acute fluid collection(s), pancreatic necrosis, transient organ failure and/or required percutaneous or surgical drainage, while 87.5 % were classified only based on a LOS ≥ 4 days. The most common reason for increased LOS was persistent post-procedural abdominal pain in 47 % of patients, followed by other reasons not related to pancreatitis in 17 %. Conclusion The consensus definition overestimates the rates of severe PEP when compared to the RAC. The majority of PEP patients classified as moderate-severe PEP have extended LOS, due to post-procedural abdominal pain rather than complications of PEP.

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