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 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 Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

2017 ◽  
Vol 63 (3) ◽  
pp. 207-209
Author(s):  
Cassia Lemos Moura ◽  
Priscila Pulita Azevedo Barros ◽  
Cristiane Mota Oliveira ◽  
Rogerio Colaiácovo ◽  
Juliana Marques Drigo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Severe Case ◽  
Treatment Modalities ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Fluid Collections

Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

Drenaje guiado por ultrasonido endoscópico con stent metálico de aposición luminal y necrosectomía endoscópica directa para el tratamiento de la necrosis pancreática infectada

2020 ◽  
Vol 50 (2) ◽  
Keyword(s):  
Pancreatic Necrosis ◽  
Tube Feeding ◽  
Safe Procedure ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Nasojejunal Tube ◽  
Fluid Collections ◽  
Walled Off Necrosis ◽  
First Time

Walled-off necrosis (WON) is a serious complication of acute pancreatitis (AP) and, when is infected, has a poor prognosis and mortality rate (15%). The endoscopic approach is preferable to surgical treatment due to its lower morbidity. Objectives. 1) Present a patient with infected pancreatic necrosis resolved by Endoscopic Ultrasound (EUS) guided drainage with a luminal apposition metal stent (LAMS) and Direct Endoscopic Necrosectomy (DEN). 2) Report placement of the LAMS Hot Axios ® (Boston Scientific) for the first time ever in Argentina. Methods. Male, 38 years old, without relevant history. He is hospitalized for a severe acute biliary pancreatitis (AP), early satiety and digestive intolerance. At 4 weeks, CT scan shows a PFC of 16 cm. EUS-guided drainage was performed with LAMS Hot Axios ®, draining 1600 ml of brown liquid content. Ten days later, another episode of severe AP. Continuous fever. New CT and EUS, showed increased collection, in situ stent and necrosis inside (WON). Four sessions of DEN through-the-LAMS and laparoscopic cholecystectomy were performed. Percutaneous drainage of left pararenal necrosis. Nasojejunal tube feeding between each necrosectomy. At 8th week, absence of necrosis and granulation tissue was observed, then the LAMS was removed. Hospital discharge. After 6 months of follow up, CT control showed normal pancreatic parenchyma. Conclusions. EUS-guided drainage of Pancreatic fluid collections (PFC) with LAMS is a safe procedure. In cases of WON, LAMS also allows transluminal interventional procedures, expediting the treatment of pancreatic necrosis, in a minimally invasive way.

(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 Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis

Pancreas ◽  
2015 ◽  
Vol 44 (8) ◽  
pp. 1290-1295 ◽  
Author(s):  
Yun Zhang ◽  
Shao-Yang Zhang ◽  
Shun-Liang Gao ◽  
Zhong-Yan Liang ◽  
Wen-Qiao Yu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastric Outlet Obstruction ◽  
Pancreatic Pseudocyst ◽  
Outlet Obstruction ◽  
Successful Resolution ◽  
Walled Off Necrosis

scholarly journals Multiple extra-splanchnic venous thromboses - an unusual vascular complication of acute pancreatitis

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Junare Parmeshwar Ramesh ◽  
Chandnani Sanjay ◽  
Suhas Udgirkar ◽  
Nair Sujit ◽  
Debnath Prasanta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Venous Thrombosis ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Splenic Vein ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Consensus Guidelines ◽  
Clinical Presentations ◽  
Fluid Collections

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable clinical presentations. Splanchnic venous thrombosis is a well-known vascular complication of AP and commonly present as thrombosis of the splanchnic venous system: splenic vein (SplV), portal vein (PV) and superior mesenteric vein (SMV), either separately or in combinations. Involvement of extra-splanchnic vessels is rare and associated with morbidity and mortality. Vascular complications are late phenomena and usually associated with local complications of AP, namely acute fluid collections, necrotizing pancreatitis and walled-off pancreatic necrosis. Pathogenesis of venous thrombosis is multifactorial in which pancreatic inflammation and systemic inflammatory response play a key role. At present, there are no consensus guidelines on treatment and use of anticoagulation for venous thrombosis in the setting of AP. Limited literature suggests the use of anticoagulation in presence of PV with or without SMV thrombosis and extrasplanchnic vessel involvement. Literature on extra-splanchnic vessels involvement in acute pancreatitis is sparse. Here we present two cases with multiple extra-splanchnic vessels involvement and their management.

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 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.

scholarly journals Severe acute pancreatitis: clinical findings and therapeutic tools in Internal Medicine practice

2013 ◽  
pp. 9-18
Author(s):  
Generoso Uomo ◽  
Pier Giorgio Rabitti
Keyword(s):  
Internal Medicine ◽  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Severity Index ◽  
Clinical Findings ◽  
Early Event ◽  
Early Evaluation ◽  
Therapeutic Tools ◽  
Marshall Score ◽  
Fluid Collections

BACKGROUND Recent advances in pathophysiology and therapeutic measures suggest that patients suffering from acute pancreatitis (AP) should undergo an early evaluation and treatment in Internal Medicine wards. Severe AP, usually associated with pancreatic necrosis and peripancreatic fluid collections, may be frequently complicated by distant organ(s) involvement. RESULTS The dreadful multi-organ failure may occur as an early event (during the first week of the disease) or in association with the infection of pancreatic necrosis in a later stage. So, during the clinical outcome, physicians may be compelled to counteract cardio-circulatory, pulmonary, renal, hepatic, haematological and hydro-electrolytic complex derangements. Arterial hypotension and shock may be consequence of hypovolemia and/or hearth failure or septic shock syndrome. Pleural effusions are frequent in the early phase of the disease as well as pulmonary densifications and renal insufficiency. Urinary, pulmonary, and biliary infections may intervene during all phases of the disease whereas pancreatic necrosis and fluid collections infections are more frequent after the second week of hospitalization. Prognostic evaluation should be obtained by simple and precise scoring system such as the modified Marshall score and CT-scan severity index. CONCLUSIONS Treatment must be initiated as soon as possible with special focusing on fluid and nutritional supplementation, pain control, cardio-respiratory support, antiproteases and antibiotics. Invasive procedures such as endoscopic sphincterotomy in biliary AP with cholangitis and/or obstruction and percutaneous drainage should be utilized in specific cases. Surgical necrosectomy is mandatory in patients with documented infection of pancreatic necrosis.

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