Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience

Objective. To describe the management and prognosis of splenic abscess after splenic arterial embolization in severe acute pancreatitis (SAP) patients.Methods. This is a retrospective observational study. From August 2012 to August 2017, SAP patients with infected pancreatic necrosis (IPN) who underwent splenic arterial embolization after massive hemorrhage of the splenic artery were screened and those who developed splenic abscess were included for analysis. The demographic characteristics, etiology, treatment of splenic abscess, and clinical outcomes of these cases were collected and analyzed.Results. A total of 18 patients with splenic abscess formed after splenic arterial embolization were included for data analysis. The median age of the 18 patients was 46 years. The etiologies included biliary AP, hypertriglyceridemic AP (HTG-AP), and other causes. Ten patients underwent minimally invasive percutaneous drainage only for splenic abscess while the other eight patients received splenectomy. One patient died due to uncontrolled infection and another patient died due to massive bleeding, and the remaining sixteen patients survived.Conclusion. The incidence of splenic abscess was high in patients requiring splenic arterial embolization due to massive bleeding. Our data showed that most splenic abscess could be successfully managed with minimally invasive interventions, and traditional splenectomy should serve as a backup treatment.

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Endoscopic Retroperitoneal Necrosectomy for Infected Pancreatic Necrosis Using a Self-Expandable Metal Stent

GE Portuguese Journal of Gastroenterology ◽

10.1159/000510025 ◽

2021 ◽

pp. 1-6

Author(s):

Gaurav Patil ◽

Amit Maydeo ◽

Ankit Dalal ◽

Arun Iyer ◽

Rajdeep More ◽

...

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Critically Ill ◽

Severe Acute Pancreatitis ◽

Critically Ill Patients ◽

Pancreatic Necrosis ◽

Flexible Endoscope ◽

Surgical Drainage ◽

Metal Stent ◽

Endoscopic Necrosectomy

Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient’s parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.

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Minimally invasive techniques in the treatment of severe acute pancreatitis

Open Medicine ◽

10.2478/s11536-013-0283-1 ◽

2014 ◽

Vol 9 (4) ◽

pp. 580-587 ◽

Cited By ~ 1

Author(s):

Ignasi Poves ◽

Fernando Burdío ◽

Dimitri Dorcaratto ◽

Luis Grande

Keyword(s):

Acute Pancreatitis ◽

Surgical Treatment ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

High Rate ◽

Multidisciplinary Teams ◽

Laparoscopic Transperitoneal ◽

Open Necrosectomy ◽

Invasive Techniques

AbstractOpen necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.

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HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

European Journal of Inflammation ◽

10.1177/20587392211000571 ◽

2021 ◽

Vol 19 ◽

pp. 205873922110005

Author(s):

Bei Lu ◽

Yang Cai ◽

Junjie Yin ◽

Jingrui Wang ◽

Zhong Jia ◽

...

Keyword(s):

Central Nervous System ◽

Acute Pancreatitis ◽

Nervous System ◽

Herpes Simplex ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Infected Pancreatic Necrosis ◽

Percutaneous Catheter Drainage ◽

Central Nervous System Complication ◽

Simplex Virus

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

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Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204446 ◽

2020 ◽

Vol 8 (11) ◽

pp. 4158

Author(s):

Pedro A. Alvarado-Bahena ◽

Enrique Chavez-Serna ◽

Jonatan Salgado-Vives ◽

Uraik F. Hernandez-Bustos ◽

Dante A. Saldivar-Vera ◽

...

Keyword(s):

Developing Countries ◽

Acute Pancreatitis ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Late Complication ◽

Late Complications ◽

Open Approach ◽

Invasive Procedures ◽

Open Necrosectomy ◽

Level Hospital

Walled-off pancreatic necrosis is defined as a necrotic collection with a defined wall, which generally occurs in 15% of patients in the fourth week after acute pancreatitis. Actually, open surgery is reserved for selected cases, with minimally invasive treatments such as image-assisted percutaneous drainage or endoscopic ultrasound being the procedures of choice. However, in developing countries the open approach continues to be an effective therapeutic alternative. We present the case of a 47-year-old male patient with no significant history who developed severe acute pancreatitis secondary to hypertriglyceridemia and who later developed walled-off pancreatic necrosis as a late complication. As a treatment, a debridement of the necrotic tissue with marsupialization was performed using the bradley III technique, secondary to the procedure, a pancreatic fistula was developed. After 8 weeks of hospitalization, in which he had a favourable response to surgical treatment, with spontaneous closure of the fistula without complications. Surgical management of late complications of acute pancreatitis remains controversial. Although minimally invasive procedures are the first option nowadays, in developing countries, open necrosectomy remains a good option for the treatment of these types of complications.

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Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

Community Based Medical Journal ◽

10.3329/cbmj.v8i2.55768 ◽

2019 ◽

Vol 8 (2) ◽

pp. 17-29

Author(s):

Mohammad Monir Hossain ◽

S M Shakwat Hossain ◽

Delowar Hossain

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Military Hospital ◽

Fatty Tissue ◽

Ct Findings ◽

Contrast Enhanced Ct ◽

Management Protocol ◽

Life Threatening

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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OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS USING MINIINVASIVE TECHNIQUES

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2020.03 ◽

2020 ◽

pp. 16-18

Author(s):

A. G. Drozdova

Keyword(s):

Acute Pancreatitis ◽

Surgical Treatment ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Minimal Invasive ◽

Hospital Treatment ◽

Bed Days ◽

Minimal Invasive Techniques ◽

Invasive Techniques

Summary. The aim of the study. To improve the results of surgical treatment of patients with acute pancreatitis using minimal invasive techniques. Matherials and Methods of the study. The results of surgical treatment of 75 patients with different forms of acute pancreatitis were analyzed. All patients were examined and operated on. Results of the study. Minimally invasive interventions were performed in 92 % of the analyzed patients. Intraoperatively acute pancreatic edema was observed in 43 % of patients, hemorrhagic pancreatic necrosis – in 24 %, infected pancreatic necrosis – in 33 %. The postoperative period was complicated by 13.3 %, the mortality rate was 9.3 %. Conclusions. The use of minimally invasive techniques for treating acute pancreatitis can significantly improve the results of surgical treatment of patients with this pathology. The frequency of complications and lethality decreases. Also, it is possible to significantly reduce operational trauma, and hence the number of bed-days of stay in hospital treatment. This contributes to reducing the financial cost of treatment in patients with acute pancreatitis, as well as improving the quality of life of this category of patients.

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Minimally invasive drainage versus open surgical debridement in SAP/SMAP – a network meta-analysis

BMC Gastroenterology ◽

10.1186/s12876-019-1078-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Kai Zhang ◽

Xiaole Zhu ◽

Chaoqun Hou ◽

Chenyuan Shi ◽

Yi Miao ◽

...

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Meta Analysis ◽

Multiple Organ ◽

Surgical Debridement ◽

Percutaneous Catheter Drainage ◽

Endoscopic Drainage ◽

Percutaneous Catheter ◽

Study Participants

Abstract Background The efficacy of some therapeutic methods (open surgical debridement (OSD), conservative treatment (CST) and minimally invasive drainage (MID)) for severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) has been widely evaluated. However, the results remained controversial. We performed this study to illuminate whether any difference in incidence exists on patients with SAP/MSAP treated with OSD and MID. Methods Eligible articles were collected base of a comprehensive review of PUBMED, EMBASE, COCHRANE, CKNI and WANGFANG for published randomized controlled trials. Two steps of meta-analysis were performed, routine pair-wise meta-analysis and network meta-analysis. Results Thirteen studies were included in this study. Participants were classed as 5 groups, CST, early MID (EMID), late MID (LMID), early OSD (EOSD) and late OSD (LOSD). And MID contains endoscopic drainage (ESD), percutaneous catheter drainage (PCD) and minimally invasive surgery (MIS). Compared with CST, MID could decrease both mortality and multiple organ dysfunction syndrome (MODS) rate but OSD couldn’t. Both EMID and MID can significantly decrease the mortality and MODS rate compared to CST. PCD might be most likely to have a benefit compared to CST. Conclusion Existing evidence for the use of MID in SAP/MSAP is reliable and it can be used as early treatment. OSD, if necessary, should be avoided or delayed as long as possible.

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Continuous regional arterial infusion versus intravenous administration of the protease inhibitor nafamostat mesilate for predicted severe acute pancreatitis: a multicenter, randomized, open-label, phase 2 trial

Journal of Gastroenterology ◽

10.1007/s00535-019-01644-z ◽

2019 ◽

Vol 55 (3) ◽

pp. 342-352 ◽

Cited By ~ 11

Author(s):

Morihisa Hirota ◽

Tooru Shimosegawa ◽

Katsuya Kitamura ◽

Kazunori Takeda ◽

Yoshifumi Takeyama ◽

...

Keyword(s):

Acute Pancreatitis ◽

Protease Inhibitor ◽

Severe Acute Pancreatitis ◽

Analgesic Effect ◽

Pancreatic Necrosis ◽

Controlled Trial ◽

Nafamostat Mesilate ◽

Open Label ◽

Arterial Infusion ◽

Continuous Regional Arterial Infusion

Abstract Background Continuous regional arterial infusion (CRAI) of protease inhibitor nafamostat mesilate (NM) is used in the context of predicted severe acute pancreatitis (SAP) to prevent the development of pancreatic necrosis. Although this therapy is well known in Japan, its efficacy and safety remain unclear. Methods This investigator-initiated and -driven, multicenter, open-label, randomized, controlled trial (UMIN000020868) enrolled 39 patients with predicted SAP and low enhancement of the pancreatic parenchyma on computed tomography (CT). Twenty patients were assigned to the CRAI group, while 19 served as controls and were administered NM at the same dose intravenously (IV group). The primary endpoint was the development of pancreatic necrosis as determined by CT on Day 14, judged by blinded central review. Results There was no difference between the CRAI and IV groups regarding the percentages of participants who developed pancreatic necrosis (more than 1/3 of the pancreas: 25.0%, range 8.7–49.1% vs. 15.8%, range 3.4–39.6%, respectively, P = 0.694; more than 2/3 of the pancreas: 20%, range 5.7–43.7% vs. 5.3%, range 0.1–26.0%, respectively, P = 0.341). The early analgesic effect was evaluated based on 24-h cumulative fentanyl consumption and additional administration by intravenous patient-controlled analgesia. The results showed that the CRAI group used significantly less analgesic. There were two adverse events related to CRAI, namely bleeding and splenic infarction. Conclusions CRAI with NM did not inhibit the development of pancreatic necrosis although early analgesic effect of CRAI was superior to that of IV. Less-invasive IV therapy can be considered a viable alternative to CRAI therapy.

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