Pancreatic duct stenting in the treatment of acute pancreatitis

Aim. To analyze management of severe acute destructive pancreatitis and to determine the main tactical, anatomical and pathophysiological factors determining risks of adverse outcomes. Material and methods. 3581 patients with acute pancreatitis were enrolled. Retrospectively, 239 patients were assigned to severe pancreatic necrosis; invasive surgical techniques were applied in 210 cases. Twenty-nine patients with pancreatic necrosis underwent endoscopic papillosphincterotomy with main pancreatic duct stenting. Results. Overall mortality in patients with severe pancreatic necrosis was 32.3%, in case of minimally invasive techniques – 29.6%, conventional approach – 34.1%. There were similar outcomes regardless surgical technique in patients with pancreatic necrosis (p > 0.05), although introduction of main statements of national recommendations for treatment of pancreatic necrosis (regardless severity) reduced mortality from 25.4% to 9.5% (p < 0.001). Advanced parapancreatitis was accompanied by mortality near 36.5%. Stenting of main pancreatic duct was followed by death of 3 out of 29 patients with pancreatic necrosis (10.3%). Conclusion. Indications and choice of surgical approach according to national recommendations are not accompanied by improved postoperative mortality in patients with severe pancreatic necrosis and multiple organ failure. However, according to analysis on the whole, there is reduced postoperative mortality regardless severity of disease if these recommendations are sustained. Widespread involvement of retroperitoneal structures is adverse prognostic factor. Early endoscopic intraduodenal drainage in effective to prevent parapancreatic tissues.

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Outcomes of the major pancreatic duct stenting and high Octreotide doses administration for acute pancreatitis

Endoskopicheskaya khirurgiya ◽

10.17116/endoskop201622418-24 ◽

2016 ◽

Vol 22 (4) ◽

pp. 18

Author(s):

M. D. Dibirov ◽

L. V. Domarev ◽

E. A. Shitikov ◽

A. I. Isaev ◽

G. S. Karsotyan ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Duct Stenting

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Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent Road Closure: Pancreatic Colonic Fistula Presenting as a Large Bowel Obstruction Treated with Pancreatic Duct Stenting

Case Reports in Gastrointestinal Medicine ◽

10.1155/2015/794282 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Justin Cochrane ◽

Greg Schlepp

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Bowel Obstruction ◽

Large Bowel ◽

Pancreatic Necrosis ◽

Clinical Manifestations ◽

Large Bowel Obstruction ◽

Colonic Fistula ◽

Increased Risk ◽

Pancreatic Duct Stenting

Context. Colonic complications associated with acute pancreatitis have a low incidence but carry an increased risk of mortality with delayed diagnosis and treatment. Pancreatic colonic fistula is most commonly associated with walled off pancreatic necrosis or abscess formation and rarely forms spontaneously. Classic clinical manifestations for pancreatic colonic fistula include diarrhea, hematochezia, and fever. Uncommonly pancreatic colonic fistula presents as large bowel obstruction.Case. We report a case of a woman with a history of recurrent episodes of acute pancreatitis who presented with large bowel obstruction secondary to pancreatic colonic fistula. Resolution of large bowel obstruction and pancreatic colonic fistula was achieved with pancreatic duct stenting.Conclusion. Pancreatic colonic fistula can present as large bowel obstruction. Patients with resolved acute pancreatitis who have radiographic evidence of splenic flexure obstruction, but without evidence of mechanical obstruction on colonoscopy, should be considered for ERCP to evaluate for PCF. PCF not associated with walled off pancreatic necrosis or peritoneal abscess can be treated conservatively with pancreatic duct stenting.

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Results of 300 pancreatic duct stenting in acute pancreatitis

Khirurgiya Zhurnal im N I Pirogova ◽

10.17116/hirurgia202011186 ◽

2020 ◽

pp. 86

Author(s):

M.D. Dibirov ◽

N.N. Khachatryan ◽

S.A. Erin ◽

L.V. Domarev ◽

M.V. Kosachenko ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Duct Stenting

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Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1719222 ◽

2021 ◽

Author(s):

Ayah Megahed ◽

Rahul Hegde ◽

Pranav Sharma ◽

Rahmat Ali ◽

Anas Bamashmos

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pleural Fluid ◽

Rare Complication ◽

Delayed Diagnosis ◽

Magnetic Resonance Cholangiopancreatography ◽

Pleural Effusions ◽

Diagnostic Challenge ◽

Abdominal Symptoms ◽

Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

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Acute Pancreatitis Secondary to an Incarcerated Paraoesophageal Hernia: A Rare Cause for a Common Problem

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s13079 ◽

2014 ◽

Vol 7 ◽

pp. CCRep.S13079 ◽

Cited By ~ 6

Author(s):

Kathryn Boyce ◽

William Campbell ◽

Mark Taylor

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Pancreatic Duct ◽

Rare Case ◽

Open Repair ◽

Pancreatic Head ◽

Good Recovery ◽

Type Iv ◽

Rare Case Report ◽

Paraoesophageal Hernia

This is a rare case report of acute pancreatitis secondary to a massive incarcerated paraoesophageal hernia. The pathogenesis resulted from obstruction of the distal pancreatic duct after displacement of the pancreatic head and body into the thorax as part of a Type IV paraoesophageal hernia. Although this condition is rare, the patient made steady progress following laparotomy and open repair of hernia. She made a good recovery after prompt therapy, therefore, this report can be a guide to the diagnosis and treatment of similar conditions.

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