scholarly journals Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience

2021 ◽  
Vol 8 (11) ◽  
pp. 3238
Author(s):  
Roshan Ghimire ◽  
Yugal Limbu ◽  
Anuj Parajuli ◽  
Dhiresh K. Maharjan ◽  
Prabin B. Thapa
Keyword(s):  
Acute Pancreatitis ◽  
Fluid Collection ◽  
College Teaching ◽  
Pancreatic Fluid Collection ◽  
Systemic Complications ◽  
Endoscopic Techniques ◽  
Local Complications ◽  
Hospital Patients ◽  
Surgery Department ◽  
Open Necrosectomy

Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, cysto-enterostomy, VARD or open necrosectomy due to failure of endoscopic or radiological intervention or due to positions of lesions being inaccessible to these techniques. All patients had clinical improvement following surgery with an acceptable complication rate given the severity of the disease.Conclusions: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

scholarly journals Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

2018 ◽  
Vol 06 (12) ◽  
pp. E1398-E1405 ◽  
Author(s):  
Tanyaporn Chantarojanasiri ◽  
Natsuyo Yamamoto ◽  
Yousuke Nakai ◽  
Tomotaka Saito ◽  
Kei Saito ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastrointestinal Tract ◽  
Fluid Collection ◽  
Adverse Event Rate ◽  
Plastic Stents ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Covered Metallic Stent

Abstract Background and study aims While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied. Contraindications for EUS-PCD are lack of encapsulation or adhesion to the gastrointestinal tract. Safety and effectiveness of early vs delayed (≥ 4 weeks) EUS-PCD were compared. Results A total of 35 patients underwent EUS-PCD (12 early and 23 delayed) using 19 large-bore fully-covered metallic stent and 16 plastic stents. The median diameter of PFC was 110 mm (40 – 180) and 122 mm (17 – 250) in the early and delayed drainage groups, respectively. Median time from onset of AP to drainage was 23 and 85 days for early and delayed drainage, respectively. The technical success rate of EUS-guided drainage was 100 %. Endoscopic necrosectomy was performed in six early and 16 cases of delayed drainage. The adverse event rate was 25 % (3 bleeding) and 13 % (2 perforations and 1 CO2 retention) in the early and delayed drainage groups, respectively. Two patients died (1 early and 1 delayed) due to multiorgan failure. Conclusion Endoscopic drainage and subsequent necrosectomy of symptomatic PFC within 4 weeks after onset of acute pancreatitis was feasible, given that the collection was encapsulated and attached to the gastrointestinal tract.

scholarly journals Skin signs in acute pancreatitis: a case report

2013 ◽  
pp. 265-268
Author(s):  
Marco Bassi ◽  
Gelorma Belmonte ◽  
Paola Billi ◽  
Angelo Pasquale ◽  
Massimo Reta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Clinical Laboratory ◽  
Epigastric Pain ◽  
Multiorgan Failure ◽  
Fluid Collection ◽  
Clinical Signs ◽  
Pancreatic Fluid Collection ◽  
Retroperitoneal Hemorrhage ◽  
Skin Signs

Introduction: Subcutaneous manifestations of severe acute pancreatitis (Cullen’s sign, Gray- Turner’s sign, Fox’s sign, and Bryant’s sign) are often discussed in journals and textbooks, but seldom observed. Although historically associated with acute pancreatitis, these clinical signs have been described in various other conditions associated with retroperitoneal hemorrhage. Case report: We describe the case of a 61-year-old male with no history of alcohol intake, who was admitted for epigastric pain, vomiting, and increasing serum amylase and lipase levels. Five days after admission, ecchymotic skin discoloration was noted over both flanks (Gray-Turner’s sign) and the upper third of the thighs (Fox’s sign). Ten days later, he developed multiorgan failure and was transferred to the ICU for 5 days. Computed tomography revealed a large pancreatic fluid collection, which was subjected to EUS-guided drainage. Cholecystectomy was later performed for persistent obstructive jaundice. After more than 4 months of hospitalization, he died as a result of severe gastrointestinal bleeding. Discussion and conclusions: Skin manifestations of retroperitoneal hemorrhage in a patient with acute pancreatitis indicate a stormy disease course and poor prognosis. The severity of acute pancreatitis is currently estimated with validated scoring systems based on clinical, laboratory, and imaging findings. However, skin signs like the ones discussed above can represent a simple and inexpensive parameter for evaluating the severity and prognosis of this disease.

scholarly journals Analysis of Factors Associated with the Severity of Acute Pancreatitis according to Etiology

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Dae Bum Kim ◽  
Woo Chul Chung ◽  
Ji Min Lee ◽  
Kang-Moon Lee ◽  
Jung Hwan Oh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Pancreatic Necrosis ◽  
Fluid Collection ◽  
Contributing Factors ◽  
Pancreatic Fluid Collection ◽  
Current Smoking ◽  
Factors Associated ◽  
Pancreatic Fluid ◽  
Index Of Severity

Background. The objective of this study was to determine the factors associated with severity of acute pancreatitis (AP) according to two major etiologies: alcohol and gallstones. Methods. We reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. A total of 905 patients with AP (660 alcohol-induced, 245 gallstone-induced) were enrolled. Among them, severe AP (SAP) occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Contributing factors between patients with and without SAP were analyzed according to the etiology. Results. Multivariate analysis demonstrated that current smoking, pancreatic necrosis, and bacteremia were associated with AP severity in both alcohol- and gallstone-induced AP. Pancreatic fluid collection was significantly associated with alcohol-induced SAP (p=0.04), whereas dyslipidemia was significantly associated with gallstone-induced SAP (p=0.01). Body mass index was significantly correlated with the Bedside Index of Severity in Acute Pancreatitis score in both alcohol- and gallstone-induced AP (p=0.03 and 0.01, resp.). Conclusions. Current smoking, pancreatic necrosis, and bacteremia can aggravate the clinical course of AP. Pancreatic fluid collection and dyslipidemia were associated with AP severity according to the different etiologies. Obesity may also be associated with AP severity in both etiologies.

scholarly journals Severe acute pancreatitis: eight fundamental steps revised according to the ‘PANCREAS’ acronym

2020 ◽  
Vol 102 (8) ◽  
pp. 555-559 ◽  
Author(s):  
CA Gomes ◽  
S Di Saverio ◽  
M Sartelli ◽  
E Segallini ◽  
N Cilloni ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Venous Pressure ◽  
Fluid Collection ◽  
Vena Cava ◽  
Previous Treatment ◽  
Infectious Complications ◽  
Epidural Block ◽  
Pancreatic Fluid Collection ◽  
The Individual

Severe acute pancreatitis remains a life-threatening condition, responsible for many disorders of homeostasis and organ dysfunction. By means of a mnemonic ‘PANCREAS’, eight important steps in the management of severe acute pancreatitis are highlighted. These steps follow the principle of goal-directed therapy and should be borne in mind after diagnosis and during clinical treatment. The first step is perfusion: the goal is to reach a central venous pressure of 12–15mmHg, urinary output 0.5–1ml/kg/hour and inferior vena cava collapse index greater than 48%. Next is analgesia: multimodal, systemic and combined pharmacological agent and epidural block are possibilities. Third is nutrition: precocity, enteral feeding in gastric or post-pyloric position. Parenteral nutrition works best in difficult cases to achieve the individual total caloric value. Fourth is clinical: mild, moderate or severe pancreatitis according to the Atlanta criteria. Radiology is fifth: abdominal computed tomography on the fourth day for prognosis or to modify management. Endoscopy is sixth: endoscopic retrograde cholangiopancreatography (cholangitis, unpredicted clinical course and ascending jaundice); management of pancreatic fluid collection and ‘walled-off necrosis’. Antibiotics come next: infectious complications are common causes of morbidity. The only rational indication for antibiotics is documented pancreatic infection. The last step is surgery: the dogma is represented by the ‘three Ds’ (delay, drain, debride). The preferred method is a minimally invasive step-up approach, which allows for gradually more invasive procedures when the previous treatment fails.

scholarly journals Unusual presentation of acute pancreatitis mimicking strangulated inguinal hernia in a patient with bladder exstrophy: a rare case report

2017 ◽  
Vol 4 (8) ◽  
pp. 2871
Author(s):  
Vijayakumar C. ◽  
Reddy VJ ◽  
Elamurugan T. P. ◽  
Jagdish S.
Keyword(s):  
Acute Pancreatitis ◽  
Inguinal Hernia ◽  
Clinical Presentation ◽  
Fluid Collection ◽  
Bladder Exstrophy ◽  
Unusual Presentation ◽  
Pancreatic Fluid Collection ◽  
Abdominal Symptoms ◽  
Pancreatic Fluid ◽  
Rare Case Report

Acute pancreatitis (AP) is a common surgical emergency. Apart from the typical clinical presentation, unusual presentations are also reported in literature. Here we present a case of acute pancreatitis presenting as a strangulated inguinal hernia. A 45-year-old male with a neglected bladder exstrophy and reducible left inguinal hernia since childhood presented with pain over the left inguinal swelling for three days duration. Patient was initially managed conservatively since there were no signs of complication. After initial conservative management, the patient developed features of strangulation and was taken up for inguinoscrotal exploration. Intra-operatively, direct inguinal hernial sac was identified without any bowel obstruction. Further explorative laparotomy revealed an inflamed, bulky pancreas. The peri-pancreatic fluid aspirated intra-operatively had an amylase value of >4000 IU. Postoperative period was uneventful and patient was discharged after 8 days. In this case an already reducible hernia became irreducible due to pancreatic fluid collection and inflammation of contents. Lack of abdominal symptoms or signs can lead to misdiagnosis and unnecessary surgery. We report an unusual presentation of acute pancreatitis mimicking a strangulated inguinal hernia in a patient with bladder exstrophy.

scholarly journals Trans abdominal Ultrasonography in Acute Pancreatitis: a cross sectional study

2021 ◽  
Vol 2 (2) ◽  
pp. 68-72
Author(s):  
Merina Gyawali ◽  
Ashish Shrestha ◽  
Prakash Sharma ◽  
Binod Bade Shrestha ◽  
Subash Bhattarai
Keyword(s):  
Acute Pancreatitis ◽  
Imaging Modality ◽  
Fluid Collection ◽  
Cross Sectional Study ◽  
P Value ◽  
Imaging Method ◽  
Pancreatic Fluid Collection ◽  
Abdominal Ultrasonography ◽  
Cross Sectional ◽  
Mild Acute Pancreatitis

BACKGROUND: Acute pancreatitis (AP) is a common cause of acute pain abdomen. Contrast-enhanced Computed Tomography (CECT) of the abdomen is the imaging method of choice in acute pancreatitis. Ultrasonography can be used as the first, easily available imaging modality for the assessment of the pancreas. This study aims to study the transabdominal USG findings in patients with acute pancreatitis. It will also compare USG findings with CT findings in acute pancreatitis. METHODS: A hospital-based cross-sectional, prospective study comprising of consecutive 55 patients with acute pancreatitis was conducted over a study period of 15 months. Trans abdominal USG findings and CECT abdominal findings in acute pancreatitis were studied and compared. Data analysis was done using SPSS version 20 and a p-value of ≤0.05 was considered significant. RESULTS: Pancreas was visualized by USG in only 69%. Ultrasonography had some pancreatic and/or extrapancreatic findings in patients with acute pancreatitis in 84.2% of patients in whom the pancreas was visualized, whereas, it was 98.2% by CECT abdomen. USG was unable to demonstrate findings in 75% of patients with mild acute pancreatitis. CONCLUSION: Transabdominal ultrasonography detection of pancreatitis was inferior to the CECT. It had a limited role in detecting mild acute pancreatic cases. Nonetheless, detection of etiological factor such as gallstones, and assessment of extra pancreatic fluid collection like ascites and pleural effusion were better visualised with ultrasound. USG is readily available, cheap, noninvasive, and can be utilized as an initial diagnostic tool for acute pancreatitis and ruling out other causes of acute abdomen.

scholarly journals Etiology, clinical profile and outcome of acute pancreatitis in a tertiary care teaching hospital in rural South India: a ten year retrospective study

2019 ◽  
Vol 6 (10) ◽  
pp. 3794
Author(s):  
Ramu R. ◽  
Vergis Paul ◽  
Devipriya S. ◽  
Nevil C. Philip
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Presentation ◽  
Epigastric Pain ◽  
Tertiary Care ◽  
Fluid Collection ◽  
Clinical Profile ◽  
Alcoholic Pancreatitis ◽  
Systemic Complications ◽  
Idiopathic Pancreatitis ◽  
Common Clinical Presentation

Background: Acute pancreatitis is a complex condition with diverse local and systemic complications, dealt by the surgeons all over the world. There were no previous detailed studies regarding the etiology, clinical profile and outcome of acute pancreatitis in rural Kerala.Methods: This is a hospital based study by retrospective chart analysis of all acute pancreatitis cases from the past 10 years in this tertiary care centre which have clinical/ laboratory/ radiological findings suggestive of acute pancreatitis.Results: Among 436 cases studied 318 (72.9%) were males and 118 (27.1%) were females. Epigastric pain without radiation to the back (51.6%) was the most common clinical presentation. Alcohol was the most common etiological factor seen in 42.4% followed by idiopathic pancreatitis (IP) (36.9% cases) and then by gallstone/biliary pancreatitis (14.5%). Acute fluid collection was the most common local complication seen in 29.1% cases and respiratory system involvement was the most common organ involvement seen in 16.5% of cases.Conclusions: Epigastric pain without radiation to the back was the most common clinical presentation. Incidence of alcoholic pancreatitis (42.4%) and idiopathic pancreatitis (36.9%) was slightly higher in our study, which should prompt us to look with further studies for identifiable new aetiologies in the idiopathic group. This work provides the first known regional description of the etiology, clinical profile and outcome of acute pancreatitis. Due to institutional and population similarities, this may represent the status of developing countries in general. This will help in formulating a hospital policy which would be beneficial.

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