scholarly journals Dual pigtail intervention in acute necrotising pancreatitis

2021 ◽  
Vol 3 (2) ◽  
pp. 51-54
Author(s):  
Santosh Rai ◽  
V. Vijayasekaran ◽  
Aishwarya N Gadwal ◽  
Abhijith Acharya
Keyword(s):  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Loss Of Weight ◽  
Alternative Approach ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Life Threatening ◽  
Walled Off Necrosis ◽  
Seriously Ill ◽  
Primary Modality

Acute pancreatitis has multiple aetiologies. Acute pancreatitis is divided into interstitial oedematous pancreatitis or necrotizing pancre­atitis based on morphology. According to the revised Atlanta classification necrotizing pancreatitis is further sub­divided into acute necrotic collec­tion if the disease develops within 4 weeks or walled-off necrosis if the disease develops after 4 weeks.We report a case of 40years male, with acute pancreatitis for 1 month, presenting with decreased appetite, loss of weight, and tremors of extremities. CT featured active necrotizing pancreatitis with peripancreatic necrosis, collections, and superadded infection which was drained by percutaneous pigtail catheter.Percutaneous pigtail insertion controls the symptoms and this procedure is effective in the management of patients with necrotizing pancreatitis. It serves as definitive or intermediate therapy to surgical necrosectomy in patients who are unfit for surgery. Percutaneous pigtail insertion can be done following a peritoneal or retroperitoneal approach, both approaches have different advantages and it is the choice of the radiologist and the location of the residual collections. The disadvantages are duct leak and it needs multiple check CT’s but in well trained and experienced hands the disadvantages are minimized. Percutaneous pigtail insertion is an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery. It can prevent life-threatening complications and it can be considered as a primary modality in treating a patient with walled-off necrosis.Percutaneous pigtail insertion an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery can be considered as the primary modality of choice in treating patients with walled-off necrosis of the pancreas.

scholarly journals A rare case of acute necrotising pancreatitis in a paediatric patient

2020 ◽  
Vol 3 (1) ◽  
pp. 061-063
Author(s):  
Jansen Lizeri ◽  
Colleran Gabrielle ◽  
Okafor Ikechukwu ◽  
Quinn Nuala
Keyword(s):  
Acute Pancreatitis ◽  
Paediatric Patient ◽  
Rare Event ◽  
Paediatric Hospital ◽  
Abdominal Symptoms ◽  
Distended Abdomen ◽  
Important Differential Diagnosis ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED). We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital. This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent. Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.

scholarly journals Spontaneous fistulisation of infected walled-off necrosis (WON) into the duodenum in a patient following acute necrotising pancreatitis

2014 ◽  
Vol 2014 (jan10 1) ◽  
pp. bcr2013202863-bcr2013202863 ◽  
Author(s):  
V. Boopathy ◽  
P. Balasubramanian ◽  
T. Alexander ◽  
R. Koshy
Keyword(s):  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Walled Off Necrosis ◽  
Acute Necrotising

scholarly journals Emblica Officinalis: A Novel Therapy for Acute Pancreatitis — An Experimental Study

HPB Surgery ◽  
1995 ◽  
Vol 9 (1) ◽  
pp. 25-30 ◽  
Author(s):  
S. P. Thorat ◽  
N. N. Rege ◽  
A. S. Naik ◽  
U. M. Thatte ◽  
A. Joshi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Cell Damage ◽  
Smooth Endoplasmic Reticulum ◽  
Emblica Officinalis ◽  
Novel Therapy ◽  
Traditional System ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Acute necrotising pancreatitis is associated with an unacceptably high mortality for which no satisfactory remedy exists. Emblica officinalis (E.o.) is a plant prescribed in Ayurveda, the Indian traditional system of medicine, for pancreas-related disorders. This study was carried out to evaluate the protective effect of E.o. against acute necrotising pancreatitis in dogs. Pancreatitis was induced by injecting a mixture of trypsin, bile and blood into the duodenal opening of the pancreatic duct. Twenty eight dogs were divided into 4 groups (n = 6-8 each): GpI–control, GpII–acute pancreatitis, GpIII–sham-operated, GpIV–pretreatment with 28 mg E.o./kg/day for 15 days before inducing pancreatitis. Serum amylase increased from 541.99 ± 129.13 IU/ml to 1592.63 ± 327.83 IU (p<0.02) 2 hrs after the induction of pancreatitis in GpII. The rise in serum amylase in both GpIII and GpIV was not significant. On light microscopic examination, acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group as compared to GpII. Electron microscopy confirmed this and showed an increased amount of smooth, endoplasmic reticulum and small, condensed granules embedded in a vacuole. More studies are needed to explore the clinical potential of E.o. and its mechanism of action.

scholarly journals Acute necrotising pancreatitis – early management in the district general hospital and tertiary hepato-pancreatico-biliary unit

2018 ◽  
Vol 20 (3) ◽  
pp. 263-267
Author(s):  
Rajiv P Lahiri ◽  
Nariman D Karanjia
Keyword(s):  
Acute Pancreatitis ◽  
Nutritional Support ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Early Management ◽  
Surgical Emergency ◽  
High Dependency ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Acute pancreatitis is a common general surgical emergency presentation. Up to 20% of cases are severe and can involve necrosis with high associated morbidity and mortality. It is most commonly due to gallstones and excess alcohol consumption. All patients with acute pancreatitis need to be scored for severity and patients with severe acute pancreatitis should be managed on the high dependency unit. The mainstay of early treatment is supportive, with care to ensure strict fluid balance and optimisation of end organ perfusion. There is no role for early antibiotic use in acute necrotising pancreatitis and antibiotics should only be used in the presence of positive cultures. Nutritional support is vitally important in improving outcomes in necrotising pancreatitis. This should ideally be provided enterally using an naso-jejunal tube if the patient cannot tolerate oral intake. Patients with significant early necrosis, persisting organ dysfunction, infected walled off necrosis requiring intervention or haemorrhagic pancreatitis should be referred to a regional hepato-pancreatico-biliary unit for advice or transfer. Percutaneous and endoscopic necrosectomy has replaced open surgery due to improved outcomes. Acute necrotising pancreatitis remains a complex surgical emergency with high morbidity and mortality that requires a multidisciplinary approach to attain optimum outcomes. The mainstay of treatment is supportive care and nutritional support. Patients with significant pancreatic necrosis or infected collections requiring drainage require input from a tertiary HPB unit to guide management.

scholarly journals QT prolongation and ventricular fibrillation caused by acute necrotising pancreatitis in a young female patient

2012 ◽  
Vol 153 (48) ◽  
pp. 1918-1920
Author(s):  
András Jánosi ◽  
István Osztheimer ◽  
Béla Merkely
Keyword(s):  
Acute Pancreatitis ◽  
Female Patient ◽  
Qt Interval ◽  
Case Reports ◽  
Young Female ◽  
Qt Prolongation ◽  
Pathophysiological Mechanism ◽  
Malignant Arrhythmia ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis

Electrocardiographic alterations associated with acute pancreatitis (AP) have been known for decades. This association may be of particular importance in differential diagnosis, since authors have reported ECG abnormalities suggestive of myocardial infarction. The pathophysiological mechanism of these ECG changes has remained unclear to date. Only a few reports have been published on pancreatitis-induced QT prolongation and malignant arrhythmia. This case report describes the case history of a young female patient with acute pancreatitis accompanied with a substantial prolongation of the QT interval, resulting in recurrent ventricular tachycardia and fibrillation. A thorough cardiologic work-up (including coronary angiography and electrophysiology screen) ruled out other causes of malignant arrhythmia. The patient received an implantable cardioverter-defibrillator. Following resolution of the pancreatitis, the QT interval normalized and arrhythmia has not recurred during long-term follow-up. To the best knowledge of the authors, there is no case reports in the literature similar to that described in this paper. Orv. Hetil., 2012, 153, 1918–1920.

scholarly journals Surgery Management of Pancreatitis with Complication: A Review Article

2022 ◽  
Vol 6 (1) ◽  
pp. 01-03
Author(s):  
Nanda Rachmad Putra Gofur ◽  
Aisyah Rachmadani Putri Gofur ◽  
Soesilaningtyas Soesilaningtyas ◽  
Rizki Nur Rachman Putra Gofur ◽  
Mega Kahdina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Necrotizing Pancreatitis ◽  
Clinical Manifestations ◽  
Healing Time ◽  
Acute Necrotizing Pancreatitis ◽  
Close Monitoring ◽  
Necrotic Tissue ◽  
Acute Necrotizing ◽  
Walled Off Necrosis

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with clinical manifestations that vary from mild to severe manifestations to death. The incidence of pancreatitis varies in various countries in the world and depends on the cause such as alcohol, gallstones, and metabolic factors. The clinical picture and the main symptom in patients with acute pancreatitis is abdominal pain. Abdominal pain varies from mild to severe and excruciating. Abdominal pain that is felt is constant and dull, and is usually felt in the epigastrium and periumbilicus and often spreads to the back, chest, waist, and lower abdomen. Discussion: The onset of acute pancreatitis, the patient should be evaluated for hemodynamic status immediately and receive the necessary resuscitation measures. Patients with acute pancreatitis should receive aggressive intravenous rehydration (250 - 500 ml/hour with isotonic crystalloid fluid) as early as possible with close monitoring, unless contraindicated with cardiovascular and/or renal comorbidities. It is most effective within the first 12-24 hours, but after that the benefits may diminish. Debridement (necrosectomy) is the gold standard in infected acute necrotizing pancreatitis and peripancreatic necrosis. Indications for intervention either through radiological, endoscopic or surgical procedures in necrotizing pancreatitis are suspected or proven infected necrotizing pancreatitis with clinical deterioration, especially after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Sterile necrotizing pancreatitis with persistent organ failure several weeks after the onset of acute pancreatitis, particularly after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Conclusion: Surgical management is often used in pancreatitis associated with gallstones. Cholecystectomy within 48 hours of the complaint can increase healing time. In addition, cholecystectomy performed early may not increase the risk of complications secondary to surgery. Surgery is not performed in acute necrotizing pancreatitis until the inflammation is reduced and the fluid accumulation no longer increases in size.

scholarly journals Multisystemic production of interleukin 10 limits the severity of acute pancreatitis in mice

Gut ◽  
1998 ◽  
Vol 43 (3) ◽  
pp. 408-413 ◽  
Author(s):  
J-L Van Laethem ◽  
R Eskinazi ◽  
H Louis ◽  
F Rickaert ◽  
P Robberecht ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Messenger Rna ◽  
Serum Levels ◽  
Interleukin 10 ◽  
Protective Role ◽  
Enzyme Release ◽  
Protein Levels ◽  
Tnf Α ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis

Background—Interleukin 10 (IL-10) decreases the severity of experimental acute pancreatitis. The role of endogenous IL-10 in modulating the course of pancreatitis is currently unknown.Aims—To examine the systemic release of IL-10 and its messenger RNA production in the pancreas, liver, and lungs and analyse the effects of IL-10 neutralisation in caerulein induced acute pancreatitis in mice.Methods—Acute necrotising pancreatitis was induced by intraperitoneal caerulein. Serum levels of IL-10 and tumour necrosis factor (TNF), and tissue IL-10 and TNF-α gene expression were assessed. After injecting control antibody or after blocking the activity of endogenous IL-10 by a specific monoclonal antibody, the severity of acute pancreatitis was assessed in terms of serum enzyme release, histological changes, and systemic and tissue TNF production.Results—In control conditions, serum IL-10 levels increased and correlated with the course of pancreatitis, with a maximal value eight hours after induction. Both IL-10 and TNF-α messengers showed a similar course, and were identified in the pancreas, liver, and lungs. Neutralisation of endogenous IL-10 significantly increased the severity of pancreatitis and associated lung injury as well as serum TNF protein levels (+75%) and pancreatic, pulmonary, and hepatic TNF messenger expression (+33%, +29%, +43%, respectively).Conclusions—In this non-lethal model, systemic release of IL-10 correlates with the course of acute pancreatitis. This anti-inflammatory response parallels the release of TNF and both cytokines are produced multisystemically. Endogenous IL-10 controls TNF-α production and plays a protective role in the local and systemic consequences of the disease.

scholarly journals Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Susanta Meher ◽  
Tushar Subhadarshan Mishra ◽  
Prakash Kumar Sasmal ◽  
Satyajit Rath ◽  
Rakesh Sharma ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Biochemical Markers ◽  
Necrotizing Pancreatitis ◽  
Pancreatic Tissue ◽  
Pancreatic Acinar Cell ◽  
Early Assessment ◽  
Prognostic Evaluation ◽  
Reactive Protein ◽  
Life Threatening

Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have discussed briefly the pathogenesis and the role of different biochemical markers in the diagnosis and severity evaluation in acute pancreatitis.

scholarly journals Necroptosis protects against exacerbation of acute pancreatitis

2021 ◽  
Vol 12 (6) ◽  
Author(s):  
Michittra Boonchan ◽  
Hideki Arimochi ◽  
Kunihiro Otsuka ◽  
Tomoko Kobayashi ◽  
Hisanori Uehara ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Neutrophil Infiltration ◽  
Dependent Manner ◽  
Protective Effects ◽  
Interacting Protein ◽  
Inflammatory Conditions ◽  
Edematous Pancreatitis ◽  
Genetic Deletion ◽  
Dose Dependent

AbstractThe sensing of various extrinsic stimuli triggers the receptor-interacting protein kinase-3 (RIPK3)-mediated signaling pathway, which leads to mixed-lineage kinase-like (MLKL) phosphorylation followed by necroptosis. Although necroptosis is a form of cell death and is involved in inflammatory conditions, the roles of necroptosis in acute pancreatitis (AP) remain unclear. In the current study, we administered caerulein to Ripk3- or Mlkl-deficient mice (Ripk3−/− or Mlkl−/− mice, respectively) and assessed the roles of necroptosis in AP. We found that Ripk3−/− mice had significantly more severe pancreatic edema and inflammation associated with macrophage and neutrophil infiltration than control mice. Consistently, Mlkl−/− mice were more susceptible to caerulein-induced AP, which occurred in a time- and dose-dependent manner, than control mice. Mlkl−/− mice exhibit weight loss, edematous pancreatitis, necrotizing pancreatitis, and acinar cell dedifferentiation in response to tissue damage. Genetic deletion of Mlkl resulted in downregulation of the antiapoptotic genes Bclxl and Cflar in association with increases in the numbers of apoptotic cells, as detected by TUNEL assay. These findings suggest that RIPK3 and MLKL-mediated necroptosis exerts protective effects in AP and caution against the use of necroptosis inhibitors for AP treatment.

scholarly journals Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy

2021 ◽  
Vol 43 (03) ◽  
pp. 220-224
Author(s):  
Julia Cristina Coronado Arroyo ◽  
Marcio José Concepción Zavaleta ◽  
Eilhart Jorge García Villasante ◽  
Mikaela Kcomt Lam ◽  
Luis Alberto Concepción Urteaga ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Clinical Course ◽  
Necrotizing Pancreatitis ◽  
Rare Condition ◽  
Severe Hypertriglyceridemia ◽  
Fetal Complications ◽  
Acute Necrotizing ◽  
History Of ◽  
Important Objective

AbstractAcute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause. We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.

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