Acute necrotising pancreatitis - causes of deaths: single-centre retrospective study

Relevance. There is a discussion about the prevalence of early or late mortality and the main causes of death in different phases of acute pancreatitis. Analysis of mortality is important for the determination of ways to improve the results of treatment of pancreatic necrosis. Aim of the research is analysis of the structure, timing characteristics and causes of deaths in pancreatic necrosis, the effect of the configuration of parapancreatitis and surgical tactics on the outcome of the disease. Materials and methods. Retrospective single-center study of lethal outcomes in acute pancreatitis was performed, the structure of mortality, cases of discrepancies in diagnoses, the timing of the onset and causes of deaths of patients were studied. The lethal outcomes were compared in the operated patients, the frequency of the mesentery root involvement, the indications and the timing of the interventions were assessed. Results. The ratio of early and late mortality was 45,2% to 54,8%, respectively. The main causes of early mortality – endotoxin shock and multi-organ failure, late one – infectious complications. In 9,6% of the patients, the diagnosis was made only with an autopsy. The prognostic value of the SOFA and SAPS II scales is characterized as low. The tactics of surgical treatment has changed in favour of minimally invasive surgery. The average conversion time for ineffective percutaneous procedures was 21,4 days. The involvement of mesentery in parapancreatitis was often accompanied by a breakthrough of the abscess into the abdominal cavity. Conclusion. The surgical component of the reduction in mortality is the rejection of unreasonable surgical interventions, the earlier conversion to "traditional" operations in case of ineffective minimally invasive treatment and the allocation of "central" localization of parapancreatitis as a serious prognostic factor of the course of severe pancreatitis.

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Minimally invasive treatment in the victim with spleen injury

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-4-58-60 ◽

2019 ◽

Vol 178 (4) ◽

pp. 58-60

Author(s):

Ya. V. Gavrishuk ◽

I. V. Kazhanov ◽

A. N. Tulupov ◽

A. E. Demko ◽

D. V. Kandyba ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Experience ◽

Abdominal Cavity ◽

Minimally Invasive Treatment ◽

Invasive Treatment ◽

Surgical Interventions ◽

Angiography And Embolization ◽

Minimally Invasive Methods

The article describes the clinical experience of treatment of the victim using minimally invasive methods such as angiography and embolization. The applied treatment tactics made it possible to preserve the damaged parenchymal organ of the abdominal cavity and avoid performing other more traumatic surgical interventions (laparoscopy, laparotomy).

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PYO-SEPTIC COMPLICATIONS OF SEVERE NECROTIZING FORMS OF ACUTE PANCREATITIS

Modern medical technologies ◽

10.34287/mmt.3(42).2019.9 ◽

2019 ◽

Vol 42 (3) ◽

pp. 37-40

Author(s):

Veligotsky N. N. ◽

Arutyunov S. E. ◽

Klymenko M. V. ◽

Aleksanyan K, A.

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Fine Needle Biopsy ◽

Infected Pancreatic Necrosis ◽

Septic Complications ◽

Blood Calcium ◽

Surgical Interventions ◽

Surgical Tactics ◽

Instrumental Methods

Purpose of the study. Develop an algorithm for the diagnosis and treatment of purulent-septic complications of severe necrotizing forms of acute pancreatitis. Materials and methods. 5400 patients with acute pancreatitis were treated. To determine the infected pancreatic necrosis, the blood calcium level, and blood procalcitonin were studied, and a fine-needle biopsy was performed. Surgical interventions were performed in 874 (16,2%) patients who underwent 1057 surgical interventions. Results. 782 minimally invasive interventions were performed in 645 patients: video laparoscopic – 608 (77,7%), puncture-draining (under ultrasound control) – 102 (13,0%), endoscopic – 38 (4,9%). The following purulent-septic complications of severe forms of acute pancreatitis were revealed: infected pancreatic necrosis in 189 (17,9%), infected peripancreonecrosis in 167 (15,8%), infected pseudocyst in 109 (12,5%) patients. 173 (19,8%) single-stage operative interventions were performed, 56 (6,4%) open-stage multistage patients were performed, and extended necrsequestrectomy was performed. Among minimally invasive interventions, minilaparotomy and lumbotomy were performed in 34 (4,3%). Conclusion. The use of monitoring laboratory and instrumental methods of research in the diagnosis of severe forms of acute pancreatitis and its complications allows you to determine in time the degree and volume of necrotic lesions of the pancreas and develop surgical tactics. Keywords: acute pancreatitis, pancreatonecrosis,purulent-septic complications.

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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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Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

Inter Collegas ◽

10.35339/ic.8.2.87-94 ◽

2021 ◽

Vol 8 (2) ◽

pp. 87-94

Author(s):

Igor Kryvoruchko ◽

Anastasiya Drozdova ◽

Nataliya Goncharova

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Postoperative Period ◽

Surgical Trauma ◽

Fast Track Surgery ◽

Surgical Interventions ◽

Minimally Invasive Surgical ◽

Treatment Measures ◽

Mechanisms Of Development ◽

Adequate Management

The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment measures for acute pancreatitis, which are based on the principles of tactics "step-up approach" were highlighted. Among them, attention is focused on the features of the conservative treatment program, minimally invasive surgical interventions, as well as the management of the postoperative period of patients. Minimally invasive surgical interventions perform the main tasks of surgical treatment in acute pancreatitis, but significantly reduce surgical trauma compared to "open" methods. Adequate management of the postoperative period of patients is carried out through the implementation of protocols "fast-track surgery".

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

Gastroenterology Research and Practice ◽

10.1155/2019/6069179 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Gang Li ◽

Lin Gao ◽

Jing Zhou ◽

Bo Ye ◽

Jingzhu Zhang ◽

...

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Splenic Artery ◽

Pancreatic Necrosis ◽

Splenic Abscess ◽

Arterial Embolization ◽

Massive Bleeding ◽

Massive Hemorrhage ◽

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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ARROSIVE BLEEDING WITH PANCREATIC NECROSIS — TACTICAL APPROACHES

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2020.12 ◽

2020 ◽

pp. 85-88 ◽

Cited By ~ 1

Author(s):

V. V. Mishchenko ◽

P. I. Pustovoit ◽

R. Yu. Vododyuk ◽

V. V. Velichko ◽

V. V. Goryachy

Keyword(s):

Minimally Invasive ◽

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

Stent Grafts ◽

Invasive Treatment ◽

Results Of Treatment ◽

Hemorrhagic Complications ◽

Necrotic Pancreatitis ◽

Acute Necrotizing

Summary. The problem of hemorrhagic complications of destructive pancreatitis is relevant. The aim of the study was to study the frequency and sources of hemorrhagic complications in patients with pancreatic necrosis, to evaluate the tactics of diagnosis and the effectiveness of methods to stop bleeding. Materials and methods. A study of the results of treatment of 40 patients with acute necrotizing pancreatitis was conducted. Results and its discussion. In 67.5 % of patients with acute necrotizing pancreatitis, hemorrhagic complications in the form of arrosive bleeding were observed. A method of endovascular occlusion of vessels using Gianturco spirals or stent grafts to stop arrosive bleeding in acute necrotizing pancreatitis has been introduced in the clinic. In 37.0 % of cases, repeated signs of arrosive bleeding were observed. In acute necrotizing pancreatitis complicated by arrosive bleeding, mortality was 44.4 %. Conclusions. The main cause of hemorrhagic complications in acute necrotic pancreatitis is acute necrotic changes, during infection of which arrosia of adjacent vessels occurs. The predominant tactic in case of bleeding from the retroperitoneal space against the background of minimally invasive treatment is clamping of drains, endovascular hemostasis using Gianturco spirals or stent grafts and the use of hemostatic soluble gauze (hemostop). Mortality in the development of arrosive bleeding in acute necrotic pancreatitis is 44.4 %.

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DIFFERENTIAL DIAGNOSIS OF STERILE AND I NFECTED PANCREONECROSIS

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2021.06 ◽

2021 ◽

pp. 31-35

Author(s):

V. V. Boyko ◽

V. M. Lykhman ◽

A. O. Merkulov ◽

D. O. Myroshnychenko ◽

S. V. Tkach ◽

...

Keyword(s):

Acute Pancreatitis ◽

Differential Diagnosis ◽

Pancreatic Necrosis ◽

Clinical Laboratory ◽

Practical Importance ◽

Modern Medicine ◽

Infectious Complications ◽

Infected Pancreatic Necrosis ◽

Septic Complications ◽

Great Practical Importance

Summary. Introduction. The search for objective methods for diagnosing the form and severity of acute pancreatitis, accurate prediction and timely prevention of infectious complications in this surgical pathology is of great practical importance for modern medicine. Materials and methods. According to clinical, morphological and bacteriological data, groups of patients were selected. The first group included 33 patients with sterile pancreatic necrosis (SP), the second group consisted of 29 patients with infected pancreatic necrosis (IP). Results and discussion. The program of differential diagnosis of sterile and infected pancreatic necrosis with calculation of the index of differential diagnosis (IDD) for each clinical-laboratory and instrumental indicator used in this system is developed. The development and evaluation of diagnostic possibilities of the method of verification of purulent-septic complications of acute pancreatitis and the transition of a sterile form of pancreatic necrosis to an infected one was carried out. Conclusions. The use of the developed method of diagnosis of sterile and infected pancreatic necrosis with the calculation of the index of differential diagnosis allowed in 93% of cases to distinguish sterile pancreatic necrosis from infected and timely determine the scope and tactics of treatment.

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