scholarly journals Synchronous Organ Failure and Infected Pancreatic Necrosis Define Genuine Critical Acute Pancreatitis

2021 ◽  
Author(s):  
Dingcheng Shen ◽  
Qin Wei ◽  
Haosu Huang ◽  
Caihong Ning ◽  
Jiarong Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Infected Pancreatic Necrosis ◽  
Mortality And Morbidity ◽  
Surgical Interventions ◽  
Icu Length Of Stay ◽  
Definition Of

Abstract Background: The determinant-based classification (DBC) of acute pancreatitis (AP) was proposed in 2012. One of the highlights of the DBC was critical acute pancreatitis (CAP), which was supposed to be strongly associated with the highest risk of adverse outcomes. However, the definition of CAP needs to be further clarified.Methods: A prospective cohort with consecutive patients of infected pancreatic necrosis (IPN) at a tertiary hospital was analyzed. Patients were assigned to IPN alone, Metachronous-CAP (MCAP) and Synchronous-CAP group (SCAP) according to presence or absence of organ failure (OF) and the crosstalk between OF and IPN. Clinical interventions and outcomes were compared among groups.Results: A total of 248 IPN patients were enrolled and the overall mortality was 25.8%. Compared with MCAP, patients with SCAP were associated with higher mortality (45/68, 66.2% vs. 5/50, 10.0%; OR= 17.6,95% CI, 6.2-50.4; P < 0.001) and morbidity (28/68, 41.2% vs. 9/50, 18.0%; P = 0.013), longer duration of OF (median 35.5 days vs. 12.0 days, P < 0.001), longer ICU length of stay (LOS) (median 28.0 days vs. 16.0 days, P = 0.001), longer hospital LOS (median 67.0 days vs. 60.0 days, P < 0.001) as well as earlier requirement for surgical interventions. The IPN alone and MCAP had comparable mortality (10.8% vs. 10.0%, P = 0.88), morbidity and hospital LOS, except that MCAP patients were characterized with longer duration of OF and ICU LOS (P< 0.05).Conclusions: SCAP, characterized with synchronous persistent OF and IPN, was associated with higher mortality and morbidity and should be defined as genuine CAP.

591c Primary Organ Failure and Secondary Organ Failure Due to Infected Pancreatic Necrosis Contribute Independently to Mortality in Acute Pancreatitis and Should Be Distinguished

2015 ◽  
Vol 148 (4) ◽  
pp. S-114
Author(s):  
Pramod K. Garg ◽  
Rajesh K. Padhan ◽  
Padmaprakash K. Vadiraja ◽  
Sanatan Behra ◽  
Sushil K. Jain ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis

scholarly journals Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit–Treated Patients with Necrotizing Severe Acute Pancreatitis

2021 ◽  
Author(s):  
Henrik Leonard Husu ◽  
Miia Maaria Valkonen ◽  
Ari Kalevi Leppäniemi ◽  
Panu Juhani Mentula
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Open Abdomen ◽  
Infected Pancreatic Necrosis ◽  
Independent Risk Factors

Abstract Background In patients with severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) is associated with a worsened outcome. We studied risk factors and consequences of IPN in patients with necrotizing SAP. Methods The study consisted of a retrospective cohort of 163 consecutive patients treated for necrotizing SAP at a university hospital intensive care unit (ICU) between 2010 and 2018. Results All patients had experienced at least one persistent organ failure and approximately 60% had multiple organ failure within the first 24 h from admission to the ICU. Forty-seven (28.8%) patients had IPN within 90 days. Independent risk factors for IPN were more extensive anatomical spread of necrotic collections (unilateral paracolic or retromesenteric (OR 5.7, 95% CI 1.5–21.1) and widespread (OR 21.8, 95% CI 6.1–77.8)) compared to local collections around the pancreas, postinterventional pancreatitis (OR 13.5, 95% CI 2.4–76.5), preceding bacteremia (OR 4.8, 95% CI 1.3–17.6), and preceding open abdomen treatment for abdominal compartment syndrome (OR 3.6, 95% CI 1.4–9.3). Patients with IPN had longer ICU and overall hospital lengths of stay, higher risk for necrosectomy, and higher readmission rate to ICU. Conclusions Wide anatomical spread of necrotic collections, postinterventional etiology, preceding bacteremia, and preceding open abdomen treatment were identified as independent risk factors for IPN.

scholarly journals PYO-SEPTIC COMPLICATIONS OF SEVERE NECROTIZING FORMS OF ACUTE PANCREATITIS

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.

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

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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