scholarly journals PECULIARITIES OF THE COURSE OF ACUTE SEVERE PANCREATITIS COMPLICATED WITH ASCITES AND PERITONITIS

2019 ◽  
Vol 19 (2) ◽  
pp. 23-25
Author(s):  
V.V. Kasian
Keyword(s):  
Acute Pancreatitis ◽  
Multiorgan Failure ◽  
Abdominal Cavity ◽  
Early Period ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Acute Severe Pancreatitis ◽  
Surgical Department ◽  
Severe Pancreatitis ◽  
Operative Drainage

Acute pancreatitis is one of the most common diseases of the digestive system that often requires urgent admission to the hospital. Ascites and peritonitis in acute severe pancreatitis is a rather common complication of the early period of the disease. The evacuation of fluid rich in potentially toxic mediators from the abdominal cavity is advocated in a number of reports as an efficient measure to alleviate the burden of disease for patients in emergency condition. The purpose of the work was to analyze the effect of enzymatic ascites and peritonitis and drainage interventions performed on the course of acute pancreatitis. The study was based on the analysis of 44 case histories of inpatients with acute pancreatitis complicated with ascites and peritonitis who took the course of treatment at the surgical department of the M.V. Sklifosovsky Poltava Regional Clinical Hospital for 2013 – 2017. The patients were divided into two groups: the first group included individuals who were performed on surgical interventions for enzymatic ascites and peritonitis in the early period of the disease; the second group included he patients who only had a comprehensive conservative treatment according to the protocols for the treatment of acute pancreatitis. The obtained results confirm that resolving enzymatic ascites enables to avoid mortality in the early period of the disease associated with the increase of organ and multiorgan failure in patients with severe and extremely severe course of acute pancreatitis, and in some cases contributes to regression of the disease. Once the damage is in progression, to some extent it can provoke a more severe course of post-operative drainage due to the number of factors as a surgical trauma, or drainage as an entrance gate for infection.

scholarly journals PREDICTIVE CRITERIA FOR SEVERE COURSE OF ACUTE PANCREATITIS BASED ON LAST REVIEWS OF ITS CLASSIFICATION SIGNS

2018 ◽  
Vol 18 (4) ◽  
pp. 128-131
Author(s):  
V.V. Kasian ◽  
O.Yu. Cherkun ◽  
D.A. Sytnik ◽  
V.D. Sheiko
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Late Phase ◽  
Relevant Information ◽  
Multiple Organ ◽  
Surgical Interventions ◽  
Acute Severe Pancreatitis ◽  
Severe Pancreatitis ◽  
Surgical Tactics ◽  
Optimal Approach

Acute pancreatitis (GP) is one of the most common diseases of the digestive system requiring urgent hospitalization, and there is a global tendency to increase the incidence of this disease. In recent years, approaches to the classification of this disease have been revised. The purpose of this work was to analyze recent year publications regarding modern views on the diagnosis, identification and prediction of the severity of acute pancreatitis. The study was based on the search of relevant information in peer-reviewed journals through the "Medline" sources over the past 5 years by key words as acute severe pancreatitis, classification. The data obtained were then carefully analyzed. Modern views on the diagnosis of severe forms of acute pancreatitis are based on the new international classifications of RAC and DBC. The presence of organ failure and its duration is a key criterion for the diagnosis of acute severe pancreatitis. In addition to organ failure, DBC recommends the use of pancreatic necrosis and its sterility / infectivity, which is more relevant for the late phase of the disease. Early diagnosis and prediction of multiple organ failure are of great significance in planning and correction of intensive care, and the diagnosis of parapancreatic complications is exceptionally important for choosing the proper surgical tactics. The correct evaluation of the classification data in the dynamics will determine the extent and staging of surgical interventions. The development and grounding of an optimal approach to the treatment of acute severe pancreatitis based on key classification features is to minimize the adverse effects.

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

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".

scholarly journals Early identification of patients at risk of acute severe pancreatitis with Systemic Inflammatory Response Syndrome score at admission

2019 ◽  
Vol 8 (2) ◽  
pp. 92-95
Author(s):  
Uttam Laudari ◽  
Abishek Thapa ◽  
Tanka Prasad Bohara ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Predictive Value ◽  
College Teaching ◽  
Systemic Inflammatory Response ◽  
P Value ◽  
Predictive Values ◽  
Acute Severe Pancreatitis ◽  
Severe Pancreatitis

Background: Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnea and change in blood leukocyte count. The relationship between SIRS symptoms at the time of presentation and severity of pancreatitis is yet to be determined though progression of SIRS in subsequent days has already been correlated.Objectives: To determine the severity of pancreatitis with SIRS score at the time of admission.Methodology: A retrospective cohort study of patients admitted to Department of Surgery, Kathmandu Medical College Teaching Hospital (KMCTH) with diagnosis of Acute Pancreatitis (AP) from December 2014 to January 2016 was conducted. Clinical, biochemical and imaging data were collected from the medical record section. Patients with diagnosis of acute pancreatitis as per Revised Atlanta Classification 2012 were included in the study. SIRS score at time of admission was correlated with Modified Marshall scoring system for organ dysfunction. Patients were grouped into severe and nonsevere group. Sensitivity, specificity and predictive values of SIRS score at admission for organ failure were calculated.Results: Among the 41 patients admitted with diagnosis of acute pancreatitis irrespective of cause, the sensitivity of SIRS score ≥2 at admission in predicting severe pancreatitis was 60 %, specificity was 20%, positive predictive value was 28% and negative predictive value was 20 %, with p-value of 0.52 and odds ratio of 1.6 (CI: 0.376-6.808).Conclusion: SIRS score at admission cannot be solely used in predicting acute severe pancreatitis. Patients can be stratified in resource deficit setting for timely referral to tertiary centre.

scholarly journals Features of laparoscopic hernioplasty of paracolostomy hernias in patients with combined abdominal pathology

2020 ◽  
Vol 24 (4) ◽  
pp. 600-603
Author(s):  
K. Yu. Parkhomenko
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Average Length ◽  
Abdominal Cavity ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Inguinal Hernias ◽  
Laparoscopic Hernioplasty ◽  
Commercial Enterprise ◽  
Laparoscopic Techniques ◽  
Ventral Hernias

Annotation. The aim of the study is to study the technological features and results of simultaneous laparoscopic hernioplasty of paracolostomy hernias in the presence of combined abdominal pathology. We analyzed the results of surgical treatment of 11 patients with paracolostomy hernias who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council “Regional Clinical Hospital” from 2016 to 2020, of whom – women – 4 (36%), men – 7 (64%), aged from 42 to 69 years old. Clinical, anamnestical and instrumental data for the prolongation of cancer were not identified in all patients. Out of 11 patients, in addition to paracolostomy hernia, 3 (27%) had inguinal hernias, 8 (73%) had postoperative ventral hernias. 3 (27%) patients with hernias also had cholecystolithiasis. All patients underwent laparoscopic hernioalloplasty of paracolostomy hernia. 3 patients underwent simultaneous TAPP for inguinal hernias, and 1 patient underwent laparoscopic cholecystectomy and TAPP. 6 patients with incisional ventral hernias underwent simultaneous IPOM according to the standard method, and 2 – according to the own method. Of the above, 2 patients suffering from cholecystolithiasis, in addition to hernioalloplasty, underwent laparoscopic cholecystectomy. In 4 (36%) patients, viscerolysis was additionally performed due to the presence of an adhesive process in the abdominal cavity. Simultaneous hernioalloplasty TAPP and IPOM, as well as laparoscopic cholecystectomy, had no significant effect on the development of complications and the duration of hospitalization. The average length of inpatient treatment was 9.2 bed-days. The study proves the expediency of widespread simultaneous surgical interventions for hernias of the anterior abdominal wall, as well as the preference for laparoscopic techniques.

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

2019 ◽  
Vol 12 (1) ◽  
pp. 29-37
Author(s):  
Denis Vladimirovich Mizgirev ◽  
Valeriy Vladimirovich Kremlev ◽  
Lyudmila Aleksandrovna Neledova ◽  
Victor Nikolaevich Pozdeev ◽  
Anastasiya Andriyanovna Katysheva ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Abdominal Cavity ◽  
Infectious Complications ◽  
Endotoxin Shock ◽  
Invasive Treatment ◽  
Surgical Interventions ◽  
Late Mortality ◽  
Causes Of Deaths

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.

INDICATIONS AND CONTRAINDICATIONS FOR REMOVAL OF FOREIGN BODIES OF LUNGS OF FLAMMABLE ORIGIN

2021 ◽  
pp. 43-47
Author(s):  
V. Kupriyanchuk ◽  
Y. Bunin ◽  
R. Mikhailusov ◽  
V. Negoduyko ◽  
E. Khoroshun ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Foreign Bodies ◽  
Comparison Group ◽  
Gunshot Wounds ◽  
Northern Region ◽  
Main Group ◽  
Surgical Instruments ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Surgical Department

Summary. The purpose of the study is to establish the indications and contraindications for the removal of foreign bodies of lungs of gunshot origin. Materials and methods. In the surgical department of the surgical clinic of the Military Medical Clinical Center of the Northern Region, 207 wounded who received gunshot wounds penetrating the chest were examined. The wounded were divided into 2 groups depending on the operational tactics used. The main group of 97 wounded who were treated using modern video endoscopic technology and magnetic surgical instruments. The comparison group consisted of 110 wounded who received traditional treatment. Results and their discussion. Using video endoscopic technologies and magnetic surgical instruments during surgery, 42 (54.5%) in the main group were removed, in the comparison group — 23 (27.4%) foreign bodies. The amount of surgery should not exceed the amount of damage that minimizes surgical trauma. The article presents indications and contraindications to the removal of foreign bodies of pulmonary origin. The differential approach allows to determine the surgical tactics depending on the location of the foreign body, its size and the fit of foreign bodies to the vessels, bronchi, mediastinum. Adherence to the rules of removal of foreign bodies of the lung, depending on the location of its location and size leads to a decrease in inappropriate surgical interventions and postoperative complications. Conclusions. 1. The distribution of foreign bodies by location and size allows you to clearly determine the tactics of treatment and avoid postoperative complications. 2. Surgical interventions to remove foreign bodies should be performed in the first days after stabilization of the patient’s condition using minimally invasive technologies.

scholarly journals Diagnosis and treatment of destructive forms of acute pancreatitis

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 65-70
Author(s):  
V. V. Mishchenko ◽  
V. V. Hrubnyk ◽  
P. I. Pustovoyt ◽  
V. V. Horyachyy ◽  
V. V. Velychko ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Cavity ◽  
Secretory Activity ◽  
Multiple Organ ◽  
Diagnosis And Treatment ◽  
Infusion Therapy ◽  
Surgical Interventions ◽  
Purulent Peritonitis ◽  
Peridural Anesthesia ◽  
Complete Cell

Purpose of the study. The study of the diagnosis and treatment of destructive forms of acute pancreatitis and the identification of possible ways to optimize them. Materials and methods. Destructive forms of acute pancreatitis were found in 16,8%. The algorithm for treating acute destructive pancreatitis consisted in artificial ventilation of the lungs, adequate infusion therapy, peridural anesthesia, setting up a nasoenteric probe, stimulating the bowels, correcting hemodynamics, intra- and extracorporal detoxification, antisecretory, anti-bacterial, hepatoprotective, cerebroprotective, antioxidant therapy, directed immune correction, use of anti-enzyme drugs, suppression of the release of mediators inflammation, external secretory activity of the pancreas. Medical video laparoscopy and puncture interventions under the control of ultrasound were used as the first stage of surgical treatment. The indications for traditional surgical interventions are large areas of aseptic destruction, unlimited infected pancreatic necrosis, infection of necrotic areas with complete cell sequestration, abscesses with large sequesters, abdominal phlegmon, signs of progressive multiple organ failure and the development of arousal hemorrhage, perforation of cystic formations in the abdominal cavity, perforation of a hollow organ, purulent peritonitis. Results. The developed therapeutic tactics allowed, in destructive forms of acute pancreatitis, to achieve a reduction in overall mortality to 23,4%. Conclusion. Diagnostic and treatment tactics for destructive forms of acute pancreatitis should be standardized depending on the timing, severity of the disease, localization and prevalence of the destructive process, systemic and local complications. Keywords: acute, destructive, pancreatitis, diagnosis, treatment.

scholarly journals STRUCTURAL ANALYSIS OF CLINICAL AND LABORATORY AND INSTRUMENTAL DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

2021 ◽  
pp. 52-58
Author(s):  
M. I. Pokidko ◽  
T. V. Formanchuk ◽  
A. G. Sychevska ◽  
O. B. Tkachenko
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Treatment ◽  
Severe Acute Pancreatitis ◽  
Abdominal Cavity ◽  
Early Period ◽  
Total Mortality ◽  
Infusion Therapy ◽  
Intravenous Contrast ◽  
Postoperative Pancreatitis ◽  
Overall Mortality

Summary. The purpose of the study: to analyze the causes of development, terms of hospitalization, the frequency of severe type, complications and overall mortality in acute pancreatitis according to the clinic data. Materials and methods: the results of treatment of 622 patients with acute pancreatitis were analyzed. Among them there were 336 women (54.1 %) and 286 men (45.9 %). The mean age of patients was (48.2 ± 2.2) years. The diagnosis of acute pancreatitis was made according to the recommendations (Atlanta, 2012). All patients with acute pancreatitis underwent ultrasound examination of the abdominal cavity and computed tomography, enhanced by intravenous contrast. Results and discussion: Etiological factors of acute pancreatitis were: biliary factor in 270 (43.4 %) patients, alcohol — in 155 (24.9 %), acute pancreatitis on the background of triglyceridemia — in 135 patients (21.7 %), 21 (3.4 %) patients had postoperative pancreatitis, medication — in 8 (1.3 %) patients and without a clear etiology — in 33 (5.3 %) patients. The terms of hospitalization of patients are as follows: after 24–48 hours from the onset of the disease — 215 (34.6 %) cases, after 6–24 hours after the onset of the disease — 204 (32.8 %) cases, after 48 hours and later from the time of the disease — 129 (20.7 %) cases and 74 (11.9 %) cases of hospitalization up to 6 hours from the onset of the disease. Severe acute pancreatitis developed in 147 (23.6 %) patients and was accompanied by the development of organ failure lasting > 48 hours. 594 (95.4 %) patients with acute pancreatitis received only conservative infusion therapy. 28 (4.5 %) patients required surgical treatment. The overall mortality in patients with acute pancreatitis was 9 (1.4 %) cases. Conclusions: Hyperdiagnosis of acute pancreatitis is a common problem in modern surgery. Formulation of the diagnosis according to the unified diagnostic criteria considerably facilitated diagnosis. The dominant factors of acute pancreatitis are biliary (43.4 %) and alcoholic factors (24.9 %). Most often (34.6 %) patients were admitted to the department on the second day after the onset of the disease. Remains high level of severe acute pancreatitis, which amounted to 23.6 % of cases. 594 (95.4 %) patients with acute pancreatitis received infusion therapy. 28 (4.5 %) patients underwent surgical treatment. The total mortality in acute pancreatitis according to our clinic was 9 (1.4 %) cases, the majority of them (7 patients) died in the early period of acute pancreatitis.

scholarly journals A Rare Cause of Acute Pancreatitis in a Transgender Female

2020 ◽  
Vol 8 ◽  
pp. 232470962092133 ◽  
Author(s):  
Lindsey C. Shipley ◽  
David T. Steele ◽  
Charles M. Wilcox ◽  
Chad M. Burski
Keyword(s):  
Acute Pancreatitis ◽  
Acute Inflammation ◽  
Sex Characteristics ◽  
Screening Methods ◽  
Female Population ◽  
Acute Severe Pancreatitis ◽  
The Third ◽  
Secondary Sex Characteristics ◽  
Severe Pancreatitis

Acute pancreatitis is defined as an acute inflammation of the pancreas and is most commonly caused by gallstones and alcohol followed by elevated triglycerides and medications. Estrogen as a cause of secondary hypertriglyceridemic pancreatitis is a rare but known phenomenon in females on hormonal therapy; however, it is not well described in the transgender female population. In this article, we present a case of a 31-year-old transgender female who developed acute, severe pancreatitis after a few months of using estrogen as transition therapy. To our knowledge, this is the third case report of a transgender female presenting with acute pancreatitis secondary to estrogen. Long-term supraphysiologic doses of sex hormones are required to maintain secondary sex characteristics placing this population at a higher risk of developing acute pancreatitis. Further research is needed to determine risk and screening methods to prevent this side effect.

scholarly journals PREDICTING INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS COMPLICATED BY ASCITIS AND PERITONITIS

2020 ◽  
Vol 20 (3) ◽  
pp. 114-118
Author(s):  
V.V. Kasian
Keyword(s):  
Acute Pancreatitis ◽  
Early Stage ◽  
Statistical Significance ◽  
Early Period ◽  
Infectious Complications ◽  
Study Group ◽  
Oral Antibiotic ◽  
Septic Complications ◽  
Surgical Department ◽  
Significant Difference

Ascites and peritonitis are fairly common complications of acute pancreatitis in the early stage of the disease. At the beginning of acute severe pancreatitis, in most cases, death occurs as a result of multiple organ failure, and starting from the second week, infectious complications can play a more serious and adverse role. However, the diagnosis of infected pancreatitis is difficult as the clinical picture does not differ from the inflammatory reaction caused by pancreatitis itself. Although the peak of infectious complications is observed mainly from the second to the fourth week since the onset of the disease, the timing of infection in pancreatic necrosis is variable and unpredictable. The aim of the study was to analyze the prognostic potential of procalcitonin in predicting the development of infectious complications in the dynamic course of acute pancreatitis complicated by ascites and peritonitis. We analyzed the findings obtained from a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites and peritonitis, including 13 patients who were treated at the surgical department of M. Sklifosovskiy Poltava Regional Clinical Hospital, and 5 patients at other emergency care settings in Poltava for 2017 – 2019. In addition to standards examination methods, procalcitonin was assessed as a biomarker to predict the adverse course of the disease in the early period. Statistical analysis of the findings was performed by the program "STATISTICA 10.0" (StatSoft, Inc., USA); methods of descriptive statistics to calculate qualitative indicators as frequencies and their percentages in the study groups were applied. The statistical significance of differences was determined by a nonparametric method between the indicators of independent groups using Fisher's exact test. Differences at p <0.05 were considered statistically significant. Infectious complications in the dynamics of the disease occurred in 39% of patients in the study group. 86% of them demonstrated an increased procalcitonin concentration at admission to the hospital. A significant difference was found (p = 0.005) when comparing differences in the occurrence of infectious complications in the dynamics of the disease in the patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospital admission. We can suggest that measuring procalcitonin to predict the occurrence of infectious complications in the dynamics of the disease will allow us to detect patients in who reduced risk of flora translocation by parenteral drugs being tropic to pancreatic tissue and early oral antibiotic prophylaxis may lessen the incidence of septic complications.

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