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 Results Of Treatment Of Acute Diffuse Purulent Peritonitis Using Laparostomy

2020 ◽  
Vol 02 (11) ◽  
pp. 66-71
Author(s):  
S. A. Ruziboev ◽  
◽  
A. A. Avazov ◽  
Sh. Kh. Sattarov ◽  
A. N. Elmuradov ◽  
...  
Keyword(s):  
Bacterial Translocation ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
The Body ◽  
Abdominal Pressure ◽  
Results Of Treatment ◽  
Abdominal Hypertension ◽  
Purulent Peritonitis ◽  
Intractable Problems ◽  
Cause Of Deaths

Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).

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.

scholarly journals EXPERIENCE IN PERFORMING PUNCTURE AND DRAINAGE MINI-INVASIVE INTERVENTIONS UNDER ULTRASOUND CONTROL IN THE DIAGNOSIS AND TREATMENT OF ABDOMINAL DISEASES AND POSTOPERATIVE COMPLICATIONS. Review

2020 ◽  
Vol 16 (3) ◽  
pp. 51-62
Author(s):  
M.P. Zakharash ◽  
Yu.M. Zakharash ◽  
A.I. Stelmakh ◽  
V.V. Moroz
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Acute Cholecystitis ◽  
Abdominal Cavity ◽  
Comparative Assessment ◽  
Diagnosis And Treatment ◽  
Advantages And Disadvantages ◽  
Implementation Techniques ◽  
Materials Used

The article presents a description of the main puncture and drainage interventions, indicating the method of their implementation, techniques, materials used for their implementation. The own experience of application of the specified minimally invasive interventions in the treatment of a syndrome of mechanical jaundice of benign and malignant genesis, acute cholecystitis, acute pancreatitis and its complications, hepatic abscesses, limited liquid accumulations of an abdominal cavity and retroperitoneal space is described. The advantages and disadvantages are noted, a comparative assessment is made and recommendations are given for the use of different puncture and drainage interventions depending on the type of pathology in which they are used.

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 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 Features of salt enteral solution application in the treatment of various forms of acute pancreatitis

2020 ◽  
Vol 7 (1) ◽  
pp. 58-66
Author(s):  
M. M. Minnullin ◽  
R. A. Zefirov ◽  
R. F. Shavaliev ◽  
R. N. Akhundov ◽  
A. Zh. Bayalieva ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Intestinal Obstruction ◽  
Multiple Organ ◽  
Early Enteral Nutrition ◽  
Septic Complications ◽  
Surgical Interventions ◽  
Complex Therapy ◽  
Overall Mortality

The article presents the results of a retrospective study of the intestinal lavage (IL) with saline enteral solution (SES) effectiveness for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. Objective: to study improve the results of patients treatment in intestinal paresis by various forms of acute pancreatitis, using IL lavage with the use of SES. Materials and methods. The study included 81 patients: 56 (69.1 %) men and 25 (30.9 %) women, average age 59.3 ± 13.4 years, who were hospitalized in the clinic at different times from the onset of the disease: from 24 hours to 7 days. Patients were divided in two groups: 1st group (46 people) included patients who started IL for the first 3 days after the onset of the disease; 2nd group (35 people) consisted of patients who started IL after 3 days of the disease, 30 patients of 2nd grouphad surgery before IL. Results. Prokinetic effect of IL in gastrostasis and dynamic bowel obstruction improve the quality of conservative treatment (up to 78.3 % in 1st group and 37.1 % in 2nd group); avoid open surgical interventions (up to 6.5 % in 1st group, up to 37.1 % in 2nd group), carry out decreasing invasive effects of drainage of limited focus (in 15.2 % of patients in 1st group, 42.9 % in 2nd group); eliminate the phenomen of gastrostasis within 3 days after IL in both groups. Reduction/elimination of the phenomen of dynamic intestinal obstruction after IL within 24 hours (up to 73.8 % in 1st group, up to 97.1 % in 2nd group), allowed to start early enteral nutrition within 48 hours (in 73.9 % of patients of 1st group, up to 42.8 % patients of 2nd group). Conclusions. Early using of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective and reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

scholarly journals THE FIRST EXPERIENCE OF LYMPHOTROPIC ANTIBACTERIAL THERAPY FOR ACUTE PANCREATITIS

2021 ◽  
Vol 9 (2) ◽  
pp. 124-128
Author(s):  
Ihor D. Duzhiy ◽  
Volodymyr V. Shimko ◽  
Hennadiy I. Pyatikop ◽  
Navras D. Al Yamani
Keyword(s):  
Acute Pancreatitis ◽  
Immune System ◽  
Antibacterial Therapy ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Infusion Therapy ◽  
Ultrasound Findings ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Immunoglobulin Levels

Acute pancreatitis remains one of the most common surgical diseases of the abdominal cavity. Its incidence has been constantly increasing in recent years. Mortality remains high with pancreatitis: 15–45%. To study capacity for increasing the effectiveness of treatment of acute pancreatitis by lymphotropic administration of antibacterial and anti-inflammatory drugs. We observed 17 patients with acute pancreatitis, with the average age of 47.7 years; all patients were hospitalized within the first two days of the disease. The treatment was performed in addition to the infusion therapy in accordance with the order of the Ministry of Health of Ukraine No. 297 dated April 2, 2010, using lymphotropic administration of antibacterial therapy, which was tested at the Department of Surgery of SSU and differed in that antibacterial and anti-inflammatory drugs were injected regionally into the pancreas. In the first 4 days, according to the ultrasound findings, the size of the inflamed pancreas decreased from 31.25, 18.5, and 27.25 cm to 25.25, 15.75, and 18 cm, and the size of the spleen decreased from 262.64 cm3 to 160.99 cm3, which is the evidence of drug targeted effect on the pancreas and spleen. Lymphotropic antibacterial and anti-inflammatory therapy used for 4 days reduced the size of the head, body and tail of the gland by 6.4, 3.9, and 7.0 cm. The reduction in the size of the gland contributed to the elimination of clinical signs of inflammation, especially pain, and leukocytes number decrease, which indicates the "targeted" effect of the drugs. The reduction in the size of the spleen from 308.9 cm3 to 227.1 cm3 proves the effect produced by lymphotropic use of drugs on the immune system. This is also supported by corrected immunoglobulin levels.

scholarly journals Staged Treatment of a Complicated Giant Gastric Ulcer: a clinical case report

2020 ◽  
Vol 13 (2) ◽  
pp. 135-137
Author(s):  
Vitaly Demchenko ◽  
Alexander Vlasov ◽  
Eugenia Cheburkova
Keyword(s):  
Gastric Ulcer ◽  
Control Method ◽  
Damage Control ◽  
Abdominal Cavity ◽  
Lower Lobe ◽  
Postoperative Mortality ◽  
Front Wall ◽  
Double Row ◽  
Surgical Interventions ◽  
Purulent Peritonitis

Introduction. The paper presents clinical outcomes of surgical treatment of a patient with a chronic giant gastric ulcer complicated by penetration into the pancreas, perforation of the anterior and posterior walls of the stomach and general purulent peritonitis. According to various data postoperative mortality in such patients ranges from 11.1% to 50%. In this regard, patients with giant penetrating ulcers need an individual approach and the issue of the optimal amount of surgical intervention still remains challenging. Methods. The damage control method and staged surgical interventions were applied in the treatment of this patient. At the first stage, the perforation hole on the back wall of the stomach was sutured with a double-row interrupted suture, the hole on the front wall was sutured using a pedunculated omentum, and sanitation of the abdominal cavity was performed. Postoperative intensive complex treatment was carried out in the intensive care unit. Results. After two days of treatment a planned relaparotomy (the Billroth II operation modified by Braun-Balfour) with resection of 2/3 part of the stomach was performed. The postoperative macrosection demonstrated that the size of the ulcer was 18.0x10.0 cm. The postoperative period was complicated: the intestinal paresis resolved in 5 days, there was a left lower lobe pleuropneumonia in the lungs suppuration of the postoperative wound. The patient recovered and was discharged in 25 days after hospitalization.

scholarly journals The effectiveness of using self-made hyperbaric solution of bupivacaine for unilateral spinal anesthesia

Pain medicine ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 63-67
Author(s):  
Iryna Kozlovska ◽  
Yurii Kozlovskiy ◽  
Inna Timokhina ◽  
Natalia Zakharchuk
Keyword(s):  
Spinal Anesthesia ◽  
Medical Practice ◽  
Abdominal Cavity ◽  
Main Idea ◽  
Infusion Therapy ◽  
Negative Effects ◽  
Surgical Interventions ◽  
Long Time ◽  
Unilateral Spinal Anesthesia ◽  
Hyperbaric Solution

The main idea of this research was to determine the effectiveness of holding the unilateral spinal anesthesia in comparison with total, positive and negative effects of these manipulations. In Ukrainian medical practice, the technique of spinal anesthesia for analgesia of surgical interventions on the abdominal cavity and lower extremities has been introduced for a long time. One of the main methods is unilateral spinal anesthesia. The study compared: the effectiveness of anesthesia, the duration of anesthesia, the volume of infusion therapy during surgery and the reaction of the cardiovascular system to the manipulations.

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