scholarly journals Multiple extra-splanchnic venous thromboses - an unusual vascular complication of acute pancreatitis

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Junare Parmeshwar Ramesh ◽  
Chandnani Sanjay ◽  
Suhas Udgirkar ◽  
Nair Sujit ◽  
Debnath Prasanta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Venous Thrombosis ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Splenic Vein ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Consensus Guidelines ◽  
Clinical Presentations ◽  
Fluid Collections

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable clinical presentations. Splanchnic venous thrombosis is a well-known vascular complication of AP and commonly present as thrombosis of the splanchnic venous system: splenic vein (SplV), portal vein (PV) and superior mesenteric vein (SMV), either separately or in combinations. Involvement of extra-splanchnic vessels is rare and associated with morbidity and mortality. Vascular complications are late phenomena and usually associated with local complications of AP, namely acute fluid collections, necrotizing pancreatitis and walled-off pancreatic necrosis. Pathogenesis of venous thrombosis is multifactorial in which pancreatic inflammation and systemic inflammatory response play a key role. At present, there are no consensus guidelines on treatment and use of anticoagulation for venous thrombosis in the setting of AP. Limited literature suggests the use of anticoagulation in presence of PV with or without SMV thrombosis and extrasplanchnic vessel involvement. Literature on extra-splanchnic vessels involvement in acute pancreatitis is sparse. Here we present two cases with multiple extra-splanchnic vessels involvement and their management.

scholarly journals Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

2017 ◽  
Vol 63 (3) ◽  
pp. 207-209
Author(s):  
Cassia Lemos Moura ◽  
Priscila Pulita Azevedo Barros ◽  
Cristiane Mota Oliveira ◽  
Rogerio Colaiácovo ◽  
Juliana Marques Drigo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Severe Case ◽  
Treatment Modalities ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Fluid Collections

Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

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.

Portosplenomesenteric Venous Thrombosis in Patients With Acute Pancreatitis Is Associated With Pancreatic Necrosis and Usually Has a Benign Course

2014 ◽  
Vol 12 (5) ◽  
pp. 854-862 ◽  
Author(s):  
Jeffrey Easler ◽  
Venkata Muddana ◽  
Alessandro Furlan ◽  
Anil Dasyam ◽  
Kishore Vipperla ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Venous Thrombosis ◽  
Pancreatic Necrosis ◽  
Benign Course

scholarly journals Staged treatment of acute necrotizing pancreatitis given the configuration of pancreatic necrosis (case report)

2021 ◽  
Vol 26 (2) ◽  
pp. 61-67
Author(s):  
А. V. Shefer ◽  
E. N. Belykh
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Clinical Observation ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Acute Necrotizing ◽  
Data Configuration ◽  
Ct Data ◽  
High Level ◽  
Staged Treatment

A clinical observation of a successful staged treatment of a patient with severe acute pancreatitis based on early diagnosis of damage to the pancreatic duct according to CT data (configuration of pancreatic necrosis) and high level of amylase in the fluid collection is presented.

scholarly journals P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
K Thejasvin ◽  
Sara-Jane Chan ◽  
Chris Varghese ◽  
Wei Boon Lim ◽  
Gemisha Cheemungtoo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Splenic Vein ◽  
Bleeding Complications ◽  
Splenic Vein Thrombosis ◽  
Splanchnic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Incidence Risk ◽  
Necrotising Pancreatitis

Abstract Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only.  On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy.  Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

Relationship of Arterial Changes in Acute Pancreatitis on CT Angiography with Modified CT Severity Index

2021 ◽  
Author(s):  
Sanya Vermani ◽  
Aditya Kaushal ◽  
Arshpreet Kaur ◽  
Mohit Singla
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Vascular Complications ◽  
Severity Index ◽  
Arterial Complications ◽  
Acute Necrotizing ◽  
Cect Scan ◽  
Enhanced Computed Tomography

Abstract Purpose To evaluate the prevalence of arterial changes in patients with acute pancreatitis (AP) on computed tomography angiography (CTA) and determine their association with etiology of AP, presence of necrosis, collections and severity of AP. Materials and Methods A total of 50 patients (20 women, 30 men; mean age: 43.04 ± 13.98; age range: 18–77 years) with AP underwent contrast-enhanced computed tomography (CECT) scan and CTA of abdomen, which was evaluated for necrosis and fluid collection (s). On CTA, splanchnic arterial structures were assessed for vascular complications. Association between vascular changes and presence of necrosis, fluid collections, etiology of AP and severity of AP (as assessed by modified computed tomography severity index CTSI) was determined. Results Arterial complications were seen in 28 percent (14/50). The most frequently involved artery was superior pancreaticoduodenal artery (12 percent), followed by splenic artery (8 percent) and right gastric artery (8 percent; Fig. 1). No significant association was seen between arterial changes and gallstone or alcohol-induced AP. Arterial changes showed a significant association with presence of acute necrotizing pancreatitis (ANP), presence of collections and severe AP (CTSI 8–10) (p < 0.05 for each). Conclusion Arterial changes on CTA are frequently seen in patients of AP having ANP. There is a significant association between arterial changes and presence of necrosis, collections and severe AP.

scholarly journals Mechanisms and Management of Acute Pancreatitis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ari Garber ◽  
Catherine Frakes ◽  
Zubin Arora ◽  
Prabhleen Chahal
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Outlet Obstruction ◽  
Gallstone Pancreatitis ◽  
Drainage Procedure ◽  
Endoscopic Techniques ◽  
Persistent Abdominal Pain ◽  
Fluid Collections ◽  
Walled Off Necrosis

Acute pancreatitis represents a disorder characterized by acute necroinflammatory changes of the pancreas and is histologically characterized by acinar cell destruction. Diagnosed clinically with the Revised Atlanta Criteria, and with alcohol and cholelithiasis/choledocholithiasis as the two most prominent antecedents, acute pancreatitis ranks first amongst gastrointestinal diagnoses requiring admission and 21st amongst all diagnoses requiring hospitalization with estimated costs approximating 2.6 billion dollars annually. Complications arising from acute pancreatitis follow a progression from pancreatic/peripancreatic fluid collections to pseudocysts and from pancreatic/peripancreatic necrosis to walled-off necrosis that typically occur over the course of a 4-week interval. Treatment relies heavily on fluid resuscitation and nutrition with advanced endoscopic techniques and cholecystectomy utilized in the setting of gallstone pancreatitis. When necessity dictates a drainage procedure (persistent abdominal pain, gastric or duodenal outlet obstruction, biliary obstruction, and infection), an endoscopic ultrasound with advanced endoscopic techniques and technology rather than surgical intervention is increasingly being utilized to manage symptomatic pseudocysts and walled-off pancreatic necrosis by performing a cystogastrostomy.

scholarly journals Fluconazole Penetration into the Pancreas

2000 ◽  
Vol 44 (9) ◽  
pp. 2569-2571 ◽  
Author(s):  
Shailesh Shrikhande ◽  
Helmut Friess ◽  
Claudia Issenegger ◽  
Marcus E. Martignoni ◽  
Huang Yong ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Antibiotic Prophylaxis ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Human Pancreas ◽  
Fungal Contamination ◽  
Experimental Acute Pancreatitis ◽  
The Mean

ABSTRACT Because of antibiotic prophylaxis for necrotizing pancreatitis, the frequency of fungal superinfection in patients with pancreatic necrosis is increasing. In this study we analyzed the penetration of fluconazole into the human pancreas and in experimental acute pancreatitis. In human pancreatic tissues, the mean fluconazole concentration was 8.19 ± 3.38 μg/g (96% of the corresponding concentration in serum). In experimental edematous and necrotizing pancreatitis, 88 and 91% of the serum fluconazole concentration was found in the pancreas. These data show that fluconazole penetration into the pancreas is sufficient to prevent and/or treat fungal contamination in patients with pancreatic necrosis.

Pancreatitis in the Critical Care Setting

2017 ◽  
Author(s):  
Lisa M. Kodadek ◽  
Pamela A. Lipsett
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Classification System ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
The United States ◽  
Complex Spectrum ◽  
Early Management ◽  
Key Words Acute Pancreatitis

Pancreatitis is a complex spectrum of disease including chronic pancreatitis, acute pancreatitis, and manifestations of severe acute pancreatitis such as sterile and infected necrotizing pancreatitis. Acute pancreatitis is the leading cause of hospitalization for gastrointestinal disorders in the United States. Pancreatitis is a dynamic condition, and severity may change and evolve during the course of the disease. Although most patients with acute pancreatitis have mild disease, 10 to 15% will run a fulminant course, leading to severe acute pancreatitis, pancreatic necrosis, and multisystem organ injury. The mortality for severe acute pancreatitis is 15 to 30%; however, the overall mortality for all patients with acute pancreatitis is less than 5%. Early management of acute pancreatitis includes fluid resuscitation, pain control, and enteral nutrition. There are no specific directed therapies proven to be effective for the early treatment of acute necrotizing pancreatitis; therapy is entirely supportive. Chronic pancreatitis is a challenging disease often marked by chronic pain. Surgical intervention may help improve quality of life and relieve pain in selected patients. International consensus guidelines provide definitions and classifications to aid clinicians with diagnosis and management of pancreatitis. This review covers advances related to pancreatitis, including literature pertaining to the step-up approach for necrotizing pancreatitis first published in 2010, discussion of the revised Atlanta Classification System for severity of acute pancreatitis published in 2013, review of the current spectrum of microbial pathogens implicated in infected necrotizing pancreatitis, and the international draft consensus proposal for a new mechanistic definition for chronic pancreatitis published in 2016. Key words: acute pancreatitis, antibiotic prophylaxis, Atlanta Classification System, biliary pancreatitis, chronic pancreatitis, necrosectomy, pancreatic necrosis, pancreatitis, step-up approach, video-assisted retroperitoneal drainage (VARD)

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