scholarly journals Skin signs in acute pancreatitis: a case report

2013 ◽  
pp. 265-268
Author(s):  
Marco Bassi ◽  
Gelorma Belmonte ◽  
Paola Billi ◽  
Angelo Pasquale ◽  
Massimo Reta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Clinical Laboratory ◽  
Epigastric Pain ◽  
Multiorgan Failure ◽  
Fluid Collection ◽  
Clinical Signs ◽  
Pancreatic Fluid Collection ◽  
Retroperitoneal Hemorrhage ◽  
Skin Signs

Introduction: Subcutaneous manifestations of severe acute pancreatitis (Cullen’s sign, Gray- Turner’s sign, Fox’s sign, and Bryant’s sign) are often discussed in journals and textbooks, but seldom observed. Although historically associated with acute pancreatitis, these clinical signs have been described in various other conditions associated with retroperitoneal hemorrhage. Case report: We describe the case of a 61-year-old male with no history of alcohol intake, who was admitted for epigastric pain, vomiting, and increasing serum amylase and lipase levels. Five days after admission, ecchymotic skin discoloration was noted over both flanks (Gray-Turner’s sign) and the upper third of the thighs (Fox’s sign). Ten days later, he developed multiorgan failure and was transferred to the ICU for 5 days. Computed tomography revealed a large pancreatic fluid collection, which was subjected to EUS-guided drainage. Cholecystectomy was later performed for persistent obstructive jaundice. After more than 4 months of hospitalization, he died as a result of severe gastrointestinal bleeding. Discussion and conclusions: Skin manifestations of retroperitoneal hemorrhage in a patient with acute pancreatitis indicate a stormy disease course and poor prognosis. The severity of acute pancreatitis is currently estimated with validated scoring systems based on clinical, laboratory, and imaging findings. However, skin signs like the ones discussed above can represent a simple and inexpensive parameter for evaluating the severity and prognosis of this disease.

scholarly journals Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

2018 ◽  
Vol 06 (12) ◽  
pp. E1398-E1405 ◽  
Author(s):  
Tanyaporn Chantarojanasiri ◽  
Natsuyo Yamamoto ◽  
Yousuke Nakai ◽  
Tomotaka Saito ◽  
Kei Saito ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastrointestinal Tract ◽  
Fluid Collection ◽  
Adverse Event Rate ◽  
Plastic Stents ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Covered Metallic Stent

Abstract Background and study aims While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied. Contraindications for EUS-PCD are lack of encapsulation or adhesion to the gastrointestinal tract. Safety and effectiveness of early vs delayed (≥ 4 weeks) EUS-PCD were compared. Results A total of 35 patients underwent EUS-PCD (12 early and 23 delayed) using 19 large-bore fully-covered metallic stent and 16 plastic stents. The median diameter of PFC was 110 mm (40 – 180) and 122 mm (17 – 250) in the early and delayed drainage groups, respectively. Median time from onset of AP to drainage was 23 and 85 days for early and delayed drainage, respectively. The technical success rate of EUS-guided drainage was 100 %. Endoscopic necrosectomy was performed in six early and 16 cases of delayed drainage. The adverse event rate was 25 % (3 bleeding) and 13 % (2 perforations and 1 CO2 retention) in the early and delayed drainage groups, respectively. Two patients died (1 early and 1 delayed) due to multiorgan failure. Conclusion Endoscopic drainage and subsequent necrosectomy of symptomatic PFC within 4 weeks after onset of acute pancreatitis was feasible, given that the collection was encapsulated and attached to the gastrointestinal tract.

scholarly journals Retropharyngeal Abscess in a Fourteen-Month-Old Child Presenting with Dysphagia and Obstructive Sleep Apnea: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Zahar Alkhadem ◽  
Lubna Lutfi ◽  
Doha Ali ◽  
Asma Anan Mohammed ◽  
Iyad Said Hamadi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Fluid Collection ◽  
Clinical Signs ◽  
Oral Intake ◽  
Retropharyngeal Abscess ◽  
High Grade Fever ◽  
Neck Stiffness ◽  
Obstructive Sleep

Retropharyngeal abscess is a relatively uncommon midline deep neck space infection that extends from the base of the skull to the posterior mediastinum, situated between the buccopharyngeal and alar fascias. In this case report, we present a 14-month-old previously healthy female patient who had a high-grade fever for 7 days, associated with neck stiffness and restriction of neck movements to the right side. Her parents noticed decreased oral intake associated with dysphagia, muffled quality of voice, and obstructive sleep apnea. However, the patient had no clinical signs of mechanical obstruction on examination. A contrast-enhanced computed tomography scan of the neck showed a large retropharyngeal septated fluid collection measuring 8 × 3 × 6 cm, which was categorized as a large retropharyngeal abscess that was complicated by descending mediastinitis. The patient was taken immediately to the operation theater for incision and drainage under general anesthesia, after which she was started on intravenous antibiotics.

scholarly journals Analysis of Factors Associated with the Severity of Acute Pancreatitis according to Etiology

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Dae Bum Kim ◽  
Woo Chul Chung ◽  
Ji Min Lee ◽  
Kang-Moon Lee ◽  
Jung Hwan Oh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Pancreatic Necrosis ◽  
Fluid Collection ◽  
Contributing Factors ◽  
Pancreatic Fluid Collection ◽  
Current Smoking ◽  
Factors Associated ◽  
Pancreatic Fluid ◽  
Index Of Severity

Background. The objective of this study was to determine the factors associated with severity of acute pancreatitis (AP) according to two major etiologies: alcohol and gallstones. Methods. We reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. A total of 905 patients with AP (660 alcohol-induced, 245 gallstone-induced) were enrolled. Among them, severe AP (SAP) occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Contributing factors between patients with and without SAP were analyzed according to the etiology. Results. Multivariate analysis demonstrated that current smoking, pancreatic necrosis, and bacteremia were associated with AP severity in both alcohol- and gallstone-induced AP. Pancreatic fluid collection was significantly associated with alcohol-induced SAP (p=0.04), whereas dyslipidemia was significantly associated with gallstone-induced SAP (p=0.01). Body mass index was significantly correlated with the Bedside Index of Severity in Acute Pancreatitis score in both alcohol- and gallstone-induced AP (p=0.03 and 0.01, resp.). Conclusions. Current smoking, pancreatic necrosis, and bacteremia can aggravate the clinical course of AP. Pancreatic fluid collection and dyslipidemia were associated with AP severity according to the different etiologies. Obesity may also be associated with AP severity in both etiologies.

Recurrent Acute Pancreatitis in Pregnancy Caused by Parathyroid Hyperplasia: A Case Report and Literature Review

2020 ◽  
Vol 103 (9) ◽  
pp. 952-959
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Epigastric Pain ◽  
Present Report ◽  
Parathyroid Hyperplasia ◽  
Pathological Examination ◽  
Recurrent Acute Pancreatitis ◽  
First Case

Background: Hypercalcemia during pregnancy leads to multiple maternal and fetal complications. To date, fewer than 30 cases of primary hyperparathyroidism (PHPT)-induced pancreatitis have been diagnosed during pregnancy. Most cases have been caused by a parathyroid adenoma. In the present report, the author described the first case of PHPT due to parathyroid hyperplasia presented with recurrent, acute pancreatitis during pregnancy. Case Report: A 38-year-old female, with a history of acute pancreatitis during her first pregnancy, presented with severe epigastric pain, nausea, and vomiting for three days at 24 weeks of gestation. Parathyroid-dependent, hypercalcemia-induced recurrence of pancreatitis was diagnosed based on the clinical presentation and laboratory investigations. An ultrasound on her neck revealed a possible parathyroid adenoma located on the inferior pole of the left thyroid gland. She underwent an uneventful left-lower parathyroidectomy. The pathological examination revealed parathyroid hyperplasia. Her serum calcium and parathyroid hormone levels returned to normal after surgery. She delivered a healthy male newborn at gestational age 38 weeks without any complications. Conclusion: PHPT-induced acute pancreatitis during pregnancy is rare. Hypercalcemia, involving both total and ionized calcium, should be investigated in pregnant women who present with acute pancreatitis. Early diagnosis and appropriate management can significantly improve the maternal, fetal, and pregnancy outcomes. Keywords: Hypercalcemia, Recurrent pancreatitis, Pregnancy, Primary hyperparathyroidism, Parathyroid hyperplasia

Spectrum of acute, recurrent and chronic pancreatitis in children

2020 ◽  
pp. 1-11
Author(s):  
Muhammad Imran ◽  
Sabeen Abid Khan ◽  
Munir Iqbal Malik
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Retrospective Study ◽  
Medical Records ◽  
Clinical Presentation ◽  
Clinical Laboratory ◽  
Epigastric Pain ◽  
Paediatric Population ◽  
Older Children ◽  
Successful Recovery

Abstract Objective: To determine the clinical presentation, aetiology and outcome of pancreatitis in paediatric population. Method: The retrospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of children with pancreatitis presenting between 2013 and 2018. Medical records were reviewed and findings of clinical, laboratory workup and management were noted on a specifically developed proforma. Data was analysed using SPSS 23. Results: Of the 51 subjects, 28(54.9%) were boys. The overall mean age was 10.6+4.9 years. The most frequent clinical symptom was epigastric pain 39(76.5%). The most common aetiology was gallstones/pancreatic stones 19(37.25%). Mean hospital stay was 5.1± 1.8 days, and it was longer in children aged up to 5 years compared to older children (p<0.05). Acute pancreatitis was seen in 23(45.09%) patients, followed by recurrent 19(37.25%) and chronic 9(17.64%). There was no mortality. Conclusion: Timely diagnosis and prompt management of hemodynamic status could lead to successful recovery without any serious complications in paediatric pancreatitis. Continuous...

scholarly journals Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience

2021 ◽  
Vol 8 (11) ◽  
pp. 3238
Author(s):  
Roshan Ghimire ◽  
Yugal Limbu ◽  
Anuj Parajuli ◽  
Dhiresh K. Maharjan ◽  
Prabin B. Thapa
Keyword(s):  
Acute Pancreatitis ◽  
Fluid Collection ◽  
College Teaching ◽  
Pancreatic Fluid Collection ◽  
Systemic Complications ◽  
Endoscopic Techniques ◽  
Local Complications ◽  
Hospital Patients ◽  
Surgery Department ◽  
Open Necrosectomy

Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, cysto-enterostomy, VARD or open necrosectomy due to failure of endoscopic or radiological intervention or due to positions of lesions being inaccessible to these techniques. All patients had clinical improvement following surgery with an acceptable complication rate given the severity of the disease.Conclusions: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

scholarly journals A real ball ache: a case report of acute pancreatitis with an unusual sequelae of events

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Sabrina Brar ◽  
Carolina Watters
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Inguinal Hernia ◽  
Inguinal Canal ◽  
Fluid Collection ◽  
Ct Scans ◽  
Surgical Drainage ◽  
Clinical Events ◽  
Radiological Data ◽  
Rare Sequence

Abstract Acute pancreatitis may present with a myriad of clinical and radiological manifestations. Assessment of the severity and prognosis of the disease is often based on clinical features, laboratory analysis and computer tomography (CT) scans; however, the predictive value of CT is not 100% accurate. We report herein a case with an especially rare sequence of clinical events, manifesting as a septic fluid collection within the inguinal canal that was misdiagnosed as an inguinal hernia on CT imaging. The patient underwent surgical drainage and an orchidectomy to treat the infection. This case illustrates the complexity and severity of acute pancreatitis as well as the challenges in interpreting and relying on diagnostic radiological data.

scholarly journals Severe acute pancreatitis: eight fundamental steps revised according to the ‘PANCREAS’ acronym

2020 ◽  
Vol 102 (8) ◽  
pp. 555-559 ◽  
Author(s):  
CA Gomes ◽  
S Di Saverio ◽  
M Sartelli ◽  
E Segallini ◽  
N Cilloni ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Venous Pressure ◽  
Fluid Collection ◽  
Vena Cava ◽  
Previous Treatment ◽  
Infectious Complications ◽  
Epidural Block ◽  
Pancreatic Fluid Collection ◽  
The Individual

Severe acute pancreatitis remains a life-threatening condition, responsible for many disorders of homeostasis and organ dysfunction. By means of a mnemonic ‘PANCREAS’, eight important steps in the management of severe acute pancreatitis are highlighted. These steps follow the principle of goal-directed therapy and should be borne in mind after diagnosis and during clinical treatment. The first step is perfusion: the goal is to reach a central venous pressure of 12–15mmHg, urinary output 0.5–1ml/kg/hour and inferior vena cava collapse index greater than 48%. Next is analgesia: multimodal, systemic and combined pharmacological agent and epidural block are possibilities. Third is nutrition: precocity, enteral feeding in gastric or post-pyloric position. Parenteral nutrition works best in difficult cases to achieve the individual total caloric value. Fourth is clinical: mild, moderate or severe pancreatitis according to the Atlanta criteria. Radiology is fifth: abdominal computed tomography on the fourth day for prognosis or to modify management. Endoscopy is sixth: endoscopic retrograde cholangiopancreatography (cholangitis, unpredicted clinical course and ascending jaundice); management of pancreatic fluid collection and ‘walled-off necrosis’. Antibiotics come next: infectious complications are common causes of morbidity. The only rational indication for antibiotics is documented pancreatic infection. The last step is surgery: the dogma is represented by the ‘three Ds’ (delay, drain, debride). The preferred method is a minimally invasive step-up approach, which allows for gradually more invasive procedures when the previous treatment fails.

Sign in / Sign up

Export Citation Format

Share Document