Successful transcatheter embolization of splenic artery pseudoaneurysm in acute necrotising pancreatitis.

Splenic artery pseudoaneurysm is a rare condition commonly arises as a sequelae of pancreatitis. Pseudoaneurysm is clinically silent until it ruptures. Thus, untreated pseudoaneurysm carries a high mortality rate up to 90%. We present a case of necrotising pancreatitis complicated with unruptured splenic artery pseudoaneurysm, which was found incidentally from computed tomography (CT) of abdomen. Patient was presented with symptomatic anemia and bleeding from the abdominal drain. We proceeded with embolization of pseudoaneurysm by using Histoacryl glue, resulting in successful complete resolution of pseudoaneurysm with good patient outcome. Transcatheter embolization is considered the current treatment of choice for pseudoaneurysm as it provides an alternative to conventional surgery due to its high successful rate. In this case report, we want to shed light on an alternative treatment approach of the splenic artery pseudoaneurysm.

Treatment of Acute Necrotising Pancreatitis and Its Complications: The Surgeon’s Perspective

Acute necrotising pancreatitis (ANP) is associated with high complication and mortality rates. It is still difficult for the surgeon to choose and schedule the most appropriate treatment. Compared to the past, the current minimally invasive “step-up” approach enables better outcomes in terms of morbidity/mortality, notwithstanding long periods of hospitalisation, and above all ensures better levels of residual pancreatic function. We hereby report the case of a patient hospitalised in our division for approximately 4 months with a diagnosis of ANP complicated by infection and late bleeding, handled with a sequential approach.

Dual pigtail intervention in acute necrotising pancreatitis

Acute pancreatitis has multiple aetiologies. Acute pancreatitis is divided into interstitial oedematous pancreatitis or necrotizing pancre­atitis based on morphology. According to the revised Atlanta classification necrotizing pancreatitis is further sub­divided into acute necrotic collec­tion if the disease develops within 4 weeks or walled-off necrosis if the disease develops after 4 weeks.We report a case of 40years male, with acute pancreatitis for 1 month, presenting with decreased appetite, loss of weight, and tremors of extremities. CT featured active necrotizing pancreatitis with peripancreatic necrosis, collections, and superadded infection which was drained by percutaneous pigtail catheter.Percutaneous pigtail insertion controls the symptoms and this procedure is effective in the management of patients with necrotizing pancreatitis. It serves as definitive or intermediate therapy to surgical necrosectomy in patients who are unfit for surgery. Percutaneous pigtail insertion can be done following a peritoneal or retroperitoneal approach, both approaches have different advantages and it is the choice of the radiologist and the location of the residual collections. The disadvantages are duct leak and it needs multiple check CT’s but in well trained and experienced hands the disadvantages are minimized. Percutaneous pigtail insertion is an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery. It can prevent life-threatening complications and it can be considered as a primary modality in treating a patient with walled-off necrosis.Percutaneous pigtail insertion an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery can be considered as the primary modality of choice in treating patients with walled-off necrosis of the pancreas.

Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines

IntroductionPancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency.Methods and analysisA review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting.ResultsRecommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines.

Acute Complicated Necrotising Pancreatitis Treated with Video-Assisted Retroperitoneal Debridement

Acute necrotising pancreatitis is a complex disease with high morbidity and mortality rates. In cases of infected necrosis, treatment consists of a step-up approach involving endoscopic or mini-invasive surgical methods. In some cases, there are extremely rare complications. In addition, the underlying comorbidities worsen the course of the disease. We report a case of a 32-year-old male with acute necrotising pancreatitis complicated with recurrent retroperitoneal abscesses, sepsis, iatrogenic pylephlebitis, exacerbation of underlying Crohn’s disease, and the outcome of the treatment was successful. During the period of hospitalisation, one ultrasound-guided percutaneous drainage, two computed tomography-guided punctures of the retroperito-neal space (percutaneous and transhepatic) and five video-assisted retroperitoneal debridement procedures were carried out. The patient was discharged after 185 days of hospitalisation.