• acute pancreatitis
• diagnosis
• gallstones
• management
• recurrence

• Etiology
• Guideline
• Morphology
• Mortality
• Pancreatitis

• Aged
• Female
• Humans
• Male
• Acute Disease
• Pancreatitis/etiology
• Prospective Studies
• Retrospective Studies
• Severity of Illness Index
• Turkey
• Middle Aged

• acute pancreatitis
• fluid resuscitation
• initial management

• Humans
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Pancreatitis/etiology
• Acute Disease
• Isotonic Solutions/adverse effects
• Fluid Therapy/adverse effects
• Ringer's Lactate

• Acute necrotic collections
• Acute necrotizing pancreatitis
• Complications
• Percutaneous catheter drainage

• Humans
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Drainage/methods
• Treatment Outcome
• Catheters

• abdominal compartment syndrome
• negative pressure wound therapy system
• open abdomen
• severe acute pancreatitis

• Acute pancreatitis
• Aggressive fluid resuscitation
• Colloids
• Crystalloids
• Fluid resuscitation
• Moderate fluid resuscitation

• Acute pancreatitis
• Aggressive intravenous hydration
• Meta-analysis
• Mortality
• Systematic review

• Gastrointestinal dysmotility
• Neostigmine
• Randomized controlled trial
• Severe acute pancreatitis

• Abdominal compartment syndrome (ACS)
• Abdominal paracentesis drainage (APD)
• Acute pancreatitis
• Intra-abdominal hypertension (IAH)
• Intra-abdominal pressure (IAP)

• Humans
• Pancreatitis/complications
• Pancreatitis/therapy
• Paracentesis/adverse effects
• Intra-Abdominal Hypertension/therapy
• Intra-Abdominal Hypertension/complications
• Retrospective Studies
• Acute Disease
• Drainage/adverse effects

• abdominal compartment syndrome
• acute pancreatitis
• compartment syndrome
• intra-abdominal hypertension
• surgery

Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.

• Acute pancreatitis
• Critical illness
• Crystalloid solutions
• Fluid therapy
• Ringer’s lactate

• ERCP
• Hydration
• Pancreatitis
• Post-ERCP pancreatitis
• Prevention

• Adult
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Humans
• Incidence
• Middle Aged
• Pancreatitis/epidemiology
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Ringer's Lactate
• Risk Factors

Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.

• abdominal compartment syndrome
• abdominal pressure
• intraabdominal hypertension

The optimal technique for nasojejunal tube (NJT) placement in terms of facilitating early enteral nutrition (EN) in patients with acute pancreatitis (AP) is unclear. In this study, we aimed to evaluate the impact of two common techniques on EN implementation and clinical outcomes in a group of AP patients.

This is a retrospective study. All the data were extracted from an electronic database from August 2015 to October 2017. Patients with a diagnosis of AP requiring NJT placement were retrospectively analyzed. The primary outcome was the successful procedural rate.

A total of 53 eligible patients were enrolled, of whom 30 received an ultrasound-assisted technique and the rest received the endoscopy method (n = 23). There was no difference in success rates of initial placement procedures between the two groups (93.3% and 95.7% in the ultrasound-assisted group and endoscopy group, respectively). The mean amount of EN delivery within the first three days after NJT placement was significantly higher in the ultrasound-assisted group (841.4 kcal (95% CI: 738.8, 944 kcal) vs. 652.5 kcal (95% CI: 562.5, 742.6 kcal), P = 0.018). Moreover, a slight increased postprocedural intra-abdominal pressure (IAP) was observed in patients undergoing endoscopic procedures, but not in the ultrasound-assisted group, especially at 6 hours after NJT placement (0.35 vs. -2.01 from baseline, P < 0.05). For clinical outcomes, we observed no difference between groups.

Compared with endoscopic procedures, ultrasound-assisted NJT placement possesses the acceptable success rates of initial placement procedures.

• Abdominal compartment syndrome
• Abdominal vac
• Acute pancreatitis
• Circulatory failure
• ICU
• Intra-abdominal hypertension
• Laparostomy
• Mesh-mediated fascial traction
• Multiple organ failure
• NPWT
• Necrotizing pancreatitis
• Negative-pressure wound therapy
• Open abdomen
• Organ failure
• Renal failure
• Severe acute pancreatitis
• VAWCM
• Vacuum-assisted wound closure

• Acute pancreatitis
• Compartment syndrome
• Computed tomography
• Intra-abdominal hypertension
• Pancreatic necrosis
• Round belly sign
• Severe acute pancreatitis

• Abbreviated laparotomy
• Emergency
• Intra-abdominal hypertension
• Intravesical pressure
• Laparostomy
• Open abdomen

• Acute Disease
• Humans
• Pancreatitis/diagnosis

• intra‐abdominal hypertension
• intra‐abdominal pressure
• prognostic marker
• severe acute pancreatitis

• acute kidney injury
• acute pancreatitis
• intra-peritoneal pressure
• procalcitonin
• renal replacement therapy

• APACHE
• Adult
• Biomarkers/blood
• China
• Female
• Glasgow Coma Scale
• Humans
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Organ Dysfunction Scores
• Pancreatitis/mortality
• Pancreatitis/therapy
• Prognosis
• Renal Replacement Therapy
• Retrospective Studies

A 44-year-old male without any significant past medical history presented to the emergency department (ED) with the chief complaint of severe constant epigastric pain for three hours. On physical examination, the abdomen was distended and tender, particularly in the epigastric region. The lab work showed an elevation of the lipase (12,405 U/L) and triglycerides (5,837 mg/dL). An abdominal CT scan with contrast was ordered, which revealed non-necrotic pancreatitis. In addition, the liver ultrasound showed no evidence of gallstones. Subsequently, fluid infusion, meropenem, pain medication, and an insulin drip were started, and the patient was transferred to the intensive care unit (ICU). After six hours in the ICU, he complained of abdominal pain despite taking a high hydromorphone dose.

On further physical examination, the abdomen was tender and distended but without rebound tenderness. The gastric distention on kidneys, ureter, and bladder (KUB) and a bladder pressure of 34 mmHg raised the suspicion for intra-abdominal hypertension (IAH), which led us to place a nasogastric tube (NGT) and consult the surgical team. The patient's symptoms and bladder pressure were closely followed and showed significant improvement. On day seven in the ICU, the patient responded well to medications; feeding through the Dobhoff tube was started, and his triglycerides decreased to approximately 1,000 mg/dL. Despite his general improvement and meropenem regimen, the patient spiked a fever of 38.5 °C. Due to the possibility of pancreatitis complications, a CT abdomen with contrast was ordered, which showed partial portal vein thrombosis (PVT). Subsequently, enoxaparin was started, and the patient was closely observed for gastrointestinal bleeding. Eventually, after 17 days in the ICU, the patient was transferred to the floor and then discharged from the hospital with normal lab tests and without evidence of portal thrombosis on abdominal CT.

In this report, we illustrate and discuss a case of hypertriglyceridemia (HTG)-induced pancreatitis (HTGP), which progressed to PVT and IAH. Physicians should be aware that patients with HTG are inclined to have severe pancreatitis. In addition, the degree of triglyceride elevation is correlated with the severity of acute pancreatitis.

• hypertriglyceridemia-induced acute pancreatitis
• intraabdominal hypertension
• portal vein thrombosis

• Acute pancreatitis
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Pancreatic fluid collections
• Percutaneous catheter drainage

• Adult
• Catheters
• Drainage/methods
• Female
• Humans
• Intra-Abdominal Hypertension/therapy
• Male
• Middle Aged
• Pancreatic Juice
• Pancreatitis/complications
• Pancreatitis/mortality
• Retrospective Studies

• Abdominal compartment syndrome
• Acute kidney injury
• Bladder pressure
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Large volume resuscitation
• Medical intensive care unit
• Open abdomen

• Critical Illness
• Delayed Diagnosis
• Hemodynamics
• Humans
• Intensive Care Units
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/epidemiology
• Intra-Abdominal Hypertension/physiopathology
• Kidney/blood supply
• Prevalence
• Risk Factors

• Abdominal compartment syndrome
• Acute pancreatitis
• Decompressive laparotomy
• Severe acute pancreatitis
• Surgical abdominal decompression

• Decompression, Surgical/methods
• Humans
• Intra-Abdominal Hypertension/diagnostic imaging
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/surgery
• Laparotomy/methods
• Pancreatitis/diagnostic imaging
• Pancreatitis/surgery

• acute pancreatitis
• ercp
• gallstones
• cholecystectomy
• resuscitation
• sirs

• Acute Disease
• Enteral Nutrition
• Fluid Therapy
• Humans
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Pancreatitis/therapy
• Patient Care Management
• Time Factors
• Triage

• KL2 TR001109 NCATS NIH HHS
• T32 DK007634 NIDDK NIH HHS

• Biological
• Closure
• Fistula
• Guidelines
• Intra-abdominal infection
• Laparostomy
• Mesh
• Non-trauma
• Nutrition
• Open abdomen
• Pancreatitis
• Peritonitis
• Re-exploration
• Reintervention
• Synthetic
• Technique
• Timing
• Trauma
• Vascular emergencies

• Abdomen/blood supply
• Abdomen/physiopathology
• Abdominal Cavity/blood supply
• Abdominal Cavity/surgery
• Abdominal Wound Closure Techniques/adverse effects
• Abdominal Wound Closure Techniques/standards
• Guidelines as Topic
• Humans
• Intra-Abdominal Hypertension/complications
• Intra-Abdominal Hypertension/prevention & control
• Negative-Pressure Wound Therapy/methods
• Postoperative Complications/prevention & control
• Prophylactic Surgical Procedures/methods
• Prophylactic Surgical Procedures/standards
• Resuscitation/methods

• Biological
• Closure
• Fistula
• Laparostomy
• Mesh
• Non-trauma
• Nutrition
• Open abdomen
• Pancreatitis
• Peritonitis
• Re-exploration
• Re-intervention
• Synthetic
• Technique
• Timing
• Vascular emergencies

• Abdominal Wound Closure Techniques/standards
• Abdominal Wound Closure Techniques/trends
• Consensus
• Critical Illness
• Humans
• Lower Body Negative Pressure/methods
• Pancreatitis/surgery

• Intraabdominal pressure
• abdominal compartment syndrome
• acute pancreatitis
• intraabdominal hypertension
• organ dysfunction

• Acute Disease
• Female
• Humans
• Intensive Care Units
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/mortality
• Male
• Pancreatitis/complications
• Pancreatitis/mortality
• Prognosis
• Prospective Studies
• ROC Curve

• Abdominal compartment syndrome
• Intraabdominal hypertension
• Intraabdominal pressure

• Acid-Base Imbalance/complications
• Acid-Base Imbalance/etiology
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Critical Illness
• Cross-Sectional Studies
• Disease Progression
• Female
• Fluid Therapy/methods
• Fluid Therapy/statistics & numerical data
• Humans
• Intensive Care Units
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/epidemiology
• Kenya/epidemiology
• Male
• Middle Aged
• Prevalence
• Prospective Studies
• Respiration, Artificial/adverse effects
• Respiration, Artificial/methods
• Risk Assessment
• Statistics, Nonparametric
• Young Adult