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Checketts TR, Madhu R, Sidhu S, Daugherty E, Al-Chalabi A. Transcolonic Necrosectomy: A Rarely-Used Pancreatic Debridement Strategy. ACG Case Rep J 2025; 12:e01634. [PMID: 40109563 PMCID: PMC11922422 DOI: 10.14309/crj.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 02/04/2025] [Indexed: 03/22/2025] Open
Abstract
Necrotizing pancreatitis represents a life-threatening sequela of acute pancreatitis in which rapid necrotization of pancreatic and abdominal tissue leads to inflammation and sometimes infection. Treatment includes debridement of necrotic tissue to prevent inflammation from spreading and antibiotics if infected. Areas of necrosis are accessed through percutaneous drainage, surgical debridement, or upper endoscopy. In this study, we present a case of walled-off necrosis debrided through a fistulous connection to the transverse colon. Transcolonic necrosectomy is a seldom used approach, which could provide treatment options for necrotizing pancreatitis in anatomically amenable patients.
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Affiliation(s)
| | | | - Suhail Sidhu
- Creighton University School of Medicine, Omaha, NE
| | - Evan Daugherty
- Department of Gastroenterology, Creighton University Medical Center, Omaha, NE
| | - Ahmed Al-Chalabi
- Department of Gastroenterology, Creighton University Medical Center, Omaha, NE
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2
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Muscat N, Soxibova F, Adnan N, Caruana Montaldo B, Abu Taha K, Alam I, Alkhazaaleh O. Correlation Between BMI and Severity of Acute Pancreatitis: A Retrospective Study. Cureus 2024; 16:e66917. [PMID: 39280457 PMCID: PMC11401634 DOI: 10.7759/cureus.66917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Background Pancreatitis, marked by sterile inflammation of the pancreas, can present as either acute or chronic. It involves the premature activation of proteolytic enzymes, leading to autodigestion, inflammation, and potential systemic effects. This study investigates the impact of obesity on the severity of acute pancreatitis, given its role in systemic inflammation and its association with severe morbidity and mortality. Methods A retrospective analysis was conducted on patients treated for acute pancreatitis over a five-month period at the Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh (WLL) NHS Foundation Trust, Wigan, United Kingdom. Patients were evaluated using diagnostic criteria such as abdominal pain, elevated serum enzyme levels, and imaging results. The study explored correlations between BMI and pancreatitis severity, hospital length of stay, and complications, applying the Atlanta severity classification. Results The analysis revealed a weak, statistically insignificant correlation between BMI and the severity of acute pancreatitis, hospital stay length, and complications. This was consistent across various statistical methods, including Pearson correlation coefficients and multiple linear regression. These findings suggest that, while obesity may influence the inflammatory response in acute pancreatitis, it does not have a significant impact on clinical outcomes within this cohort. Conclusions The study highlights the complex role of obesity in exacerbating pancreatic inflammation but also emphasizes the need for larger, more definitive studies to explore this relationship further. It underscores the importance of early recognition and intervention in managing acute pancreatitis, regardless of BMI status.
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Affiliation(s)
- Neil Muscat
- General Surgery, Bolton NHS Foundation Trust, Bolton, GBR
| | - Firuza Soxibova
- General Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh (WLL) NHS Foundation Trust, Wigan, GBR
| | - Naqqash Adnan
- General Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh (WLL) NHS Foundation Trust, Wigan, GBR
| | | | | | - Imran Alam
- Surgery, Wrightington, Wigan and Leigh (WLL) NHS Foundation Trust, Wigan, GBR
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3
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Zerem E, Kurtcehajic A, Kunosić S, Zerem Malkočević D, Zerem O. Current trends in acute pancreatitis: Diagnostic and therapeutic challenges. World J Gastroenterol 2023; 29:2747-2763. [PMID: 37274068 PMCID: PMC10237108 DOI: 10.3748/wjg.v29.i18.2747] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023] Open
Abstract
Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.
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Affiliation(s)
- Enver Zerem
- Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo 71000, Bosnia and Herzegovina
| | - Admir Kurtcehajic
- Department of Gastroenterology and Hepatology, Plava Medical Group, Tuzla 75000, Bosnia and Herzegovina
| | - Suad Kunosić
- Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Dina Zerem Malkočević
- Department of Internal Medicine, Cantonal Hospital “Safet Mujić“ Mostar, Mostar 88000, Bosnia and Herzegovina
| | - Omar Zerem
- Department of Internal Medicine, Cantonal Hospital “Safet Mujić“ Mostar, Mostar 88000, Bosnia and Herzegovina
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Ye J, Wang L, Lu S, Yang D, Hu W, Lu H, Zhang Y. Clinical study on cystogastrostomy and Roux-en-Y-type cystojejunostomy in the treatment of pancreatic pseudocyst: A single-center experience. Medicine (Baltimore) 2021; 100:e25029. [PMID: 33725885 PMCID: PMC7969232 DOI: 10.1097/md.0000000000025029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/26/2020] [Accepted: 02/07/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis' occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.
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Affiliation(s)
- Jun Ye
- Department of Hepatopancreatobiliary Surgery
| | - Lan Wang
- Department of General Practice, Chengdu Second People's Hospital
| | - Shan Lu
- Department of Breast Surgery
| | | | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huimin Lu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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5
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Singh AK, Dawra S, Rana S, Gupta P, Samanta J, Sinha SK, Gupta V, Yadav TD, Kochhar R. Can serum resistin predict severity of acute pancreatitis? Biomarkers 2021; 26:31-37. [PMID: 33089708 DOI: 10.1080/1354750x.2020.1841295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Acute pancreatitis (AP) is a common disorder with high mortality in severe cases. Several markers have been studied to predict development of severe AP (SAP) including serum resistin with conflicting results. This study aimed at assessing the role of baseline serum resistin levels in predicting SAP. METHODS This prospective study collected data from 130 AP patients from July 2017 to Nov 2018. Parameters measured included demographic profile, serum resistin at admission, severity scores, hospital stay, surgery, and mortality. Patients were divided into two groups, severe and non-severe AP. The two groups were compared for baseline characteristics, serum resistin levels, hospital stay, surgery and mortality. RESULTS Among 130 patients, 53 patients had SAP. SAP patients had higher BMI, baseline CRP, APACHE II and CTSI scores (p-value 0.045, <0.001, <0.001 and 0.001, respectively). Both groups had comparable serum resistin levels. Serum resistin levels were also not different for obese and non-obese patients (p-value = 0.62). On multivariate analysis, BMI and high APACHE II score and CRP levels were found to independently predict SAP. CONCLUSION We found that serum resistin is not a useful marker for predicting the severity of AP and does not correlate with increasing body weight.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Dawra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyavati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Section of GI radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ordoñez AA, Jain SK. Imaging of Bacterial Infections. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jiang X, Shi JY, Wang XY, Hu Y, Cui YF. The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study. Mil Med Res 2020; 7:38. [PMID: 32799919 PMCID: PMC7429726 DOI: 10.1186/s40779-020-00265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). METHODS We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. RESULTS In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). CONCLUSION Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.
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Affiliation(s)
- Xun Jiang
- Tianjin Medical University, Tianjin, 300041 China
| | - Ji-Yu Shi
- Tianjin Medical University, Tianjin, 300041 China
| | - Xia-Yu Wang
- Tianjin Medical University, Tianjin, 300041 China
| | - Yong Hu
- Tianjin Medical University, Tianjin, 300041 China
| | - Yun-Feng Cui
- Tianjin Medical University, Tianjin, 300041 China
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai district, Tianjin, 300110 China
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Gao CC, Li J, Cao F, Wang XH, Li A, Wang Z, Li F. Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis. World J Gastroenterol 2020; 26:3087-3097. [PMID: 32587450 PMCID: PMC7304114 DOI: 10.3748/wjg.v26.i22.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent decades, an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis (IPN) because of the benefits in reducing postoperative multiple organ failure and mortality. However, there are limited published data regarding infection recurrence after treatment of this patient population.
AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.
METHODS Medical records for 193 IPN patients, who underwent minimally invasive treatment between February 2014 and October 2018, were retrospectively reviewed. Patients, who survived after the treatment, were divided into two groups: one group with infection after drainage catheter removal and another group without infection. The morphological and clinical data were compared between the two groups. Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence. Sensitivity and specificity for diagnostic performance were determined.
RESULTS Of the 193 IPN patients, 178 were recruited into the study. Of them, 9 (5.06%) patients died and 169 patients survived but infection recurred in 13 of 178 patients (7.30%) at 7 (4-10) d after drainage catheters were removed. White blood cell (WBC) count, serum C-reactive protein (CRP), interleukin-6, and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without (all P < 0.05). In addition, drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection (P = 0.025 and P < 0.0001, respectively). Although these parameters all correlated positively with the incidence of infection (all P < 0.05), only WBC, CRP, procalcitonin levels, and catheter length were identified as independent predictors for infection recurrence. The sensitivity and specificity for infection prediction were high in WBC count (≥ 9.95 × 109/L) and serum procalcitonin level (≥ 0.05 ng/mL) but moderate in serum CRP level (cut-off point ≥ 7.37 mg/L). The catheter length (cut-off value ≥ 8.05 cm) had a high sensitivity but low specificity to predict the infection recurrence.
CONCLUSION WBC count, serum procalcitonin, and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients. These biomarkers should be considered before removing the drainage catheters.
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Affiliation(s)
- Chong-Chong Gao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiao-Hui Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhe Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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9
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Singh AK, Samanta J, Dawra S, Gupta P, Rana A, Sharma V, Kumar-M P, Sinha SK, Kochhar R. Reduction of intra-abdominal pressure after percutaneous catheter drainage of pancreatic fluid collection predicts survival. Pancreatology 2020; 20:772-777. [PMID: 32360000 DOI: 10.1016/j.pan.2020.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Intra-abdominal hypertension (IAH) can adversely affect the outcome in patients of acute pancreatitis (AP). Effect of percutaneous drainage (PCD) on IAH has not been studied. We studied the effect of PCD on IAH in patients with acute fluid collections. MATERIAL AND METHODS Consecutive patients of AP undergoing PCD between Jan 2016 and May 2018 were evaluated for severity markers, clinical course, hospital and ICU stay, and mortality. Patients were divided into two groups: with IAH and with no IAH (NIAH). The two groups were compared for severity scores, organ failure, hospital and ICU stay, reduction in IAP and mortality. RESULTS Of the 105 patients, IAH was present in 48 (45.7%) patients. Patients with IAH had more often severe disease, BISAP ≥2, higher APACHE II scores and computed tomography severity index (CTSI). IAH group had more often OF (87.5% vs. 70.2%, p = 0.033), prolonged ICU stay (12.5 vs. 6.75 days, p = 0.007) and higher mortality (52.1% vs. 15.8%, p < 0.001). After PCD, IAP decreased significantly more in the IAH group (21.85 ± 4.53 mmHg to 12.5 ± 4.42 mmHg) than in the NIAH group (12.68 ± 2.72 mmHg to 8.32 ± 3.18 mmHg), p = <0.001. Reduction of IAP in patients with IAH by >40% at 48 h after PCD was associated with better survival (63.3% vs. 36.7%, p = 0.006). CONCLUSION We observed that patients with IAH have poor outcome. PCD decreases IAP and a fall in IAP >40% of baseline value predicts a better outcome after PCD in patients with acute fluid collections.
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Affiliation(s)
- Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Saurabh Dawra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Gupta
- Section of GI Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Atul Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Dłuski OP, Durmaj AA, Kosieradzki M, Jonas M, Szczepankiewicz B, Czerwiński J, Adamczyk A, Palczewski P. Spinal Cord Ischemia Because of Microvascular Thrombosis in a Patient with Necrotizing Pancreatitis. Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923273. [PMID: 32393730 PMCID: PMC7252832 DOI: 10.12659/ajcr.923273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 37-year-old Final Diagnosis: Acute pancreatitis • thrombotic microangiopathy Symptoms: Epigastric pain • paresis Medication: — Clinical Procedure: Computed tomography • ERCP • hemodialysis • magnetic resonance imaging • omentectomy Specialty: Critical Care Medicine • Gastroenterology and Hepatology • Radiology • Surgery
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Affiliation(s)
- Olaf Patryk Dłuski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Agnieszka Durmaj
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maurycy Jonas
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Jarosław Czerwiński
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Agata Adamczyk
- Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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11
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Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service. Am J Emerg Med 2019; 38:1994.e1-1994.e2. [PMID: 31884024 DOI: 10.1016/j.ajem.2019.158488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 11/24/2022] Open
Abstract
Because of the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis in patients presenting with abdominal pain in emergency departments. Acute pancreatitis due to severe hypertriglyceridemia during pregnancy is rare but due to the increased risk of maternal and fetal mortality, diagnosis and treatment options should be known and should be performed in the emergency department, which is the first admission site. In this case report, we present a 20-year-old woman with 19 weeks pregnant who presented to the emergency department with abdominal pain and whose biochemistry parameters were high enough to give lipemic stimulation was hospitalized in the emergency ıntensıve care unit (EICU) in the emergency department and lipid apheresis treatment was planned successfully. Lipid apheresis treatment in patients with resistant hypertriglyceridemia in the emergency department should become an easy, safe and effective option with the use of an emergency intensive care unit.
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12
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Abstract
There has been an increasing demand in image-guided minimally invasive procedures and these have become an integral part of present-day clinical practice. Basic interventional radiology (IR) procedures have greatly reduced the need for invasive procedures for sampling as well as treating conditions like abscess and fluid collections. Owing to their minimally invasive nature, most of these procedures may be performed on the outpatient patients as daycare procedures. Some of these procedures in critically ill patients may be lifesaving. Basic interventional radiology (IR) procedures consist of image-guided fine-needle aspiration cytology and biopsy, tru-cut (core) biopsy, needle aspiration/drainage and percutaneous catheter drainage. This review aims to provide practice requisites for basic IR procedures.
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
| | - Krishna Bhardwaj
- Department of Radiology, VMMC and Safdarjung Hospital, Ansari Nagar, New Delhi, India
| | - Chander Mohan
- Department of Interventional Radiology, BLK Superspecialty Hospital, Pusa Raod, New Delhi, India
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13
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Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, Khetpal N, Ahmad S. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg 2019; 11:198-217. [PMID: 31123558 PMCID: PMC6513789 DOI: 10.4240/wjgs.v11.i4.198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.
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Affiliation(s)
- Mamoon Ur Rashid
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Ishtiaq Hussain
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
| | - Sundas Jehanzeb
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
| | - Waqas Ullah
- Internal Medicine, Abington Hospital, Abington, PA 19001, United States
| | - Saeed Ali
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Akriti Gupta Jain
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Neelam Khetpal
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Sarfraz Ahmad
- Department of Gynecologic Oncology, Advent Health Cancer Institute, Orlando, FL 32804, United States
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Acton HJ, Mulholland D, Torreggiani WC. Quantification of the impact of interventional radiology in the management of acute pancreatitis. Ir J Med Sci 2019; 188:1195-1200. [PMID: 30759306 DOI: 10.1007/s11845-019-01970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Interventional radiology plays a central role in the management of complicated acute pancreatitis, contributing to image-guided drainages, treating haemorrhagic complications and maintaining the patency of the biliary tree. In addition, many of these patients require long-term venous access for antibiotics or parenteral feeding. The aim of this study was to evaluate the role and level of involvement of the interventional radiology in this sub-group of patients. METHODS This was a single-centre retrospective review of all admissions for acute pancreatitis over a 5-year period. Each case was assessed to determine whether radiological intervention was utilised. RESULTS Our review included 401 patients. A total of 18.7% (75/401) of patients required vascular access procedures and 18.4% (74/401) required image-guided drainage. A total of 1.2% (2/401) patients had embolisation procedures performed. The embolisation procedures were performed to treat a pseudoaneurysm that had formed. Overall, 20.9% (84/401) of patients were referred to the interventional radiology department for a procedure; a majority of these patients were referred for multiple procedures over the course of their admission. The patients in the 'severe pancreatitis' category had a total of 154 procedures performed, which was 65.5% of the total procedures. On average, the patients who underwent multiple interventional procedures tended to have a longer admission and more complex disease. CONCLUSION The diagnosis and treatment of complicated acute pancreatitis is heavily dependent on the interventional radiology department. A substantial proportion of patients with pancreatitis required radiological intervention as part of their management, the proportion of which increased significantly in complex disease.
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Affiliation(s)
- Holly J Acton
- Trinity College Dublin, St James's Hospital, James's Street, Dublin 8, Ireland.
| | - Douglas Mulholland
- Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Li Z, Wang G, Zhen G, Zhang Y, Liu J, Liu S. Effects of hemodialysis combined with hemoperfusion on severe acute pancreatitis. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:198-202. [PMID: 29749327 DOI: 10.5152/tjg.2018.17415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Severe acute pancreatitis (SAP) is characterized by persistent organ failure. This research aimed to evaluate the effect of hemodialysis combined with hemoperfusion on SAP. MATERIALS AND METHODS Thirty-seven patients who were treated with hemoperfusion combined with hemodialysis were included in group O, and 31 patients treated with conventional therapy and hemoperfusion were included as control (group C). Leukocyte count, neutrophil percentage, amylase (AMY), blood urine nitrogen (BUN), creatinine (Cr), and total bilirubin (TBIL) were noted. The time when symptoms disappeared as well as complications after treatment was recorded. RESULTS Leukocyte count, neutrophil percentage, AMY, BUN, Cr, and TBIL in two groups were remarkably decreased after treatment. However, these indexes were significantly lower in group O than those in group C after treatment, especially the neutrophil percentage, AMY, BUN, Cr, and TBIL. The time when the symptoms disappeared was 3.01±1.02 days in group O, which was shorter than 5.56±1.88 days in group C. There were 4 patients with acute renal failure and 2 patients had multiple organ failure in group C after treatment. But only 1 patient developed acute renal failure in group O. The difference in complications between two groups was significant (p<0.024). CONCLUSION The combination of hemodialysis and hemoperfusion could have a better effect on SAP in removing toxic metabolites and inflammation mediators. It not only shortens the time of symptoms disappearing but also decreases the incidence of complications and the mortality.
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Affiliation(s)
- Zhenhe Li
- Department of Emergency, Yishui Center Hospital of Linyi City, Linyi, China
| | - Guixia Wang
- Department of Hemodialysis, Yishui Center Hospital of Linyi City, Linyi, China
| | - Guodong Zhen
- Department of Emergency, Yishui Center Hospital of Linyi City, Linyi, China
| | - Yuliang Zhang
- Department of Hemodialysis, Yishui Center Hospital of Linyi City, Linyi, China
| | - Jiaqiang Liu
- Department of Hemodialysis, Yishui Center Hospital of Linyi City, Linyi, China
| | - Shanmei Liu
- Department of Hemodialysis, Yishui Center Hospital of Linyi City, Linyi, China
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Sriram R, Sun J, Villanueva-Meyer J, Mutch C, De Los Santos J, Peters J, Korenchan DE, Neumann K, Van Criekinge M, Kurhanewicz J, Rosenberg O, Wilson D, Ohliger MA. Detection of Bacteria-Specific Metabolism Using Hyperpolarized [2- 13C]Pyruvate. ACS Infect Dis 2018; 4:797-805. [PMID: 29405697 DOI: 10.1021/acsinfecdis.7b00234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The differentiation of bacterial infection from other causes of inflammation is difficult in clinical practice and is critical where patient outcomes rely heavily on early interventions. In addition to physical exam and laboratory markers, several imaging modalities are frequently employed, but these techniques generally target the host immune response, rather than the living microorganisms themselves. Here, we describe a method to detect bacteria-specific metabolism using hyperpolarized (HP) 13C magnetic resonance spectroscopy. This technology allows visualization of the real-time conversion of enriched 13C substrates to their metabolic products, identified by their distinct chemical shifts. We have identified the rapid metabolism of HP [2-13C]pyruvate to [1-13C]acetate as a metabolic signature of common bacterial pathogens. We demonstrate this conversion in representative Gram-negative and Gram-positive bacteria, namely, Escherichia coli and Staphylococcus aureus, and its absence in key mammalian cell types. Furthermore, this conversion was successfully modulated in three mutant strains, corresponding to deletions of relevant enzymes.
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Affiliation(s)
- Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Jinny Sun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Javier Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Christopher Mutch
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Justin De Los Santos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Jason Peters
- Microbiology and Immunology, University of California, San Francisco, 600 16th Street, San Francisco, California 94158, United States
| | - David E. Korenchan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Kiel Neumann
- Department of Radiology, University of Virginia, 480 Ray C. Hunt Drive, Charlottesville, Virginia 22903, United States
| | - Mark Van Criekinge
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Oren Rosenberg
- Division of Infectious Diseases, School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California 94143, United States
| | - David Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Fourth Street, Box 2520, San Francisco, California 94158, United States
- Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, California 94110, United States
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Tian C, Xu X. Multislice Spiral Perfusion Computed Tomography to Assess Pancreatic Vascularity in Mild Acute Pancreatitis. J Comput Assist Tomogr 2017; 41:284-288. [DOI: 10.1097/rct.0000000000000500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Acute Pancreatitis: Revised Atlanta Classification and the Role of Cross-Sectional Imaging. AJR Am J Roentgenol 2015; 205:W32-41. [PMID: 26102416 DOI: 10.2214/ajr.14.14056] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The 2012 revision of the Atlanta Classification emphasizes accurate characterization of collections that complicate acute pancreatitis: acute peripancreatic fluid collections, pseudocysts, acute necrotic collections, and walled-off necroses. As a result, the role of imaging in the management of acute pancreatitis has substantially increased. CONCLUSION This article reviews the imaging findings associated with acute pancreatitis and its complications on cross-sectional imaging and discusses the role of imaging in light of this revision.
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Zerem E, Hauser G, Loga-Zec S, Kunosić S, Jovanović P, Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol 2015; 21:6850-6860. [PMID: 26078561 PMCID: PMC4462725 DOI: 10.3748/wjg.v21.i22.6850] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/29/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023] Open
Abstract
A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity. Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.
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Islim F, Salik AE, Bayramoglu S, Guven K, Alis H, Turhan AN. Non-invasive detection of infection in acute pancreatic and acute necrotic collections with diffusion-weighted magnetic resonance imaging: preliminary findings. ACTA ACUST UNITED AC 2015; 39:472-81. [PMID: 24441591 DOI: 10.1007/s00261-014-0076-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the contribution of diffusion-weighted magnetic resonance imaging (DW-MRI) to the detection of infection in acute pancreatitis-related collections. METHODS A total of 21 DW-MRI, and computed tomography (CT) were performed on 20 patients diagnosed as acute pancreatitis with acute peri-pancreatic fluid or necrotic collections. Collections were classified as infected or sterile according to the culture and follow-up results. Collections with gas bubbles on CT images were considered to be infected. Collections with peripheral bright signals on DW-MRI images were considered to be positive, whereas those without signals were considered to be negative. Apparent diffusion coefficient (ADC) values of the peripheral and central parts of the collections were measured. Student's t test was used to compare the means of ADC values of independent groups. RESULTS Apart from one false positive result, the presence of infection was detected by DW-MRI with 95.2% accuracy. The sensitivity and accuracy of DW-MRI were higher than CT for the detection of infection. The ADC values in the central parts of the collections were significantly different between the infected and sterile groups. CONCLUSION DW-MRI can be used as a non-invasive technique for the detection of infection in acute pancreatitis-associated collections.
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Affiliation(s)
- Filiz Islim
- Department of Radiology, Istanbul Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey,
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21
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Zerem E. Treatment of severe acute pancreatitis and its complications. World J Gastroenterol 2014; 20:13879-13892. [PMID: 25320523 PMCID: PMC4194569 DOI: 10.3748/wjg.v20.i38.13879] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/08/2014] [Accepted: 06/02/2014] [Indexed: 02/06/2023] Open
Abstract
Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.
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22
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The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. ACTA ACUST UNITED AC 2013; 38:125-36. [PMID: 22584543 DOI: 10.1007/s00261-012-9908-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the myriad of associated complications but also familiarity with the appropriate radiologic nomenclature as defined by the Atlanta symposium in 1992 and, more recently, by the Acute Pancreatitis Classification Working Group in 2008. The accurate description of the radiological findings plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease. There have been increasing efforts to develop uniformity in the use of terminology used to define the radiologic findings in acute pancreatitis, in particular, the terminology for fluid collections, a common area of inconsistency and confusion. Terms such as "acute peripancreatic fluid collections," "acute post- necrotic fluid collections," "pseudocyst," and "walled-off pancreatic necrosis" are now recommended as they describe the evolution of fluid collections in patients with both interstitial and necrotizing pancreatitis and nonspecific terms such as "pancreatic abscess" and "phlegmon" are being abandoned. In this review we illustrate, with case examples, the standardized terminology used in the radiological and clinical description of acute pancreatitis, its severity, and complications with an emphasis on the role of ultrasound, computed tomography and magnetic resonance imaging. Different management options of the associated complications are also discussed. The use of standardized terminology will hopefully improve the communication between radiologists, gastroenterologists, and surgeons to facilitate treatment planning and will lead to enhanced outcomes for patients with acute pancreatitis as well as create uniformity for enrollment into research studies.
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Ham H, McInnes MDF, Woo M, Lemonde S. Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain. Emerg Radiol 2011; 19:19-26. [PMID: 22072086 DOI: 10.1007/s10140-011-0996-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/18/2011] [Indexed: 01/12/2023]
Abstract
The purpose of this study is to calculate the negative predictive value (NPV) CT of the abdomen in patients presenting to the emergency department (ED) with undifferentiated upper abdominal pain. Approved by the hospital research ethics board, this retrospective study examined consecutive patients presenting to the ED with undifferentiated upper abdominal pain whose intravenous contrast-enhanced CT of the abdomen was reported as "normal" from June 2006-August 2010. Exclusion criteria included active malignancy, trauma, and known inflammatory bowel disease. True-negative (TN) vs. false-negative (FN) cases were categorized by consensus opinion of radiologist and emergency physician using a composite reference standard including clinical, laboratory, imaging, surgery, pathology, and patient self-reporting via phone questionnaire. The NPV was calculated with confidence intervals of 95%. The TN and FN groups were compared based on gender, age, site of pain, oral contrast use, and laboratory values. One hundred twenty-seven patients were included for analysis. The NPV was 64% (95% CI 55-72). The FN group had a higher proportion of patients with epigastric pain (p = 0.02) and a lower proportion of patients with left upper quadrant pain (p = 0.02). The WBC, lipase, and ALT were all higher in the FN group compared with the TN group. The most commonly missed pathologies were inflammatory conditions of the biliary tract and upper gastrointestinal systems. The NPV of CT for evaluation of undifferentiated upper abdominal pain in the ED was low at 64%. Physicians should consider this limitation and the commonly missed pathology when discharging patients with a "normal" CT report.
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Affiliation(s)
- Hyungjoo Ham
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, ON, Canada
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Abstract
The challenge for the pancreatologist managing patients with infected pancreatic necrosis is to devise a treatment algorithm that enables recovery but at the same time limits the morbidity and mortality. The current gold standard remains open necrosectomy. Recent literature contains scattered reports of endoscopic, radiologic, laparoscopic, percutaneous and lumbotomy approaches to managing patients with this condition. This literature review addresses the role of techniques that aim to minimize the physiological insult to the patient with infected pancreatic necrosis.
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Affiliation(s)
- A Peter Wysocki
- Department of Surgery, Logan Hospital, Meadowbrook, Queensland, Australia.
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Abstract
Acute pancreatitis is a common condition (thought to be increasing in incidence worldwide), which has a highly variable clinical course. The radiologist plays a key role in the management of such patients, from diagnosis and staging to identification and treatment of complications, as well as in determining the underlying aetiology. The aim of this article is (i) to familiarize the reader with the pathophysiology of acute pancreatitis, the appearances of the various stages of pancreatitis, the evidence for the use of staging classifications and the associated complications and (ii) to review current thoughts on optimising therapy.
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Affiliation(s)
- B C Koo
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB20QQ, UK
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Bollen TL, van Santvoort HC, Besselink MG, van Leeuwen MS, Horvath KD, Freeny PC, Gooszen HG. The Atlanta Classification of acute pancreatitis revisited. Br J Surg 2008; 95:6-21. [PMID: 17985333 DOI: 10.1002/bjs.6010] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In a complex disease such as acute pancreatitis, correct terminology and clear definitions are important. The clinically based Atlanta Classification was formulated in 1992, but in recent years it has been increasingly criticized. No formal evaluation of the use of the Atlanta definitions in the literature has ever been performed. METHODS A Medline literature search sought studies published after 1993. Guidelines, review articles and their cross-references were reviewed to assess whether the Atlanta or alternative definitions were used. RESULTS A total of 447 articles was assessed, including 12 guidelines and 82 reviews. Alternative definitions of predicted severity of acute pancreatitis, actual severity and organ failure were used in more than half of the studies. There was a large variation in the interpretation of the Atlanta definitions of local complications, especially relating to the content of peripancreatic collections. CONCLUSION The Atlanta definitions for acute pancreatitis are often used inappropriately, and alternative definitions are frequently applied. Such lack of consensus illustrates the need for a revision of the Atlanta Classification.
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Affiliation(s)
- T L Bollen
- Department of Radiology, St Antonius Hospital Nieuwegein, The Netherlands
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Abstract
Imaging of the abdomen for suspected gastrointestinal and hepatic disease during pregnancy is assuming greater importance. Like clinical evaluation, imaging of the abdomen and pelvis is challenging but is vitally important to prevent delayed diagnosis or unnecessary interventions. Also choice of imaging modality is influenced by factors which could impact on fetal safety such as the use of ionising radiation and magnetic resonance imaging. This article discusses important issues in imaging of gastrointestinal and hepatic disease in pregnancy and the puerperium.
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Affiliation(s)
- Philip A Hodnett
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Imaging and Intervention in Acute Pancreatic Conditions. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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