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Journal of Visceral Surgery Apr 2019Acute pancreatitis is a frequent pathology with 11,000 to 13,000 new cases per year in France. A biliary origin (30 to 70% of the cases) should be suspected when alanine... (Review)
Review
Acute pancreatitis is a frequent pathology with 11,000 to 13,000 new cases per year in France. A biliary origin (30 to 70% of the cases) should be suspected when alanine amino-transferases are elevated during the first 48 hours, and it is confirmed by the presence of gallstones at trans abdominal ultrasound. Abdominal computed-tomography scan is performed around the fifth day, and is repeated according to clinical and biological evolution. Management of acute biliary pancreatitis varies according to its severity, which should be assessed according to systemic inflammatory response syndrome and organ failures. For mild acute pancreatitis, cholecystectomy should be performed during in-hospital stay, before oral feeding. For moderately severe and severe acute pancreatitis, treatment is based on resuscitation, early enteral continuous feeding, and management of complications. Interval cholecystectomy is performed at a later stage. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be performed in emergency when angiocholitis is associated, and in delayed emergency before oral feeding for persistent common bile duct stone. A common bile duct stone should be searched for during cholecystectomy and can be treated during the same surgical procedure if local conditions are adequate. Cholelithiasis is the most frequent cause of acute pancreatitis during pregnancy, and its diagnosis and the treatment have some particularities.
Topics: Alanine Transaminase; Biomarkers; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Cholelithiasis; Drainage; Enteral Nutrition; Female; Gallstones; Humans; Intra-Abdominal Hypertension; Length of Stay; Multiple Organ Failure; Pancreatic Pseudocyst; Pancreatitis; Pancreatitis, Acute Necrotizing; Pregnancy; Pregnancy Complications; Severity of Illness Index; Systemic Inflammatory Response Syndrome; Tomography, X-Ray Computed; Ultrasonography; Vascular Diseases
PubMed: 30385271
DOI: 10.1016/j.jviscsurg.2018.08.002 -
Digestive Diseases and Sciences Jul 2017Chronic pancreatitis is a disease that leads to irreversible changes in the pancreatic morphology and function. The loss of function can lead to diabetes mellitus and... (Review)
Review
Chronic pancreatitis is a disease that leads to irreversible changes in the pancreatic morphology and function. The loss of function can lead to diabetes mellitus and exocrine pancreatic insufficiency. The inflammation and fibrosis can also lead to other complications including a chronic abdominal pain syndrome, metabolic bone disease, and pancretic cancer. This article reviews our current understanding of the mechanisms and management of these complications of chronic pancreatitis.
Topics: Bone Diseases, Metabolic; Diabetes Mellitus; Exocrine Pancreatic Insufficiency; Humans; Pancreatic Neoplasms; Pancreatic Pseudocyst; Pancreatitis, Chronic
PubMed: 28281169
DOI: 10.1007/s10620-017-4518-x -
World Journal of Gastroenterology Jan 2009Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound... (Review)
Review
Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Diagnosis, Differential; Drainage; Endosonography; Female; Humans; Magnetic Resonance Imaging; Male; Pancreatic Pseudocyst; Pancreatitis; Tomography, X-Ray Computed
PubMed: 19115466
DOI: 10.3748/wjg.15.38 -
Surgical Pathology Clinics Dec 2016Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is... (Review)
Review
Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed.
Topics: Alcohol-Induced Disorders; Autoimmune Diseases; Carcinoma, Pancreatic Ductal; Chronic Disease; Diagnosis, Differential; Humans; Pancreas; Pancreatic Ducts; Pancreatic Pseudocyst; Pancreatitis
PubMed: 27926364
DOI: 10.1016/j.path.2016.05.008 -
Antimicrobial Agents and Chemotherapy Oct 2017Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens,...
Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Aged; Anti-Bacterial Agents; Bacteriophages; Drug Resistance, Multiple, Bacterial; Gallstones; Humans; Male; Minocycline; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing; Phage Therapy
PubMed: 28807909
DOI: 10.1128/AAC.00954-17 -
Revista Espanola de Enfermedades... Jun 2020Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis,... (Review)
Review
Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.
Topics: Acute Disease; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing
PubMed: 32450706
DOI: 10.17235/reed.2020.6814/2019 -
Experimental and Therapeutic Medicine Feb 2021Advances in radiological techniques have led to an increase in the number of diagnoses of pancreatic pseudocyst, which is the most common pancreatic cyst lesion disease,... (Review)
Review
Advances in radiological techniques have led to an increase in the number of diagnoses of pancreatic pseudocyst, which is the most common pancreatic cyst lesion disease, accounting for two-thirds of all pancreatic cyst lesions. Historically, the management of pancreatic pseudocyst has been achieved through the use of conservative treatments and surgery; however, due to the complications and recurrence rate associated with these techniques, the management of pancreatic pseudocyst is challenging. Surgeons and gastroenterologists have attempted to determine the optimal management technique to treat pancreatic pseudocyst to reduce complications and the recurrence rate. From these investigations, percutaneous catheter, surgical and endoscopic drainage with ultrasonography guidance have become promising management techniques. The present review aimed to summarize the diagnostic and therapeutic methods used for the management of pancreatic pseudocyst and to compare percutaneous catheter, surgical and endoscopic drainage.
PubMed: 33456526
DOI: 10.3892/etm.2020.9590 -
Gut and Liver Sep 2017In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the... (Review)
Review
In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.
Topics: Acute Disease; Drainage; Endosonography; Gastrostomy; Humans; Necrosis; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Stents
PubMed: 28494574
DOI: 10.5009/gnl16178 -
International Journal of Surgery Case... Aug 2022Chylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow....
INTRODUCTION
Chylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow. It is caused mainly by congenital anomalies, trauma, and malignancy. Chylous ascites following blunt abdominal injury is uncommon in pediatrics. Chyle duct and pancreatic injuries present a rare clinical sequela yet to be reported in the literature. Conservative management is the mainstay of treating chyle duct injuries, reserving invasive measures for unique circumstances.
CASE PRESENTATION
A case of an eleven-year-old female who suffered blunt thoracoabdominal trauma and sustained injuries to the chest, pancreas, and chyle duct. She had clinical signs of peritonism and decreased air entry on the right hemithorax. While she underwent abdominal exploration, the chylous ascites eventually resolved on conservative management, and the pancreatic pseudocyst was later drained percutaneously.
DISCUSSION
Chylous ascites and pancreatic pseudocyst is uncommon in pediatrics. While surgery is indicated in selected cases, a conservative approach is advocated in managing lymphatic leaks. Diet with low triglycerides and high protein is advocated to decrease lymph production. Treatment of pancreatic pseudocyst varies from conservative (watchful waiting) to drainage measures.
CONCLUSION
Although chylous ascites is not expected following trauma, has to be considered among differential free peritoneal fluid. Pancreatic injuries are common but difficult to diagnose. CT and MRCP are preferred modalities for diagnosing pancreatic injuries. While dietary modification and drainage of the chylous ascites were the mainstays in managing chyle duct injury, pancreatic pseudocyst resolved after percutaneous drainage.
PubMed: 35839653
DOI: 10.1016/j.ijscr.2022.107406 -
Annals of Surgery Aug 1995The authors examined the prevalence and complications of pancreatitis in severely burned patients. Factors predictive for the development of pancreatitis after burns are...
OBJECTIVE
The authors examined the prevalence and complications of pancreatitis in severely burned patients. Factors predictive for the development of pancreatitis after burns are considered.
SUMMARY BACKGROUND DATA
Pancreatitis has been documented at necropsy after burns; however, it is not clinically recognized as a common complication of burn injury. Recent improvements in survival rates could yield previously unrecognized complications, such as pancreatitis, particularly in those patients who previously would have not survived. The hypothesis is that pancreatitis is a frequent complication after major burn injury and causes significant morbidity for patients with large burns.
METHODS
This retrospective review of adult patients with large burns examines postburn pancreatitis using stepwise logistic regression analysis.
RESULTS
Forty-nine of 121 (40%) patients developed hyperamylasemia or hyperlipasemia well after the admission period (23 +/- 3 days), and all enzyme abnormalities were temporally associated with emerging infections. Most of these patients (40/49, 82%) had symptoms of pancreatitis. Three patients (6%) had pancreatic pseudocysts or abscesses. Inhalation injury (p = 0.0001), associated trauma (p = 0.0311), and escharotomy (p = 0.0415) were risk factors for pancreatitis. Using Fischer's exact test, patients with pancreatitis had increased mortality and length of stay. Patients with high enzyme elevations and > or = 50% body surface area burned were at severe risk of pancreatic pseudocyst or abscess development (43%; 90% confidence interval of 23-77%).
CONCLUSIONS
Pancreatitis is a frequent complication after large burn injuries. Patients at high risk for pancreatitis complications should receive surveillance examinations during their acute hospitalization.
Topics: Abscess; Adult; Amylases; Bacterial Infections; Body Surface Area; Burns; Female; Forecasting; Humans; Length of Stay; Lipase; Logistic Models; Male; Middle Aged; Multiple Trauma; Pancreatic Diseases; Pancreatic Pseudocyst; Pancreatitis; Retrospective Studies; Risk Factors; Smoke Inhalation Injury; Survival Rate
PubMed: 7543741
DOI: 10.1097/00000658-199508000-00008