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Kaiser L, Petzold G, Seif Amir Hosseini A, Ellenrieder V, Neesse A, Ammer-Herrmenau C. [Acute necrotizing pancreatitis with hemorrhagic shock in secondary splenic rupture: a case report and literature review]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1494-1499. [PMID: 36736345 PMCID: PMC10635783 DOI: 10.1055/a-2003-9694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Indexed: 02/05/2023]
Abstract
Atraumatic splenic rupture is a rare complication of acute and chronic pancreatitis. It arises due to its anatomical proximity to the pancreas, for instance, due to erosion of large pseudocysts or walled-of-necrosis (WON).Following we describe the case of a 62-year-old woman who presented for further diagnostics and treatment of acute pancreatitis with the development of large walled-of necrosis (WON) in the pancreatic corpus and tail. During the course, the patient developed a hemorrhagic shock. An emergency computer tomography (CT) of the abdomen revealed a ruptured spleen with a large capsular hematoma with no evidence of active bleeding. In contrast to previous published case reports, our treatment was exclusively minimal-invasive: by radiological guided embolization of the splenic artery and by endosonographic guided implantation of a lumen apposing metal stent (LAMS). The splenic hematoma was spontaneously regressive without secondary drainage.
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Affiliation(s)
- Leon Kaiser
- Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Golo Petzold
- Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institut für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Albrecht Neesse
- Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Ammer-Herrmenau
- Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
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Affiliation(s)
- J. Testart
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - L. Boyet
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - G. Perrier
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - E. Clavier
- Département d’imagerie médicale, Service Pr. Thiebot, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - C. Peillon
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
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Jain D, Lee B, Rajala M. Atraumatic Splenic Hemorrhage as a Rare Complication of Pancreatitis: Case Report and Literature Review. Clin Endosc 2019; 53:311-320. [PMID: 31337192 PMCID: PMC7280842 DOI: 10.5946/ce.2019.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
Splenic hemorrhage (hematoma and rupture) is a rare complication of pancreatitis. In this article, we present a rare case of spontaneous splenic rupture as a complication of acute pancreatitis. A literature review was also completed to describe the patient characteristics, associated pancreatitis etiology, clinical presentations, risk factors, diagnostic and treatment modalities, and outcomes.
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Affiliation(s)
- Deepanshu Jain
- Division of Gastroenterology, Department of Digestive Diseases and Transplantation, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Byeori Lee
- Department of Internal Medicine, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Michael Rajala
- Division of Gastroenterology, Department of Digestive Diseases and Transplantation, Albert Einstein Healthcare Network, Philadelphia, PA, USA
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4
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Tan J, Tan H, Hu B, Ke C, Ding X, Chen F, Leng J, Dong J. Short-term outcomes from a multicenter retrospective study in China comparing laparoscopic and open surgery for the treatment of infected pancreatic necrosis. J Laparoendosc Adv Surg Tech A 2012; 22:27-33. [PMID: 22217005 DOI: 10.1089/lap.2011.0248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Laparoscopic surgery for confirmed infected pancreatic necrosis (IPN) represents a relatively new solution. There are no studies comparing the outcomes of laparoscopic and open surgery for patients with IPN. The aims of this study were to investigate the feasibility of laparoscopic management for patients with IPN and to compare the outcomes of laparoscopic and open surgery. METHODS Seventy-six patients with IPN who underwent open surgery (Open-group) or laparoscopic surgery (Lap-group) were retrospectively reviewed. Demographic data, white blood cell count, and APACHE II score upon admission, operative findings, major complications, and mortality were compared between the Open-group and the Lap-group. The Lap-group was further divided into two subgroups (early and late), and the operative difficulty was compared between the two subgroups. RESULTS There were no significant differences between the Open-group and the Lap-group with respect to demographic data, white blood cell count, and APACHE II score. Although the mean operative time was significantly shorter in the Open-group than in the Lap-group, the estimated blood loss was significantly greater in the Open-group than in the Lap-group, as was the rate of complications. The mean postoperative hospital stay in the Open-group was significant longer than in the Lap-group, too. In the Lap-group, the mean operating time, estimated blood loss, and conversion rate in the early subgroup were significantly lower than in the late subgroup. CONCLUSION Laparoscopic necrosectomy and the placement of an intermittent irrigation and continuous suction drainage system for IPN is feasible, effective, and of minimal invasiveness. The late laparoscopic necrosectomy is relatively difficult.
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Affiliation(s)
- JingWang Tan
- Hepatobiliary Surgery Department, Northern Jiangsu People's Hospital, YangZhou University, YangZhou, China
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5
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Garrido F, Sancho E, Gasz A, Menéndez Sanchez P, Gambí Pisonero D. [Pneumoperitoneum secondary to spontaneous gaseous gangrene of the pancreas due to Klebsiella sp]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:585-6. [PMID: 19539404 DOI: 10.1016/j.gastrohep.2009.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 02/26/2009] [Indexed: 11/15/2022]
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Sriaroon C, Dalal P, Sompalli S, Thethi I, Huq S. Splenic rupture: a rare delayed complication of acute necrotizing pancreatitis. Am J Gastroenterol 2007; 102:1136-7. [PMID: 17489797 DOI: 10.1111/j.1572-0241.2007.01180_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7
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Ortega Carnicer J, Otero Fernández R, Bocharán Ocaña S. [Spontaneous gaseous gangrene of the pancreas and pneumoperitoneum without visceral perforation due to Clostridium perfringens]. Med Intensiva 2007; 30:407-8. [PMID: 17129541 DOI: 10.1016/s0210-5691(06)74557-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Reddy M, Jindal R, Gupta R, Yadav TD, Wig JD. Outcome after pancreatic necrosectomy: trends over 12 years at an Indian centre. ANZ J Surg 2007; 76:704-9. [PMID: 16916387 DOI: 10.1111/j.1445-2197.2006.03835.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pancreatic necrosectomy for necrotizing pancreatitis is a formidable operation. There are limited data from the Indian subcontinent regarding outcome and recent trends in management. METHODS Patients undergoing pancreatic necrosectomy over a 12-year period were identified from a prospective database. Data regarding the hospital course, complications and outcome were extracted by case file review. Descriptive statistics were used to present the data. An attempt was made to identify trends in management and outcome over the study period. RESULTS One hundred and eighteen patients underwent necrosectomy. The median age was 39.5 years (interquartile range, 32-46). Median Acute Physiology And Chronic Health Evaluation II score at admission was 8 (interquartile range, 6-10). Thirty-nine patients (33%) had organ failure at admission. Patients underwent surgery a median of 23 days (interquartile range, 14-34) after onset of illness. There was high incidence of loco-regional complications (68/118, 58%) and organ failure (88/118, 75%) in the postoperative period. The mortality rate was 38%. There was an increase in the median onset to surgery interval (17 vs 25.5 days; P = 0.001), increased use of percutaneous interventions (20 vs 36%; P = 0.05) and decreased mortality (47 vs 29%; P = 0.052) in the later half of the study period. CONCLUSION Pancreatic necrosectomy continues to be associated with significant morbidity and mortality in India. A trend towards increased use of percutaneous interventions and delayed surgery is evident.
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Affiliation(s)
- Mettus Reddy
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Cinquepalmi L, Boni L, Dionigi G, Rovera F, Diurni M, Benevento A, Dionigi R. Long-term results and quality of life of patients undergoing sequential surgical treatment for severe acute pancreatitis complicated by infected pancreatic necrosis. Surg Infect (Larchmt) 2006; 7 Suppl 2:S113-6. [PMID: 16895491 DOI: 10.1089/sur.2006.7.s2-113] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infected pancreatic necrosis (IPN) is one of the most severe complications of acute pancreatitis (AP). Sequential surgical debridement represents one of the most effective treatments in terms of morbidity and mortality. The aim of this paper is to describe the quality of life and long-term results (e.g., nutritional, muscular, and pancreatic function) of patients treated by sequential necrosectomy at the Department of Surgery of the University of Insubria (Varese, Italy). METHODS Data were collected on patients undergoing sequential surgical debridement as treatment for IPN. The severity of AP was evaluated using the Ranson criteria, the Acute Physiology and Chronic Health Evaluation (APACHE II) Score, and the Sepsis Score, as well as the extent of necrosis. The surgical approach was through a midline or subcostal laparotomy, followed by exploration of the peritoneal cavity, wide debridement, and peritoneal lavage. The abdomen was either left open or closed partially with a surgical zipper, with multiple re-laparotomies scheduled until debridement of necrotic tissue was complete. The long-term evaluation focused on late morbidity, performance status, and abdominal wall function. RESULTS In the majority of patients (68%), mixed flora were isolated. Pseudomonas aeruginosa was the microorganism identified most commonly (59%), often associated with Candida albicans or C. glabrata. The mean total hospital stay was 71+/-38 days (range 13-146 days), of which 24+/-19 days (range 0-66 days) were in the intensive care unit. Eight patients died, the deaths being caused by multiple organ dysfunction syndrome in seven patients and hemorrhage from the splenic artery in one. Normal exocrine and endocrine pancreatic function was observed in 28 patients (88%). At discharge, four patients had steatorrhea, which was temporary. Eight patients (23%) developed pancreatic pseudocysts, and in six, cystogastostomy was performed. Most patients (29/32, 91%) developed a post-operative hernia, but only five required surgical repair. All patients had a Short Form (SF)-36 score>60%, and 20 of the 32 patients (68%) had scores>70-80% (good quality of life). The worst scores were related to alcoholic pancreatitis. CONCLUSIONS The degree of pancreatic failure (exocrine and endocrine function) is not related to the amount of pancreatic necrosis. Even with a need for repeated laparotomy and multiple surgical procedures, the abdominal wall capacity as well as long-term quality of life remain excellent.
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Olakowski M, Lesiecka M, Handzlik R, Lampe P. Duodenojejunal Anastomosis with Proximal Jejunostomy in the Treatment of Duodenal Necrosis. Visc Med 2006. [DOI: 10.1159/000093366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Isaji S, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Kimura Y, Takeda K, Koizumi M, Otsuki M, Matsuno S. JPN Guidelines for the management of acute pancreatitis: surgical management. ACTA ACUST UNITED AC 2006; 13:48-55. [PMID: 16463211 PMCID: PMC2779397 DOI: 10.1007/s00534-005-1051-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2–3 days. The Japanese (JPN) guidelines were designed to provide recommendations regarding the management of acute pancreatitis in patients having a diversity of clinical characteristics. This article sets forth the JPN guidelines for the surgical management of acute pancreatitis, excluding gallstone pancreatitis, by incorporating the latest evidence for the surgical management of severe pancreatitis in the Japanese-language version of the evidence-based Guidelines for the Management of Acute Pancreatitis published in 2003. Ten guidelines are proposed: (1) computed tomography-guided or ultrasound-guided fine-needle aspiration for bacteriology should be performed in patients suspected of having infected pancreatic necrosis; (2) infected pancreatic necrosis accompanied by signs of sepsis is an indication for surgical intervention; (3) patients with sterile pancreatic necrosis should be managed conservatively, and surgical intervention should be performed only in selected cases, such as those with persistent organ complications or severe clinical deterioration despite maximum intensive care; (4) early surgical intervention is not recommended for necrotizing pancreatitis; (5) necrosectomy is recommended as the surgical procedure for infected pancreatic necrosis; (6) simple drainage should be avoided after necrosectomy, and either continuous closed lavage or open drainage should be performed; (7) surgical or percutaneous drainage should be performed for pancreatic abscess; (8) pancreatic abscesses for which clinical findings are not improved by percutaneous drainage should be subjected to surgical drainage immediately; (9) pancreatic pseudocysts that produce symptoms and complications or the diameter of which increases should be drained percutaneously or endoscopically; and (10) pancreatic pseudocysts that do not tend to improve in response to percutaneous drainage or endoscopic drainage should be managed surgically.
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Affiliation(s)
- Shuji Isaji
- Department of Hepatobiliary Pancreatic Surgery and Breast Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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Watanabe J, Kushihata F, Honda K, Kobayashi N. The usefulness of early laparoscopic surgery for determining a medical treatment plan in severe acute pancreatitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2005; 12:422-5. [PMID: 16258814 DOI: 10.1007/s00534-005-1007-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Accepted: 05/09/2005] [Indexed: 10/25/2022]
Abstract
A 41-year-old woman presented with sudden onset severe epigastric pain. She was diagnosed as having severe acute pancreatitis (SAP) with an APACHE II score of 10, and initially, general supportive therapy was performed. Because the patient's condition kept worsening, early laparoscopic surgery was performed. It revealed swelling, hemorrhagic necrosis of the pancreas, and massive fluid collection in the abdominal cavity. Kocherization and bursectomy were performed for these lesions, and drainage tubes were indwelled. The white blood cell count (WBC) and serum interleukin-6 value prominently improved shortly after the operation, and the WBC count remained at a low level. The patient gradually recovered and was finally discharged 39 days after her initial presentation. To summarize, we performed a successful exploration for SAP, and we found that postoperative continuous lavage effectively eliminated toxic enzymatic exudates in the abdominal cavity and prevent them from circulating. Regarding SAP with peritonitis, early laparoscopic surgery is very useful for determining the pathological extent of the disease and for selecting appropriate treatment options.
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Affiliation(s)
- Jota Watanabe
- First Department of Surgery, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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13
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Necrosis of the duodenum resulting from acute necrotising pancreatitis and treated with complete duodenopancreatectomy. SRP ARK CELOK LEK 2005. [DOI: 10.2298/sarh0512510c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Necrosis of the duodenum resulting from acute necrotising pancreatitis is a rare but potentially lethal complication. A small number of cases has been reported so far, the majority of which having, unfortunately, had a lethal outcome. We present the cases of two patients, a 21-year-old woman and a 54- year-old man, both suffering from extensive duodenal necrosis stemming from acute necrotising pancreatitis, and both cases involving the second and third sections of the duodenum, one of which was probably caused by the thrombosis of nutritive blood vessels, the other by an abscess of the head of the pancreas. Due to the extent of the necrosis of the duodenum, there was no option to close so large a hole or to employ any less drastic procedure, so that a complete duodenopancreatectomy had to be performed. One patient survived and has remained in good health for a period of almost ten years, to date. The other patient died six days after surgery due to infection, in spite of an absence of any sort of anastomic complications.
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Stockinger ZT, Corsetti RL. Pneumoperitoneum from gas gangrene of the pancreas: three unusual findings in a single case. J Gastrointest Surg 2004; 8:489-92. [PMID: 15120375 DOI: 10.1016/j.gassur.2003.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 62-year-old man was first seen with acute pancreatitis with diffuse intrapancreatic gas and pneumoperitoneum. An immediate exploratory operation revealed diffuse pancreatic necrosis but no perforated viscus; postoperatively, the patient rapidly died. This case represents a constellation of extremely rare findings: Clostridium perfringens infection of the pancreas, pancreatic emphysema or "gas gangrene," and pneumoperitoneum without a perforated viscus.
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Affiliation(s)
- Zsolt T Stockinger
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana 70112-2699, USA.
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Antonio P, Mariano S, Luigia R. Correspondence. Perforation of a gastrojejunal anastomosis due to acute pancreatitis revealed by helical computed tomography. Acta Radiol 2003. [DOI: 10.1046/j.1600-0455.2003.00151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
INTRODUCTION Severe acute pancreatitis (SAP) remains a serious disease state difficult to manage. Laparoscopic surgery represents a relatively new solution to this problem. This study was aimed to investigate the feasibility of laparoscopic treatment of SAP and the selection of laparoscopic procedures in various stages of SAP according to different pathologic alterations. METHODS Thirteen patients, 9 men and 4 women with an average age of 46 years old, were diagnosed with SAP. Laparoscopic necrosectomy followed by external drainage were performed on 7 patients with massive fluid collections and/or infected necrosis in acute reaction phase of SAP. For 2 cases in subacute phase characterized by fresh-formed adhesions and encapsulation, laparoscopic intracavitary debridement experienced difficulty. For the other 4 patients in late phase with well-defined pancreatic or peripancreatic pseudocyst/abscess, ultrasound-guided, directly visualized laparoscopic intracavitary debridement, and external drainage were carried out with ease and efficiency. RESULTS Laparoscopic procedures were accomplished successfully on 12 patients (92.3%), except for 1 conversion (7.7%) to open laparotomy owing to poor exposure and hard maneuvers in subacute phase. There was no mortality in this group. Patients were witnessed to have accelerated recovery following laparoscopic surgery. CONCLUSION Laparoscopic technique offers new hope for the treatment of SAP. It is recommended as a feasible, effective, and less traumatic therapeutic means on condition that the strategy of individualization is followed.
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Affiliation(s)
- Zong-Guang Zhou
- Department of General Surgery & Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, Peoples Republic of China
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Abstract
BACKGROUND The appropriate surgical treatment for severe acute pancreatitis has been disputed for a long time. Herein we describe our experience with the laparoscopic treatment of this disease. METHODS Ten patients, seven male and three female, with an average age of 55 years were diagnosed with severe acute pancreatitis. All cases but one were found to be without biliary stones by ultrasonic and CT scans. Laparoscopic exploration, irrigation, drainage, and decompression of the pancreas were performed. Further treatment, including gastric decompression, irrigation via the drainage tubes, antibiotics, somatostatin, and parenteral nutrition, was continued in all patients following the laparoscopic procedures. RESULTS Nine patients recovered successfully; one died from adult respiratory distress syndrome (ARDS) soon after the operation. The hospital stay was 10-30 days. CONCLUSIONS The laparoscopic era offers new hope for the treatment of severe acute pancreatitis. The technique can be used to determine the pathologic extent of the disease, to irrigate and drain the abdominal cavity, and to decompress the pancreas. Almost every surgical procedure for acute pancreatitis can be performed laparoscopically.
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Affiliation(s)
- J F Zhu
- Department of General Surgery, Jinan General Hospital, 25 Shi Fan Road, Jinan, 250031, People's Republic of China
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