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Yin J, Chen Z, Niu W, Feng L, Fan B, Zhou L, Zeng B, Zhang J, Chen H, Tong B, Tong L, Chen X. Using a multidisciplinary team for the staged management and optimally minimally invasive treatment of severe acute pancreatitis. Biosci Trends 2021; 15:180-187. [PMID: 33840680 DOI: 10.5582/bst.2021.01075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe acute pancreatitis (SAP) is a common critical disease with a high mortality rate that involves a complex, rapid change in condition and multiple organ systems. Therefore, a multidisciplinary team (MDT), including staff from the emergency department, intensive care unit, pancreatic surgery, gastroenterology , and imaging, is necessary for the early diagnosis, evaluation, and treatment of patients with SAP. This involves managing the systemic inflammatory response and maintaining organ function in the early stage and managing systemic infection and treatment of peripancreatic complications in the middle-to-late stages. The MDT should be led by departments corresponding to the clinical characteristics of each stage, and those departments should be responsible for the coordination and implementation of treatment by other relevant departments. In the late stage, pancreatic surgery and gastroenterology are the main departments that should manage peripancreatic complications. In line with the principle of minimally invasive treatment, the timely and reasonable selection of endoscopic or minimally invasive surgical debridement can achieve good therapeutic outcomes. Open surgery is also an effective method for treating an intractable massive hemorrhage in the abdominal cavity or necrotic cavity, intractable abdominal compartment syndrome, visceral perforation, and fistulae.
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Affiliation(s)
- Junxiang Yin
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Zhi Chen
- Critical Care Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Wei Niu
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lili Feng
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bing Fan
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Longfei Zhou
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bingliang Zeng
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Jun Zhang
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Hui Chen
- Microbiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bo Tong
- Pulmonary and Critical Care Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lingfei Tong
- Clinical Pharmacy Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Xiaoliang Chen
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
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Gao X, Tang X, Ai L, Gao Q, Liao Q, Chen M, Chen X, Zhou H, Ye Y, Li M, Han J, Wang F. Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immunocell activation. J Am Acad Dermatol 2020; 84:644-653. [PMID: 32561372 PMCID: PMC7297678 DOI: 10.1016/j.jaad.2020.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Complications involving internal organs are usually present in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, pancreatic complications are rarely reported and studied. OBJECTIVE To summarize clinical characteristics of SJS/TEN-associated acute pancreatic injuries and to investigate underlying inflammatory mechanisms. METHODS Clinical records of 124 inpatients with SJS/TEN were reviewed. Serum levels of tumor necrosis factor α, interleukin (IL) 6, IL-18, IL-15, IL-12p70, and soluble CD56 were determined in 18 healthy donors and 17 patients with SJS/TEN, including 3 with acute pancreatic injuries. RESULTS Acute pancreatic injury was diagnosed in 7.3% of patients (9/124) in the SJS/TEN cohort. Elevation of serum transaminase level and hypoalbuminemia occurred more frequently in patients with acute pancreatic injuries compared with those without pancreatic symptoms (P = .004 and <.001, respectively). Although acute pancreatic injury did not alter mortality rate of SJS/TEN, it was associated with longer hospitalization stays (P = .008). Within the serum cytokines whose levels were elevated in SJS/TEN, only IL-18 was found to be selectively increased in patients with acute pancreatic injuries compared with those without them (P = .03). LIMITATIONS Cohort was small. CONCLUSION Acute pancreatic injury is a gastrointestinal complication of SJS/TEN in which hepatotoxicity is more likely to occur. Overexpression of IL-18 might be involved in this unique entity.
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Affiliation(s)
- Xuemei Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Lu Ai
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Qian Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Qiman Liao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Mukai Chen
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Xiaohong Chen
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Hui Zhou
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Yanting Ye
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Minyi Li
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Jiande Han
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong.
| | - Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong.
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