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Ali H, Inayat F, Jahagirdar V, Jaber F, Afzal A, Patel P, Tahir H, Anwar MS, Rehman AU, Sarfraz M, Chaudhry A, Nawaz G, Dahiya DS, Sohail AH, Aziz M. Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality. World J Methodol 2024; 14:91810. [DOI: 10.5662/wjm.v14.i3.91810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus.
AIM To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States.
METHODS A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality.
RESULTS A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06).
CONCLUSION Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.
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Affiliation(s)
- Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
| | - Arslan Afzal
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Pratik Patel
- Division of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
| | - Hamza Tahir
- Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
| | - Muhammad Sajeel Anwar
- Department of Internal Medicine, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Attiq Ur Rehman
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Muhammad Sarfraz
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology, and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
| | - Amir H Sohail
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
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Kejela S, Ager G, Gebremariam MS. Free intraperitoneal air in infected pancreatic necrosis with intraperitoneal rupture: A rare presentation of a complex diseases. Clin Case Rep 2024; 12:e8958. [PMID: 38803324 PMCID: PMC11128488 DOI: 10.1002/ccr3.8958] [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] [Received: 01/20/2024] [Revised: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical Message Among the multitude of causes for acute abdomen patients presenting with free intraperitoneal air, one almost never finds infected pancreatic necrosis as one of the culprits. In patients with risk factors for acute pancreatitis presenting with generalized peritonitis with free intraperitoneal air, consideration should be given to this often deadly entity. Abstract Acute pancreatitis is a morbid acute abdominal pathology that has been increasing in incidence in recent years. Most patients have a mild disease and treated medically, while a few proportion require interventional procedures. We present the case of a 39-year-old male patient who presented with progressive abdominal pain, vomiting, and yellowish discoloration of the eyes. The abdominal condition progressed to the point where clinical signs became consistent with generalized peritonitis and an x-ray finding of free intraperitoneal air. The patient underwent exploratory laparotomy with intraoperative findings of intraperitoneal rupture of infected pancreatic necrosis with intraperitoneal purulent collection. He was managed with necrosectomy and discharged improved after intensive care and general ward stay.
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Affiliation(s)
- Segni Kejela
- Department of Surgery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Genet Ager
- Department of Surgery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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Kosti A, Borakati A, Varma A, Gupta A, Mustafa A, Hakeem A, Quddus A, Sahl AB, Beniwal A, Adesuyi A, Krzak AM, Brooks A, Frampton A, Gadhvi A, Talbot A, Elnogoomi A, Mahgoub A, Naqvi A, Pervez A, Bodla AS, Taha A, Tawfik A, Prabhu A, Puri A, Belgaumkar A, Gupta A, McCrorie A, Findlay A, Healey A, De Prendergast A, Farrugia A, Dosis A, Adiamah A, Sallam A, Wong A, Bradley A, Martin A, Collins A, Awan A, Bond A, Koh A, Kourdouli A, Patel AG, Dhannoon A, Khalil A, Banerjee A, Khan A, Elserafy A, Alamassi A, Owen A, Benjafield A, Zuccarrelli A, Luhmann A, Jones A, Kennedy-Dalby A, Smith AM, Kaul A, Kumar A, White A, Baker A, Minicozzi A, Bardoli A, Golpe AL, Manzelli A, Sivakumar A, Saha A, Shajpal A, Lango A, Cotton A, Nair A, Brown A, Menon A, Tandon A, Afza A, Hassan A, Shamali A, Khalid A, Regan A, Piramanayagam B, Oyewole B, Ibrahim B, Murphy B, Clayton B, Jenkins B, Kumar B, Rybinski B, Khor BY, Davidson BR, Lees B, Blacklock C, Johnstone C, Salinas CH, Boven C, Wolstenholme C, Chin C, Gilmore C, Sharp C, Walker C, Harris C, Khanna C, Ferguson C, Kyriakides C, Bee C, Currow C, Parmar C, Collins C, Halloran C, Smart CJ, Neophytou C, Delaney C, Anele C, Heugh C, Choh CTP, Kenington C, Wyatt C, Borg CM, Mole D, Arumugam D, Gunia D, Porter D, Berry D, Griffith D, Hou D, Longbotham D, Mitton D, Strachan D, Di Mauro D, Worku D, Heaphy D, Dunne D, Yeung D, Arambepola D, Leswas DA, Pournaras DJ, Damaskos D, Saleh D, Osilli D, Pearman D, Whitelaw D, Haq EU, Mack E, Spurring E, Jamieson E, Lenzi E, Gemmill E, Gammeri E, Bota E, Britton E, Farrow E, Lloyd E, Moran E, Itobi E, Craig E, Tanaka E, Chohda E, Muhammad FU, Youssef F, Roslan F, Amir F, Froghi F, Di Franco F, Abbadessa F, DiMaggio F, Gurung G, Faulkner G, Choa G, Kerans G, Davis GN, Galanopoulos G, Karagiannidis G, McCabe G, Mohammadi-Zaniani G, Nawaz G, Van Boxel G, Bond-Smith G, Tierney GM, Muthukumarasamy G, Grey G, Wong G, Finch G, Khan H, Bourne H, Javanmard-Emamghissi H, Murray H, Rottenburg H, Wright H, Khalil H, Spiers HVM, Bashiti H, Shanti H, Ebied H, Ng HJ, Hamid HKS, Kim H, Wilson I, Rajendran I, Gerogiannis I, Patel I, El-Abbassy I, Burridge I, Caldwll J, Jackman J, Clark J, Duncan J, Milburn J, O’Kelly J, Olivier J, Rink J, Royle J, Rai J, Latif J, Ahmad J, Maliyil J, Carr J, Coles J, McGarry J, Apollos J, Lim J, Gray J, Thomas J, Bennett J, Findlay J, Spearman J, Young J, Lund JN, Meilak J, Alfred J, Welsh J, Chan JH, Martin J, Patel K, Ko KYK, Isand K, Razi K, Sarathy K, Powezka K, Foster K, Peleki K, Bevan K, Fox K, Edwards K, Larsen K, Spellar K, Oh KE, Kong K, Brown K, Roberts KJ, Seymour K, Beatson K, Etherson K, Willis K, Mann K, Nizami K, Rajput K, Lavery L, Sawdon L, Nip L, Al-Hamed L, Fagan L, Watton L, Saint-Grant AL, Convie L, Girard LP, Huppler L, Marsh L, Seretny L, Newton L, Buksh M, Sallam M, Mathew M, Prasanth MN, Nayar M, Wijeyaratne M, Hollyman M, Ransome M, Popa M, Galea M, Taylor M, Gismondi M, Michel M, Wadley M, Al-Azzawi M, Claxton M, Kuzman M, Bonomaully M, Newman M, Bhandari M, Courtney M, Jones M, Rarity M, Wilson M, Ebraheem M, Elnaghi M, Mohamed MSN, Al-Hijaji M, Al-Rashedy M, Qayum MK, Zourob M, Gaber M, Rao M, Islam MA, Rashid MU, Zafar M, Naqvi M, Ahmad MN, Telfah M, Merali N, Hanbali N, Gulnaz N, Kumar N, Husain N, Angamuthu N, Murali N, Kirmani N, Assaf N, Doshi N, Shah NS, Basra N, Menezes N, Dai N, Schuijtvlot N, Kansal N, Chidumije N, Yassin N, Babalola O, Oyende O, Williams O, Pawlik O, O'Connor O, Jalil OA, Ryska O, Vaz O, Sarmah P, Jayawardena P, Patel P, Hart P, Cromwell P, Manby P, Marriott P, Needham P, Ghaneh P, Rao PKD, Eves P, Coe PO, May-Miller P, Szatmary P, Ireland P, Seta P, Ravi P, Janardhanan P, Patil P, Mistry P, Heer P, Patel P, Nunes Q, Ain Q, Clifford R, Brindle R, Lee RXN, Lim RQH, Rahman R, Kumar RM, Lunevicius R, Mukherjee R, Lahiri R, Behmida R, Rajebhosale R, Levy R, Chhabra R, Oliphant R, Freeman R, Jones RM, Elkalbash R, Brignall R, Bell R, Byrom R, Laing RW, Patel R, Buhain R, Clark R, Sutton R, Presa R, Lawther R, Patel R, Zakeri R, Mashar R, Wei R, Baron R, Tasleem S, Kadambot SS, Azam S, Wajed S, Ali S, Body S, Saeed S, Bandyopadhyay S, Mohamed S, Pandanaboyana S, Hassasing S, Dyer S, Small S, Seeralakandapalan S, Arumugam S, Chakravartty S, Ong SL, Ooi SZY, Nazir S, Zafar S, Shirazi S, Bharucha S, Majid S, Ahmed S, Rajamanickam SK, Albalkiny S, Ng S, Chowdhury S, Yahia S, Handa S, Fallis S, Fisher S, Jones S, Phillips S, Mitra S, Aroori S, Thanki S, Rozwadowski S, Tucker S, Conroy S, Barman S, Bhat S, McCallion S, Knight SR, Tezas S, van Laarhoven S, Cowie S, Rao S, Sellahewa S, Bhatti S, Kaistha S, Moug SJ, Argyropoulos S, Virupaksha S, Difford T, Shikh-Bahaei T, Saafan T, Lo T, Magro T, Gala T, Katbeh T, Athwal T, Lo T, Fraser T, Anyomih T, Chase TJG, Walker T, Ward T, Gallagher TK, Richardson T, Wiggins T, Ali U, Patnam V, Kanakala V, Beynon V, Hudson VE, Morrison-Jones V, Korwar V, Massella V, Parekh V, Ng V, Toh WH, Toh W, Hawkins W, Cambridge W, Harrison W, Tan YY, Aal YA, Malam Y, Toumi Z, Khaddar ZA, Bleything Z. PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK. BJS Open 2023; 7:zrad008. [PMID: 37161673 PMCID: PMC10170253 DOI: 10.1093/bjsopen/zrad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. METHODS All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. RESULTS A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. CONCLUSION Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.
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Alzerwi N. Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches. World J Gastrointest Surg 2023; 15:307-322. [PMID: 37032793 PMCID: PMC10080605 DOI: 10.4240/wjgs.v15.i3.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/19/2022] [Accepted: 02/15/2023] [Indexed: 03/27/2023] Open
Abstract
Acute pancreatitis (AP) is a serious condition presenting catastrophic consequences. In severe AP, the mortality rate is high, and some patients initially diagnosed with mild-to-moderate AP can progress to a life-threatening severe state. Treatment of AP has evolved over the years. Drainage was the first surgical procedure performed for AP; however, later, surgical approaches were replaced by more conservative approaches due to the availability of advanced medical care and improved understanding of the course of AP. Currently, surgery is used to manage several complications of AP, such as pseudocysts, pancreatic fistulas, and biliary tract obstruction. Patients who are unresponsive to conservative treatment or have complications are typically considered for surgical intervention. This review focuses on the surgical approaches (endoscopic, percutaneous, and open) that have been established in recent studies to treat this acute condition and summarizes the common management guidelines for AP, discussing the relevant indications, significance, and complications. It is evident that despite their reduced involvement, surgeons lead the multidisciplinary care of patients with AP; however, given the gaps in existing knowledge, more research is required to standardize surgical protocols for AP.
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Affiliation(s)
- Nasser Alzerwi
- Department of Surgery, Majmaah University, Riyadh 11952, Saudi Arabia
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Ghabili K, Shaikh J, Pollak J, Elwood D, Majdalany BS, Nezami N. Percutaneous Chemical and Mechanical Necrosectomy for Walled-Off Pancreatic Necrosis. J Vasc Interv Radiol 2023; 34:454-459.e2. [PMID: 36423816 DOI: 10.1016/j.jvir.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/07/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To test the hypothesis that percutaneous combined chemical and mechanical necrosectomy using a Malecot anchor drain and an Arrow-Trerotola percutaneous thrombolytic device (PTD) in patients with walled-off pancreatic necrosis (WOPN) is feasible, safe, and effective compared with a control group undergoing mechanical necrosectomy alone. MATERIALS AND METHODS In a retrospective analysis, patients with WOPN not amenable to endoscopic-guided cystogastrostomy placement were studied as case and control groups. The patients in the case group underwent percutaneous combined chemical (hydrogen peroxide 3%) and mechanical necrosectomy using a Malecot anchor drain and/or Arrow-Trerotola PTD from December 2020 to April 2022. The controls underwent mechanical necrosectomy alone without chemical necrosectomy. Clinical success was defined as complete resolution of the cavity on follow-up noncontrast computed tomography scans with subsequent drain removal. RESULTS Thirteen patients in the case group and 11 patients in the control group underwent percutaneous drain placement followed by percutaneous combined chemical and mechanical necrosectomy (case group) or mechanical necrosectomy only (control group) for WOPN. Drain placement and necrosectomy were technically successful in all patients studied. One patient in the case group developed postprocedural sepsis because of communication between the cavity and the splenic vein. Another patient in the case group developed bleeding from a branch of the pancreaticoduodenal artery on postnecrosectomy day 9, which was successfully embolized by interventional radiology. No pancreaticocutaneous fistula was reported at the 3-month follow-up. The clinical success rates in the case and control groups were 100% and 38.4%, respectively (P = .003). CONCLUSIONS Percutaneous combined chemical and mechanical necrosectomy is a feasible, safe, and effective treatment of WOPN.
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Affiliation(s)
- Kamyar Ghabili
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Jamil Shaikh
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Vascular and Interventional Radiology, Tampa General Hospital, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - David Elwood
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nariman Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland.
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Hidalgo NJ, Pando E, Alberti P, Mata R, Fernandes N, Adell M, Villasante S, Blanco L, Balsells J, Charco R. The role of high serum triglyceride levels on pancreatic necrosis development and related complications. BMC Gastroenterol 2023; 23:51. [PMID: 36829113 PMCID: PMC9955530 DOI: 10.1186/s12876-023-02684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. METHODS We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (< 150 mg/dL), Borderline-high TG (150-199 mg/dL), High TG (200-499 mg/dL) and Very high TG (≥ 500 mg/dL). We analyzed the association of TG levels and other risk factors with the development of pancreatic necrosis. RESULTS A total of 211 patients were included. In the Normal TG group: 122, in Borderline-high TG group: 38, in High TG group: 44, and in Very high TG group: 7. Pancreatic necrosis developed in 29.5% of the patients in the Normal TG group, 26.3% in the Borderline-high TG group, 52.3% in the High TG group, and 85.7% in the Very high TG group. The trend analysis observed a significant association between higher TG levels and pancreatic necrosis (p = 0.001). A multivariable analysis using logistic regression showed that elevated TG levels ≥ 200 mg/dL (High TG and Very high TG groups) were independently associated with pancreatic necrosis (OR: 3.27, 95% CI - 6.27, p < 0.001). CONCLUSIONS An elevated TG level at admission ≥ 200 mg/dl is independently associated with the development of pancreatic necrosis. The incidence of pancreatic necrosis increases proportionally with the severity of HTG.
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Affiliation(s)
- Nils Jimmy Hidalgo
- grid.7080.f0000 0001 2296 0625Universitat Autonoma de Barcelona, Bellaterra, Spain ,grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Bellaterra, Spain. .,Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, 119 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.
| | - Piero Alberti
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Rodrigo Mata
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Nair Fernandes
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Montse Adell
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Sara Villasante
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Laia Blanco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Joaquim Balsells
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Ramon Charco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
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Has COVID-19 Modified the Weight of Known Systemic Inflammation Indexes and the New Ones (MCVL and IIC) in the Assessment as Predictive Factors of Complications and Mortality in Acute Pancreatitis? Diagnostics (Basel) 2022; 12:diagnostics12123118. [PMID: 36553125 PMCID: PMC9777733 DOI: 10.3390/diagnostics12123118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed at evaluating the prognostic capacity of the inflammatory indices derived from routine complete blood cell counts in two groups of patients with acute pancreatitis from two different time periods, before and during the COVID-19 pandemic, when a high incidence of complications with surgical risk and mortality was found. Two new markers were introduced: the mean corpuscular volume to lymphocyte ratio (MCVL) and the cumulative inflammatory index (IIC), which were calculated at a baseline in the two groups of patients. Of the already established markers, none of them managed to effectively predict the complications with surgical risk and mortality, with a decrease of less than 50% in specificity in the peri-COVID group. The MCVL had the best prediction of complications with surgical risk in both the pre-COVID and peri-COVID groups, validated it as an independent factor by multivariate analysis. The IIC had the best prediction of mortality in both periods and was proven to be an independent factor by multivariate analysis. As the IIC predicted death best, we tested the occurrence of death and found that patients with PA who had an IIC > 12.12 presented a risk of death 4.08 times higher in the pre-COVID group and 3.33 times higher in the peri-COVID group. The new MCVL and IIC independent markers had a superior sensitivity and specificity in predicting surgical risk complications and, respectively, mortality in the group of patients with acute pancreatitis during the COVID-19 pandemic, which makes them widely applicable in populations with modified immune and inflammatory status. Conclusions: In patients with acute pancreatitis, MCVL has a significant predictive value regarding complications with surgical risk (abscess, necrosis, and pseudocyst), and the IIC has a significant predictive value for mortality.
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Hong XX, Wang HY, Yang JM, Lin BF, Min QQ, Liang YZ, Huang PD, Zhong ZY, Guo SJ, Huang B, Xu YF. Systemic injury caused by taurocholate‑induced severe acute pancreatitis in rats. Exp Ther Med 2022; 24:468. [PMID: 35747153 PMCID: PMC9204573 DOI: 10.3892/etm.2022.11395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/13/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xin-Xin Hong
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Hong-Yan Wang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Jiong-Ming Yang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Bao-Fu Lin
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Qin-Qin Min
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Yi-Zhong Liang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Pei-Di Huang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Zi-You Zhong
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Shao-Ju Guo
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Bin Huang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Yi-Fei Xu
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
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9
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Zhang S, Han Z, Zhang Y, Gao X, Zheng S, Wang R, Wu D. Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study. Front Pharmacol 2022; 12:772975. [PMID: 34970144 PMCID: PMC8712680 DOI: 10.3389/fphar.2021.772975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP. Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP. Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups. Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005). Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.
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Affiliation(s)
- Shengyu Zhang
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziying Han
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - Xiaomao Gao
- Department of Gastroenterology, The Sixth Hospital of Beijing, Beijing, China
| | - Shicheng Zheng
- Department of Gastroenterology, West China Longquan Hospital Sichuan University, Chengdu, China
| | - Ruifeng Wang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dong Wu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
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10
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Ashraf H, Colombo JP, Marcucci V, Rhoton J, Olowoyo O. A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management. Cureus 2021; 13:e19764. [PMID: 34938639 PMCID: PMC8684888 DOI: 10.7759/cureus.19764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
An inflammatory process involving the pancreas, known as pancreatitis, can be categorized as either acute or chronic and may present in one of many ways. The clinical manifestations of acute pancreatitis are generally limited to epigastric or right upper quadrant pain, while manifestations of chronic pancreatitis are broader and may include abdominal pain in tandem with signs and symptoms of pancreatic endocrine and exocrine insufficiency. An understanding of the initial insult, proper classification, and prognosis are all factors that are of paramount importance as it pertains to managing patients who are afflicted with this disease. Our review delves into the depths of pancreatitis by exploring the embryology and anatomy of the pancreas, the pathophysiology and etiology of acute and chronic pancreatitis, and the medical and surgical management of acute and chronic pancreatitis.
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Affiliation(s)
- Hamza Ashraf
- Medical Education, St. Peter's University Hospital, New Brunswick, USA
| | - John Paul Colombo
- Medical Research, St. Peter's University Hospital, New Brunswick, USA.,Medical Research, St. George's University School of Medicine, True Blue, GRD
| | | | - Jonathan Rhoton
- Surgery, Hackensack University Medical Center, Hackensack, USA
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11
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Sudarsanam H, Ethiraj D, Govarthanan NK, Kalyanasundaram S, Chitra SA, Mohan S. COVID-19 Associated Acute Necrotizing Pancreatitis with Normal Serum Amylase and Lipase Levels: Report of an Unusual Finding. Oman Med J 2021; 36:e304. [PMID: 34733550 PMCID: PMC8557306 DOI: 10.5001/omj.2021.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Coronaviruses are a large family of single-stranded RNA viruses infecting humans and animals, causing a multitude of symptoms. COVID-19 is not only known to affect the respiratory system, but shows unusual gastrointestinal complications. Pancreatitis can be caused by biliary stones, alcohol abuse, viruses, drug intake, metabolic syndromes, or trauma. Diagnosis of acute pancreatitis requires any two of the three criteria: acute onset of severe upper abdominal pain, consistent with pancreatitis; elevation of serum amylase or lipase, three times the upper limit of normal; and/or characteristic imaging findings. COVID-19 associated pancreatitis is thought to be mediated by the angiotensin-converting enzyme-2 receptor on the host cells, which are highly expressed in the pancreatic cells. Here, we report a unique case of acute necrotizing pancreatitis caused by COVID-19 with hyperglycemia and normal amylase and lipase levels.
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Affiliation(s)
- Hemanth Sudarsanam
- Department of Radio-diagnosis, Dr. Rela Institute and Medical Centre, Chennai, India
| | - Dillibabu Ethiraj
- Department of Radio-diagnosis, Dr. Rela Institute and Medical Centre, Chennai, India
| | | | | | | | - Saisurendar Mohan
- Department of Emergency Medicine, Dr. Rela Institute and Medical Centre, Chennai, India
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12
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Shi N, Sun GD, Ji YY, Wang Y, Zhu YC, Xie WQ, Li NN, Han QY, Qi ZD, Huang R, Li M, Yang ZY, Zheng JB, Zhang X, Dai QQ, Hou GY, Liu YS, Wang HL, Gao Y. Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study. World J Gastroenterol 2021; 27:6453-6464. [PMID: 34720534 PMCID: PMC8517775 DOI: 10.3748/wjg.v27.i38.6453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common acute pancreatitis (AP)-associated complications that has a significant effect on AP, but the factors affecting the AP patients’ survival rate remains unclear.
AIM To assess the influences of AKI on the survival rate in AP patients.
METHODS A total of 139 AP patients were included in this retrospective study. Patients were divided into AKI group (n = 72) and non-AKI group (n = 67) according to the occurrence of AKI. Data were collected from medical records of hospitalized patients. Then, these data were compared between the two groups and further analysis was performed.
RESULTS AKI is more likely to occur in male AP patients (P = 0.009). AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score, higher Sequential Organ Failure Assessment score, lower Glasgow Coma Scale score, and higher demand for mechanical ventilation, infusion of vasopressors, and renal replacement therapy than AP patients in non-AKI group (P < 0.01, P < 0.01, P = 0.01, P = 0.001, P < 0.01, P < 0.01, respectively). Significant differences were noted in dose of norepinephrine and adrenaline, duration of mechanical ventilation, maximum and mean values of intra-peritoneal pressure (IPP), maximum and mean values of procalcitonin, maximum and mean serum levels of creatinine, minimum platelet count, and length of hospitalization. Among AP patients with AKI, the survival rate of surgical intensive care unit and in-hospital were only 23% and 21% of the corresponding rates in AP patients without AKI, respectively. The factors that influenced the AP patients’ survival rate included body mass index (BMI), mean values of IPP, minimum platelet count, and hospital day, of which mean values of IPP showed the greatest impact.
CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI, which necessitates further attention to AP patients with AKI in surgical intensive care unit.
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Affiliation(s)
- Ni Shi
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Guo-Dong Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yuan-Yuan Ji
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Ying Wang
- Department of Critical Care Medicine, The First People Hospital of Mudanjiang city, Mudanjiang 157000, Heilongjiang Province, China
| | - Yu-Cheng Zhu
- Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan 155811, Heilongjiang Province, China
| | - Wan-Qiu Xie
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Na-Na Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Qiu-Yuan Han
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Zhi-Dong Qi
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Rui Huang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Ming Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Zhen-Yu Yang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Jun-Bo Zheng
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Xing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Qing-Qing Dai
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Gui-Ying Hou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Yan-Song Liu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Hong-Liang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Yang Gao
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
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13
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Affiliation(s)
- Amy Y Li
- Department of Surgery, Section of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, Room H3591, Stanford, CA 94305, USA
| | - John R Bergquist
- Department of Surgery, Section of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, Room H3591, Stanford, CA 94305, USA
| | - Brendan C Visser
- Department of Surgery, Section of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305-5655, USA.
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14
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Rana SS, Sharma R, Kishore K, Dhalaria L, Gupta R. Safety and Efficacy of Early (<4 Weeks of Illness) Endoscopic Transmural Drainage of Post-acute Pancreatic Necrosis Predominantly Located in the Body of the Pancreas. J Gastrointest Surg 2021; 25:2328-2335. [PMID: 33547585 DOI: 10.1007/s11605-021-04945-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic transmural drainage is usually not performed for pancreatic necrotic collection (PNC) < 4 weeks after onset of acute necrotizing pancreatitis (ANP) because of lack of encapsulating wall and increased risk of complications. OBJECTIVE Study safety and efficacy of early (<4 weeks) endoscopic transluminal drainage in patients with symptomatic PNC. METHODS Retrospective analysis of data base of patients with PNC treated with endoscopic transmural drainage within 4 weeks of onset of ANP (early drainage) was done. The outcomes and complications were compared with patients with PNC who underwent delayed endoscopic drainage (≥4 weeks of onset of ANP). RESULTS Thirty-four patients (26 males; mean age: 35.9 ± 8.6 years) underwent early and 136 patients (115 males; mean age: 37.9 ± 9.4 years) underwent delayed endoscopic drainage. The PNC was significantly larger (12.3 ± 2.1 cm vs 10.5 ± 2.7 cm, p <0.001) with increased solid component (47.7 ± 8.9% vs 28.3 ± 11.7%, p <0.001) in the early group. Clinical success was achieved in 94% patients in the early group and all patients in the delayed group. Direct endoscopic necrosectomy was performed more frequently in the early group (50% vs 7.4%; p<0.001). There was increased mortality (5.7% vs 0%), need for rescue surgical necrosectomy (5.7% vs 0%), and clinically significant bleeding (20% vs 1.5%, p<0.001) in the early group as compared to the delayed group. CONCLUSION Early endoscopic drainage of PNC is feasible and seems to be safe as well as effective but is associated with increased risk of complications as compared to delayed drainage.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Lovneet Dhalaria
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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15
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Pandit N, Awale L, Deo KB, Pradhan B. Post-pancreatic necrosectomy biliary fistula: thinking beyond the box. J Surg Case Rep 2021; 2021:rjab189. [PMID: 33996025 PMCID: PMC8110302 DOI: 10.1093/jscr/rjab189] [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] [Received: 03/25/2021] [Accepted: 04/18/2021] [Indexed: 11/14/2022] Open
Abstract
Walled-off pancreatic necrosis is a challenging problem and pancreatic necrosectomy is associated with significant morbidity and mortality. Following necrosectomy, postoperative bile leak is a rare complication. We present such a case of delayed bile leak from the distal common bile duct in an 81-year-old lady following pancreatic necrosectomy, which was successfully managed by endoscopic stenting.
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Affiliation(s)
- Narendra Pandit
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Laligen Awale
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Kunal Bikram Deo
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Bickram Pradhan
- Department of Gastroenterology and Hepatology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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16
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Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy. Case Rep Surg 2021; 2021:5532096. [PMID: 33815860 PMCID: PMC7990526 DOI: 10.1155/2021/5532096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day. Conclusion The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.
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17
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Prajapati R, Manay P, Sugumar K, Rahandale V, Satoskar R. Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention. Turk J Surg 2021; 37:13-21. [PMID: 34585089 PMCID: PMC8448565 DOI: 10.47717/turkjsurg.2021.5072] [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: 11/03/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP. MATERIAL AND METHODS This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson's score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups. RESULTS A total of 100 patients with AP were treated during out study period. Ranson's score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p <0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p <0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson's score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p <0.05). CONCLUSION We validate SIRS, Ranson's, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.
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Affiliation(s)
- Ramlal Prajapati
- Department of Surgery, University Hospitals, Seidman Cancer Center, Cleveland, United States
| | - Priyadarshini Manay
- Department of Transplant Surgery, University of Iowa Hospitals & Clinics, Iowa City, United States
| | - Kavin Sugumar
- Department of Surgery, University Hospitals, Seidman Cancer Center, Cleveland, United States
| | - Vinay Rahandale
- Department of Surgery, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Rajeev Satoskar
- Department of Surgery, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
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18
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Rebhun J, Nassani N, Pan A, Hong M, Shuja A. Outcomes of Open, Laparoscopic, and Percutaneous Drainage of Infected Walled-Off Pancreatic Necrosis: A Nationwide Inpatient Sample Study. Cureus 2021; 13:e12972. [PMID: 33654633 PMCID: PMC7913891 DOI: 10.7759/cureus.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN. Methods Using the Nationwide Inpatient Sample (NIS), patients aged 18 years and older discharged with the diagnosis of WOPN between January 1, 2016 and December 31, 2016 who underwent open, laparoscopic, or percutaneous drainage were included. Patients’ characteristics including age, gender, and body mass index were reported. The primary endpoints were the mortality rate as well as length and cost of stay in each group. The secondary endpoint was the rate of procedural complications in each arm. Endpoints were reported and compared with studies assessing similar outcomes. Statistical Analysis System (SAS) statistical software (SAS Institute Inc., Cary, NC, USA) was used to perform the analysis. Results A total of 229 patients with the diagnosis of acute pancreatitis with infected necrosis were identified. Of these 229 patients, 27, 15, and 20 underwent open, laparoscopic, and percutaneous drainage, respectively. A total of eight studies were used for comparison of outcome variables. Mortality rate was found to be similar among comparison studies. LOS and costs varied widely among studies. There were significantly fewer pancreatic fistula and significantly more multi-organ failure complications as a result of open necrosectomy in the NIS study sample. Conclusion Overall, in analyzing the outcomes of patients undergoing intervention for infected WOPN through the 2016 NIS database, it appears that the database is representative of the majority of outcomes seen in similar clinical trials.
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Affiliation(s)
- Jeffrey Rebhun
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Najib Nassani
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Alex Pan
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Mindy Hong
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Asim Shuja
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
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