Compartment Syndromes ; diagnosis ; etiology ; therapy ; Humans ; Pancreatitis, Acute Necrotizing ; complications

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ² test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ²=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ²=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.
Male ; Female ; Humans ; Retrospective Studies ; Pancreatitis, Acute Necrotizing/complications* ; Acute Disease ; Intraabdominal Infections/complications* ; Necrosis/complications* ; Treatment Outcome

Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7%) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
*Abdomen ; *Compartment Syndromes/diagnosis ; *Compartment Syndromes/etiology ; *Compartment Syndromes/surgery ; Decompression, Surgical ; *Multiple Organ Failure/diagnosis ; *Multiple Organ Failure/etiology ; *Multiple Organ Failure/surgery ; *Pancreatitis, Acute Necrotizing/complications ; *Pancreatitis, Acute Necrotizing/diagnosis ; *Pancreatitis, Acute Necrotizing/surgery

BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
Bacterial Infections/diagnosis/*prevention & control ; Humans ; Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy ; Retrospective Studies ; Treatment Outcome

Infected pancreatic necrosis(IPN) is the main surgical indication of acute pancreatitis. Minimally invasive debridement has become the mainstream surgical strategy of IPN,and it is only preserved for IPN patients who are not response for adequate non-surgical treatment. Transluminal or retroperitoneal drainage is preferred,and appropriate debridement can be performed. At present,it is reported that video assisted transluminal,trans-abdominal and retroperitoneal approaches can effectively control IPN infection. However,in terms of reducing pancreatic leakage and other complications,surgical and endoscopic transgastric debridement may be the future direction in the treatment of IPN.
Humans ; Pancreatitis, Acute Necrotizing/complications* ; Acute Disease ; Debridement/methods* ; Endoscopy/methods* ; Drainage/methods* ; Intraabdominal Infections/complications* ; Treatment Outcome

OBJECTIVETo investigate the therapeutic effects of double filtration plasmapheresis(DFPP) in treatment of hyperlipidemic acute pancreatitis.

METHODSNine patients with acute hyperlipidemic pancreatitis were treated with DFPP in addition to the conventional therapeutic measures. The clinical symptoms,serum levels of triglyceride (TG) and APACHE II scores were observed before and after DFPP.

RESULTAfter DFPP the clinical symptoms of patients were improved greatly; serum levels of TG decreased from (83.48 +/-2.54)mmol/L to (4.09 +/-0.65)mmol/L(P<0.01) and APACHE II scores decreased from 12.2 +/- 2.3 to 6.2 +/- 1.3(P <0.05). There were no significant side effects during and after DFPP.

CONCLUSIONDFPP can be effectively and safely applied in patients with acute hyperlipidemic pancreatitis.

Acute Disease ; Adult ; Female ; Filtration ; methods ; Hemofiltration ; methods ; Humans ; Hyperlipidemias ; etiology ; therapy ; Male ; Middle Aged ; Pancreatitis ; complications ; therapy ; Pancreatitis, Acute Necrotizing ; therapy ; Plasmapheresis ; instrumentation ; Young Adult

OBJECTIVETo summarize our hospital's experience in the diagnosis and treatment of Candida infection in patients with acute necrotizing pancreatitis (ANP).

METHODSSeventy-eight cases with ANP were reviewed. There were diagnoses either by operative finding or by CT scanning. Sixty-two cases received prophylactic antibiotic treatment, other sixteen did not. For cultivation of Candida, blood, urine, stool, sputum and wound drainage fluid culture, and swabs were examined microbiologically for fungi.

RESULTSThe incidence of Candida infection in all patients with ANP was 17.9% (14/78) and mortality was 28.6% (4/14). The incidence of prophylactic antibiotic group was 19.4% (12/62) and mortality was 25.0% (3/12). Non prophylactic group was 12.5% (2/16) and 50.0%.

CONCLUSIONSOur data provide evidence for the clinical significance of Candida infection in patients with ANP. The current prophylactic antibiotic treatment can prevent a septic course of the ANP, but might lead to the evolution of Candida infection.

Adult ; Aged ; Aged, 80 and over ; Candidiasis ; drug therapy ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; complications ; drug therapy

OBJECTIVETo investigate the clinical treatment of pancreatic encephalopathy (PE) complicated in severe acute pancreatitis (SAP) patients.

METHODSClinical data of 22 PE cases in 326 SAP patients admitted from January 1987 to December 2006 were collected and analyzed retrospectively. The incidence, clinical manifestation and therapy methods of PE were discussed respectively.

RESULTSAll the cases were divided into 2 subgroups according to the changing of treatment strategy for SAP in the past 20 years. Thirteen cases of PE complicated in 114 SAP patients during the first decade (1987 - 1996) with the incidence of 11.4%, including eight early pancreatic encephalopathy (EPE) ones and five cases of delayed pancreatic encephalopathy (DPE). Only one patient survived and the mortality was 92.3%. During the second decade (1997 - 2006), nine cases of PE (all EPE) were observed in 212 SAP patients. The incidence was 4.2% and they all survived. Patients with PE usually presented with dysphoria, disturbance of orientation, lethargy, illusion and even coma. Physical examination of nerve system could find signs of meningeal irritation, increased intracranial pressure and elevated amylase in cerebrospinal fluid. Fungal infection and body fluid and metabolic disturbance frequently complicated in DPE patients. The total incidence was 6.6% (22/326) and mortality was 54.5% (12/22). Death mostly happened in the first ten years and all died with multiple organ failure.

CONCLUSIONSElimination of different causes would be effective to decrease the incidence and intensive cerebral resuscitation and nerve nutrition therapy in the early stage is very important to decrease the mortality.

Aged ; Brain Diseases ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; complications ; therapy ; Retrospective Studies

Mini-invasive surgical or endoscopic step-up approach is the first choice of pancreatic necrosectomy for infected wall-off necrosis. Surgical debridement has the advantage of high efficiency,low cost and good accessibility,while the complication rate of pancreatic fistula and incision hernia after endoscopic necrosectomy is low.Laparoscopic transgastric necrosectomy(LTGN) can combine the advantages of surgical and endoscopic debridement,and may become one of the important methods for the surgical treatment of necrotizing pancreatitis in the future. This paper focuses on the technical advantages,surgical points,indications and application status of LTGN,so as to provide reference for the technical promotion.
Debridement/methods* ; Drainage/methods* ; Humans ; Laparoscopy/methods* ; Necrosis/complications* ; Pancreatitis, Acute Necrotizing/surgery* ; Tomography, X-Ray Computed ; Treatment Outcome

The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5% (17/19), the incidence of re-bleeding after TAE was 36.8% (7/19) and the successful rate of hemostatis by second TAE was 71.4% (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery; In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.
Aneurysm, False/diagnosis ; Aneurysm, False/etiology ; Aneurysm, False/therapy ; *Embolization, Therapeutic/methods ; Hemoperitoneum/diagnosis ; Hemoperitoneum/etiology ; Hemoperitoneum/*therapy ; Pancreatic Pseudocyst/diagnosis ; Pancreatic Pseudocyst/etiology ; Pancreatic Pseudocyst/therapy ; Pancreatitis, Acute Necrotizing/*complications ; Pancreatitis, Acute Necrotizing/therapy ; Retrospective Studies