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

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

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

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

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis.
Acute Disease ; Colonic Diseases/*diagnosis/etiology ; Constriction, Pathologic/diagnosis ; Diagnosis, Differential ; Humans ; Intestinal Obstruction/*diagnosis/etiology/surgery ; Male ; Middle Aged ; Pancreatitis/complications/*diagnosis ; Pancreatitis, Acute Necrotizing/complications/*diagnosis ; Tomography, X-Ray Computed

Hypertriglyceridemia (HTG) is a rare cause of pancreatitis. However, the relationship between acute pancreatitis and severe HTG is well recognized. We report a case of necrotizing pancreatitis due to severe HTG (type IV) in a patient with poorly controlled diabetes. It was of particular interest that serum pancreatic enzymes were normal even though the imaging studies indicated the presence of necrotizing pancreatitis. Our case clearly demonstrates the various indices of HTG-induced necrotizing pancreatitis with a normal pancreatic enzyme level despite there being a serum triglyceride level < or=1,000 mg/dL. We present this case with a review of literature for hyperlipidemic pancreatitis in Korea.
Adult ; Diabetes Mellitus, Type 2/complications/diagnosis ; Humans ; Hypertriglyceridemia/complications/*diagnosis ; Male ; Pancreatitis, Acute Necrotizing/*diagnosis/etiology ; Tomography, X-Ray Computed ; Triglycerides/blood

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 ; Adult ; Aged ; Compartment Syndromes ; diagnosis ; etiology ; surgery ; Decompression, Surgical ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; diagnosis ; etiology ; surgery ; Pancreatitis, Acute Necrotizing ; complications ; diagnosis ; surgery

OBJECTIVETo report the experience in diagnosis and management of bleeding pseudoaneurysms associated with severe acute pancreatitis (SAP).

METHODSThe medical records of 12 patients with bleeding pseudoaneurysms associated with SAP treated between October 1990 and October 2006 were retrospectively reviewed. The etiologies of the 12 patients were gallstones in 6 patients, hyperlipidemia in 3 patients, hyperparathyroidism in 1 patient and the other 2 patients had no definitive causes.

RESULTSAbdominal computed tomography revealed bleeding pseudoaneurysms in 6 of 9 patients. Angiography determined correct diagnosis in 12 patients (12/12). The most involved vessels were peripancreatic arteries. Eight patients were managed by trans-catheter arterial embolization (TAE) as "one point" (a proximal point of the pseudo-aneurysm). Two patients were treated by TAE as "two points" (both distal and proximal to the pseudo-aneurysm). The last two cases were treated by surgery as suture and ligation. Four of the "one point" TAE patients were re-bleeding 4 to 7 days later, and 2 of them were treated with surgery, the other 2 patients were controlled with "two points" TAE. Three patients were died of infection and multiple organ dysfunction syndromes. Overall mortality rate was 25% (3/12).

CONCLUSIONSAngiography is the main diagnostic methods for bleeding pseudoaneurysms in SAP patients. "Two points" embolization and emergency surgery are an effective treatment options in these patients.

Adult ; Aged ; Aneurysm, False ; diagnosis ; etiology ; therapy ; Aneurysm, Ruptured ; diagnosis ; etiology ; therapy ; Angiography ; Embolization, Therapeutic ; Female ; Hemorrhage ; diagnosis ; etiology ; therapy ; Humans ; Ligation ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the principle and measures of combined treatment of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP).

METHODSThe clinical data of 54 patients with HL-SAP including two phases from January 1996 to December 2000 and from January 2001 to August 2006 were analyzed retrospectively. In the first phase, 25 patients were performed by routine methods to decrease triglyceride, or additional operative treatments. In the second phase, 29 cases were treated by multiple ways of non-operative combined therapy, or additional operative treatments mainly by minimally invasive procedures.

RESULTSAmong 54 cases with HL-SAP, 33 cases (61.1%) received non-operative therapy and 21 cases (38.9%) received surgical intervention. Overall mortality was 18.5% (10/54). In the first phase of 25 cases, the mortality in non-operative group and surgical intervention group was 21.4% (3/14) and 36.3% (4/11), respectively. In the second phase of 29 cases, the mortality in non-operative group and surgical intervention group was 10.5% (2/19) and 10.0% (1/10), respectively. The overall curative rate, morbidity, overall mortality, content of triglyceride at the fourth day after onset, APACHE II score at the fourth day after onset and average stay were obviously improved in the second phase compared with the first phase (P < 0.05).

CONCLUSIONSAccording to individualized therapy principles, treatment for HL-SAP should emphasis on multiple ways of non-operative combined therapy and appropriate choices of the timing, indication in surgical intervention. And the choice of operative procedure should follow the principle of minimally invasive surgery. Meanwhile, pay more attention to monitoring and controlling the level of triglyceride post-discharge for the patients with the history of HL-SAP.

Adult ; Aged ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Hyperlipidemias ; complications ; therapy ; Hypolipidemic Agents ; therapeutic use ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pancreatitis, Acute Necrotizing ; diagnosis ; etiology ; therapy ; Prognosis ; Retrospective Studies

Acute necrotizing pancreatitis often progresses into infection, sepsis, multiorgan failure and then, mortality and morbidity which are very high. From January 1988 to December 1996, 14 patients with surgically proved acute necrotizing pancreatitis at the Department of Surgery, Catholic University were analysed. 1) The patients consisted of 12 men and 2 women ranging in age from 27 to 74 years. 2) The ethiological factors included excessive alcohol abuse in 8 patients, biliary tract disease in 2 patients and unknown in 4 patients. 3) In clinical findings, the majority of the patients complained of sudden severe upper abdominal pain, nausea and vomiting, tachycardia, and abdominal distension. 4) Serum amylase level did not increase in 50% although the necrosis was severe, but aspartate transaminase increased in 13 cases. The lactic dehydrogenase and C-reactive protein increased in all tested cases. 5) In regards to diagnostic methods, computerized tomography was highly effective in getting early diagnosis and in finding the complications. 6) Early necrosectomy and drainage procedure was safe and effective. 7) Postoperative complications included pulmonary complications in 3 patients, pancreas fistula in 2, pancreas pseudocyst in 2, acute renal failure in 2, Diabetes mellitus in 2, gastrointestinal bleeding 1, and subphrenic abscess in 1 case. 8) Mortality rate was 36 %. In conclusion, computerized tomography may be used for early detection of acute necrotizing pancreatitis;. Aspartate transaminase, Lactate dehydrogenase and C-reactive protein may be good diagnostic and prognostic indicators upon admission. Necrosectomy and drainage should be chosen as the best surgical treatment in acute necrotizing pancreatitis patients.
Abdominal Pain ; Acute Kidney Injury ; Alcoholism ; Amylases ; Aspartate Aminotransferases ; Biliary Tract Diseases ; C-Reactive Protein ; Diabetes Mellitus ; Drainage ; Early Diagnosis ; Female ; Fistula ; Hemorrhage ; Humans ; L-Lactate Dehydrogenase ; Male ; Mortality ; Nausea ; Necrosis ; Oxidoreductases ; Pancreas ; Pancreatitis, Acute Necrotizing* ; Postoperative Complications ; Sepsis ; Subphrenic Abscess ; Tachycardia ; Vomiting