Humans ; Infection ; etiology ; therapy ; Pancreatitis ; complications ; therapy

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

Medical management of acute pancreatitis relies on supportive care such as fluid resuscitation and pain control. Prophylactic antibiotics can reduce the opportunity of infection in severe pancreatitis. The effect of somatostatin or protease inhibitors still needs to be evaluated through further study. Early endoscopic retrograde cholangiopancreatography (ERCP) can ameliorate the course of severe biliary pancreatitis. Although sterile pancreatic necrosis, acute fluid collection, and pseudocyst usually resolve spontaneously, endoscopic or percutaneous drainages are needed when these complications are infected.
Acute Disease ; English Abstract ; Humans ; Pancreatitis/complications/*therapy

Emergency Treatment ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; complications ; therapy ; Myocardial Infarction ; complications ; therapy ; Pancreatitis ; complications ; therapy ; Treatment Outcome

The peripancreatic infection is a severe complication during severe acute pancreatitis. Early diagnosis, effective prevention and timely treatment are directly associated to prognosis. In recent years, with the promotion and application of the concept of damage control and the rapid development of imaging intervention techniques, the treatment for peripancreatic infection has become "multi-step, step-up" minimally invasive surgical strategy from early laparotomy. The transformation of this concept and method has significantly improved the efficacy of peripancreatic infection in clinical practice. However, there are still many problems to be solved, such as prophylactic antibiotics, the choice of minimally invasive surgical techniques, and the management of early ascites. In addition, due to the variability and complexity of the course of severe acute pancreatitis, there is no uniform standard for clinical treatment and management of peripancreatic infection. Only through multidisciplinary collaboration, including surgery, imaging, nutrition and intensive care, can we truly achieve appropriate risk assessment, accurate clinical diagnosis and effective individualized treatment for these patients.
Acute Disease ; Bacterial Infections ; complications ; therapy ; Humans ; Laparotomy ; Minimally Invasive Surgical Procedures ; Pancreatitis ; complications

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

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

We recently treated two cases of chronic pancreatitis with obstructive jaundice due to compression of the common bile duct by pancreatic pseudocyst. The two cases were males admitted with the complaint of icteric skin color. The first, a 46-year-old male, admitted with the complaint of icteric skin color. He was treated by operative cystojejunostomy after percutaneous drainage of the pseudocyst and percutaneous transhepatic biliary drainage. The other case was a 58 year-old male who admitted with the complaint of icteric skin color. He had an infected pseudocyst in the pancreas and was endoscopically treated. Both of them were discharged with favorable clinical course and normal laboratory findings after the treatment. The former patient remained well 11 months after treatment, but the latter patient died from necrotizing pancreatitis and septic shock 6 months after treatment. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct rather than due to compression of the bile duct by the pseudocyst. In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, differentiating between these two conditions is an important aspect of accurate diagnosis and therapy. Herein we report two unusual cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice.
Case Report ; Cholestasis/therapy ; Cholestasis/etiology* ; Chronic Disease ; Human ; Male ; Middle Age ; Pancreatic Pseudocyst/complications* ; Pancreatitis/complications*

OBJECTIVETo investigate therapeutic strategy of fulminant acute pancreatitis (FAP) in acute response stage.

METHODSSixty-four patients were divided into Death group (27 patients) and Survival group (37 patients). The time course of shock and recovery of enteral function, parameters of fluid resuscitation, PaO(2)/FiO(2) and AaDO(2) at 24 hours prior to mechanical ventilation, rate of continuous venovenous hemofiltration (CVVH) and abdominal compartment syndrome (ACS), severity of the disease in the acute response stage were investigated. And the effect of surgical manner and time on the prognosis was also analyzed.

RESULTSCompared with Survival group, the time course of shock and recovery of enteral function in Death group were prolonged significantly (P < 0.05). Between the groups, there was no difference in the amount of crystal fluid infused from admission to 72 hours after, but the amount of colloid fluid infused and ratio of amount of colloid and crystal fluid in Survival group were higher (P < 0.05). The amount of fluid retention in third space from admission to 72 hours after in Death group was higher than that of Survival group significantly (P < 0.05). The fluid infusing rate in Survival group in the first day of admission was faster than Death group (P < 0.05). PaO(2)/FiO(2) and AaDO(2) in 24 hours prior to mechanical ventilation in Death group were negatively changed significantly. Within 72 hours after the onset of the disease, the rate of CVVH in Survival group was higher than Death group. Incidence rate of ACS and the APACHEII scores within 72 hours after admission in Death group were higher than in Survival group. The cure rate of the patients operated in the day 7 to day 14 after admission was higher than that of patients operated prior and post this period. Time for the first operation in operated patients was earlier than patients received minimally invasive drainage (MID) and its cure rate was lower than that of MID Group.

CONCLUSIONSIt is the key point to shorten the time course of ischemia, to control persistent systemic inflammatory response syndrome (SIRS) and to adopt reasonable surgical intervention in acute response stage for FAP.

Acute Disease ; Adult ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis ; complications ; mortality ; therapy ; Resuscitation ; methods ; Retrospective Studies

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