Percutaneous minimally invasive methods as a step-up intervention in the complex treatment of fluid accumulations in patients with acute pancreatitis

Abstract

Annotation. Analysis of recent publications on the definition of fluid accumulation in patients with complicated forms of acute pancreatitis and the possibility of their correction by minimally invasive methods according to the clinic, analysis of a clinical case that demonstrates the possibility of staged percutaneous drainage of fluid accumulation in acute infected necrotic pancreatic. The results of treatment of 622 patients who were hospitalized in the surgical department of MNPE City Clinical Hospital of Ambulance and Emergency Care during 2020 were analyzed. The mean age of patients was 48.2±2.2 years. The patient examination plan included a comprehensive clinical, laboratory and instrumental examination. Puncture and drainage of fluid accumulations were performed under local anesthesia under ultrasound control using a linear sensor with a frequency of 7.5 MHz in gray-scale mode. Statistical data processing was performed by the method of mathematical statistics with StatSoft Statistica 6.0 software and Microsoft Office Excel. It is established that the cause of acute pancreatitis in 270 (43.4%) patients was a biliary factor, in 155 (24.9%) – alcohol, 135 (21.7%) – acute pancreatitis developed on the background of triglyceridemia, in 21 (3.4%) the patient had postoperative pancreatitis, medical – in 8 (1.3%) patients and without establishing a clear etiology – in 33 (5.3%) patients. In order to eliminate fluid accumulations in 12 (1.9% of the majority of patients with acute pancreatitis and 7.6% of 157 with fluid accumulations) patients were used percutaneous puncture-drainage method under ultrasound control, among them in 5 cases the method was used to eliminate fluid accumulations due to acute peripancreatic fluid accumulation, in 2 cases – acute necrotic effusion, limited necrosis – in 2 cases, and pancreatic pseudocyst – in 3 cases. A clinical case of acute necrotic pancreatitis complicated by the development of acute necrotic effusion is presented, for the treatment of which a combination of transcutaneous minimally invasive and open surgical methods of treatment was used at different stages of the disease. So, fluid accumulations around the pancreas belong to the local complications of acute pancreatitis and are recommended for correction by conservative or minimally invasive methods. The question of choosing the optimal minimally invasive method of treatment requires an individual approach. This clinical case demonstrated the possibility of using puncture-drainage method under the ultrasound control as a “step-up” intervention in early stage of treatment and allowed to postpone the open surgery.