Complication Of Acute Pancreatitis Research Articles

Laparoscopic vs Endoscopic Management of Pancreatic Pseudocysts: A Scoping Review.

Pancreatic pseudocyst (PPC) and walled-off necrosis (WON) develop as late complications of acute pancreatitis that have been historically managed surgically. With the advancement in endoscopic equipment and the evolution of endoscopic surgery, the management of PPC has evolved considerably in recent years from surgical drainage to transmural endoscopic drainage. Till the end of the 20th century, a limited number of surgeons performed laparoscopic drainage of PPCs. Due to the steep learning curve needed for performing advanced laparoscopic suturing, a majority of studiesconducted during this period have compared open surgical drainage with endoscopy.The efficacy of these modalities has largely been evaluated using retrospective studies and a few meta-analysesparticularly due to the low-volume caseload of individual centres. Also, these studies include PPC and WON together in data analysis despite WON being a distinct entity. There are limited prospective well-designed clinical trials comparing endoscopic and laparoscopic management of pure PPCs. There is also a lack ofspecific recommendations for the management of PPCs. Considerable overlap of indications between these two modalitiesexists. The efficacy of endoscopic transmural drainage as an index intervention when compared to laparoscopy has not been proven in the research literature. Previous studies have not considered multiple endoscopic interventions within a four-week period of index intervention as a failure.We reviewed the literature using appropriate MeSH terms on the PubMed search engine for articles comparing laparoscopic and endoscopic transmural management of PPCs according to our inclusion and exclusion criteria. Seven articles were identified for inclusion in the qualitative synthesis. This scoping review was conducted to answer some pertinent unanswered questions, identify gaps in knowledge regarding the laparoscopic vs endoscopic management of PPCs, and guide further research.

Acute necrotizing pancreatitis with hemorrhagic shock in secondary splenic rupture: a case report and literature review

Atraumatic splenic rupture is a rare complication of acute and chronic pancreatitis. It arises due to its anatomical proximity to the pancreas, for instance, due to erosion of large pseudocysts or walled-of-necrosis (WON).Following we describe the case of a 62-year-old woman who presented for further diagnostics and treatment of acute pancreatitis with the development of large walled-of necrosis (WON) in the pancreatic corpus and tail. During the course, the patient developed a hemorrhagic shock. An emergency computer tomography (CT) of the abdomen revealed a ruptured spleen with a large capsular hematoma with no evidence of active bleeding. In contrast to previous published case reports, our treatment was exclusively minimal-invasive: by radiological guided embolization of the splenic artery and by endosonographic guided implantation of a lumen apposing metal stent (LAMS). The splenic hematoma was spontaneously regressive without secondary drainage.

Lactated Ringer's Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis.

Fluid therapy is the cornerstone of early supportive therapy in acute pancreatitis (AP). Regrettably, the type of fluid is still debated among clinicians, despite recent evidence from randomized controlled trials (RCTs). We aimed to incorporate all evidence from RCTs comparing lactated Ringer's solution (LR) with normal saline (NS) in adult and pediatric AP patients, with particular emphasis on clinically relevant outcomes. We evaluated RCTs comparing intravenous fluid resuscitation with LR to NS in adult or pediatric AP patients according to a prospectively registered protocol (CRD42021224542). Moderate-to-severe AP (MSAP), mortality, length of hospitalization (LoH), need for intensive care, the incidence of systemic (organ failure, OF) and local complications (in total), necrosis and pseudocyst formation were analyzed separately. Risk ratio (RR) and median difference (MD) were calculated with 95% confidence intervals (CI) using a random effect model. Risk of bias and quality of evidence were assessed. Altogether, 8 eligible RCTs were found, including 557 patients (LR: 278; NS: 279). LR reduced the risk of MSAP by 31% (RR: 0.59, 95% CI: 0.36-0.97, high quality) and the risk of death by 62% (RR: 0.48; 95% CI: 0.24-0.98, very low quality). LR was associated with a significantly lower risk of need for intensive care (RR: 0.50, 95% CI: 0.33-0.77), OF (RR: 0.78, 95% CI: 0.61-0.99) and local complications (RR: 0.64, 95% CI: 0.46-0.89). No significant risk reduction was observed for LoH (MD: -0.57 days, CI: -1.33-0.19), necrosis, pseudocyst and inflammatory parameters by LR compared to NS. LR reduces severity, mortality, need of intensive care and systemic and local complications in AP.

Instrumental and laboratory diagnostics of early complications in acute pancreatitis

The aim of the study. Assessment of markers of early complications in patients with acute pancreatitis. Materials and methods. Observation was carried out for 151 patients who were in the clinic from 2011 to 2019, with a diagnosis of acute pancreatitis (OP). The average age of patients (47.8±1.5) years. The patients were divided into 2 groups: group I - 78 patients with developing pancreatic pseudocyst (PP) and group II - 73 patients with free fluid accumulations (FFA) of the abdominal cavity. All patients underwent comprehensive examinations, including histology of emerging cysts, clinical and biochemical blood tests, sonography and computed tomography, bacteriological and enzyme immunoassays with assessment of the level of endogenous intoxication, procalcitonin, microbial contamination and cytokines. Results. In comparison with group I patients with developing PP, the observed group II patients with FFA showed a significant increase in the degree of endogenous intoxication. A 3.0-fold increase in the level of procalcitonin in 26.8% of group I patients and in 67.1% of group II patients (p<0.05) with a directly proportional dependence of this indicator on the level of bacterial contamination (r=+0.51; p<0.05) indicated the activation of infection processes in general and, to a greater extent, in group II patients. At the same time, the condition of their last worsened due to the transition of the inflammatory process to the parapancreatic region and into the retroperitoneal space. The high level of proinflammatory cytokines IL-6, TNF-α in patients of group II compared with group I, an imbalance and a decrease in the activity of the anti-inflammatory mediator IL-10 determined a significantly greater (p<0.05) activity of the inflammatory process in patients with SFS, and were associated with an unfavorable prognosis. Conclusion. The formation of a PP is a relatively favorable outcome of acute pancreatitis, accompanied by significantly less pronounced toxemia and infection rate in comparison with patients with free fluid accumulations of the abdominal cavity.

Imaging Features of Acute Pancreatitis and the Revised Atlanta Classification System

Acute pancreatitis is a major cause of hospital admissions in the United States, with the two primary causes being gallstones and alcohol.1 The Atlanta classification system is an international classification on the severity of acute pancreatitis. In 2012, deficiencies and outdated nomenclature were removed to make a revised system that take into account advancements in research and clinical management. The revised Atlanta classification system (RACS) in 2012 standardized the nomenclature for acute pancreatitis and local complications to facilitate effective communication between clinicians and radiologists alike. Older terms such as pancreatic abscess, phlegmon, acute pseudocyst, and fluid collection are no longer used, as they are vague and can be misleading.

Ischemic Changes in the Mucous Membrane of the Transverse Colon as a Complication of Acute Pancreatitis

Aim: to present a clinical case of a patient with a complicated course of acute pancreatitis.Key points. A 31-year-old patient was admitted to the surgical department with a clinical picture of acute alcoholic pancreatitis. Signs of anemia were regarded as a consequence of gastrointestinal bleeding. Computed tomography with contrast enhancement, along with an increase in the size of the pancreas, the presence of foci of pancreatic necrosis with multiple fluid accumulations in the parapancreatic space, revealed smoothed gaustration and thickening of the walls of the predominantly transverse colon. During colonoscopy, ischemic changes of the colon mucosa were detected in a timely manner. Negative results of analysis for toxins A and B of Clostridioides difficile and pathogenic intestinal flora were obtained. By the means of intensive care, it was possible to achieve complete stabilization of the patient's condition, normalization of laboratory blood parameters and relief of ischemic processes in the colon wall.Conclusion. Ischemic changes of the colon can serve as a complication of acute pancreatitis. A thorough analysis of the results of computed tomography at the first signs of colon lesion and colonoscopy contributed to the rapid detection of complications and prevention of irreversible colon ischemia.

Thrombosis of Extrasplanchnic and Splanchnic Venous System in Acute Pancreatitis- A Case with Rare Combination of Vascular Complication

Vascular complications in acute pancreatitis are common and seen in 25% of cases. While it is common to have venous thrombosis in the Superior Mesenteric Vein (SMV), portal vein, and splenic vein, thrombosis of extra-splanchnic vessels such as Inferior Vena Cava (IVC) and left renal vein due to acute pancreatitis is a rare entity, with more adverse outcomes. A 48-year-old male presented with severe epigastric pain, vomiting, and constipation for seven days. Outside Ultrasonography (USG) report was suggestive of acute pancreatitis. His serum amylase, serum lipase, and D-dimer levels were raised. Computed Tomography (CT) of abdomen and pelvis revealed acute necrotising pancreatitis with peripancreatic fluid collection and thrombosis of splenic vein, left renal vein, and IVC. Thrombosis in pancreatitis can occur due to pancreatic proteolytic enzymes which can cause intimal injury. An enlarged pancreas, walled-off necrosis, and pancreatic pseudocyst can compress veins, resulting in venous stasis. Pancreatitis has a systemic hypercoagulable or prothrombotic state. The patient was given symptomatic treatment along with an injection (inj.) of clexaine and monocef. He showed improvement in 10 days and was symptomatically well on follow-up. Early detection of these findings and targeted treatment for the same is crucial to prevent morbidity and mortality of such patients.

Extrahepatic Bile Duct Necrosis: An Exceedingly Rare Complication in Severe Acute Pancreatitis

Extrahepatic Bile Duct Necrosis: An Exceedingly Rare Complication in Severe Acute Pancreatitis

Acute pancreatitis - predicting the severity of the disease.

Acute pancreatitis (AP) is a serious acute abdominal disease. AP is often referred to as an unpredictable illness, which can take a mild to severe (fatal) course. 1) To identify clinical parameters that are significantly related to the clinical course of acute pancreatitis. 2) To compile a scoring system enabling the severity of AP to be predicted when the patient is first admitted to hospital. Analysis of available publications and clinical guidance, and retrospective analysis of data on patients hospitalised with AP at our clinic enable us to identify clinical details and laboratory results recorded at the time of patients' admission to hospital that are related to the subsequent severity of the disease. For the purposes of statistical analysis, the sample of patients was divided into two groups: group A (mild AP, without local or organ complications), group B (moderately severe and severe AP with local and/or organ complications). In total, between 01.01.2013 and 30.06.2022, 312 patients with acute pancreatitis were allocated to the retrospective-prospective study sample. 74 % (231/312) of these patients were allocated to group A and 26 % (81/312) were allocated to group B. Univariate analysis of the data collected on the patient sample identified 5 parameters that are statistically significantly associated with the severity of the clinical course of the disease. Presence of SIRS on admission (A vs B, Odds ratio 10.787, 95% CI 5.09-22.85, p < 0.0001), diabetes mellitus type 2 in case history (A vs B, Odds ratio 7.703, 95% CI 3.04-19.51, p 2 mmol/l (A vs B, Odds ratio 3.293, 95% CI 1.59-6.82, p = 0.0013).In order to develop a scoring system, each of these parameters was allocated a points value based on its Odds ratio (OR): presence of SIRS 3 points, hypocalcaemia 3 points, diabetes mellitus type 2 in case history 2 points, urea concentration > 8 mmol/l 1 point and lactate concentration > 2 mmol/l 1 point. The authors refer to their scoring system as The Acute Pancreatitis Admission Score (APAS). The accuracy of APAS was modelled for various cut off values. Across the whole sample, we ascertained that an APAS ≥ 4 points predicts moderately severe or severe AP with a sensitivity of 81 % (95% CI: 71 - 89 %) and specificity of 87 % (95 CI: 81 - 91 %). The positive predictive value (PPV) of APAS ≥ 4 is 0.68, while its negative predictive value (NPV) is 0.93 and accuracy 0.85 (95% CI 0.81 - 0.89). In this study we identify significant simple clinical and laboratory parameters that are commonly tested as part of an initial examination when admitting a patient with AP to hospital. Having identified these parameters we are able to establish a simple scoring system that is able to predict the severity of the course of AP at the moment of hospitalisation (Tab. 5, Fig. 2, Ref. 27).

TO STUDY THE ROLE OF C-REACTIVE PROTEIN TO PREDICT THE RISK OF PANCREATIC NECROSIS

INTRODUCTION Acute pancreatitis is an inammation of pancreas of variable severity. Its severity varies from mild to severe attacks like necrotizing pancreatitis which has bad prognosis. C-reactive protein is an inammatory mediator synthesized in the liver and is raised in acute pancreatitis. To study t AIM OF THE STUDY he role of C-reactive protein in predicting the risk of pancreatic necrosis and other severe complications of acute pancreatitis. MATERIALS AND METHODS Ÿ Study setting: The study was conducted on patients admitted in the Department of General Medicine with features suggestive of Acute Pancreatitis. Ÿ Study period: The study was conducted between November 2021 to October 2022 Ÿ Sample size: The present study included 50 patients admitted in the Department of General Medicine with features suggestive of Acute Pancreatitis. INCLUSION CRITERIA1)Patients of any age and either sex presenting with acute pain abdomen and fourfold elevation of Serum Amylase and/or Serum Lipase. EXCLUSION CRITERIA 1)Patients with ischemic heart disease and angina 2)Patients with prior history of fever before onset of pain 3)Patients with chronic infectious diseases and known case of collagen vascular disease. RESULTS Based on 5th day CRP values 50 patients are divided into 3 groups, 1st group(n-30) CRP less than 100mg/dl, 2nd group(n-8) CRP levels between 100-200mg/dl, 3rd group(n-12) CRP levels more than 300mg/dl. The development of necrotizing pancreatitis in correlation with CRP was out of 30 patients in the 1st group, 4(13.33%) developed necrotizing pancreatitis, in the 2nd group, out of 8 patients, 4(50%) developed necrotizing pancreatitis, in the 3rd group, out of 12 patients, all 12(100%) of them developed necrotizing pancreatitis. CRP CONCLUSION levels peaked at 5th day of illness and cut off value of 150mg/dl can be taken above which pancreatic necrosis can be predicted with high probability. This value has a specicity of 80%. CRP values above 200mg/dl has a specicity of 100%.

Endoscopic ultrasound drainage of pancreatic fluid collections: do we know enough about the best approach?

Pancreatic fluid collection often occurs as a local complication of acute pancreatitis, and drainage is indicated in symptomatic patients. The drainage may be surgical, percutaneous, or endoscopic ultrasound (EUS) guided. In symptomatic collections older than 4 weeks and localized in the upper abdomen, EUS-guided drainage is the first choice of treatment. Lumen-apposing metal stents are useful in cases of walled-off necrosis, facilitating access to the cavity; however, they do not reduce the number of necrosectomy sessions required. In most pancreatic pseudocysts requiring drainage, plastic stents remain the first choice of treatment. This review aimed to summarize the principles and techniques of step-up therapy of pancreatic fluid collections, including preprocedural and postprocedural assessment and practical approaches of drainage and necrosectomy, making available evidence more accessible to endoscopists aiming to train for this procedure. Successful and safe EUS drainage connotes early recognition and treatment of complications and the presence of a multidisciplinary team for optimal patient management. However, the best time for necrosectomy, modality of drainage method (lumen-apposing metal stents or plastic stents), and duration of antibiotherapy are still under evaluation.

Роль бактеріального чинника у розвитку гострого панкреатиту та його гнійно-септичних ускладнень

Introduction. A feature of acute pancreatitis is the high risk of developing complications (occurring in 50% of patients), the total mortality of which reaches 15%, and in severe cases it varies within 40-70%. The aim of the study was to determine the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications. Materials and methods. The results of treatment of 280 patients with acute pancreatitis were analyzed, which were divided into two groups: the main group (n=187) – patients with severe acute pancreatitis and the comparison group (n=93) – patients with a mild and moderate course of the disease. In addition, in order to determine prognostic criteria for the development of purulent-septic complications, the patients of the main group were divided into two subgroups. The first subgroup included patients with a severe course and the development of purulentseptic complications (n=59), the second (n=128) – with a severe course without the development of purulent-septic complications of acute pancreatitis. Results. When screening patients for Helicobacter pylori, the results of the express test were positive in 232 patients (82.9%), while in the main group 165 (88.2%) patients, in the comparison group – 75 (80.6%) patients (χ2= 2.9, 95% CI -1.1-17.6, p=0.08). An increase in the content of immunoglobulin M to Helicobacter pylori was also determined in patients with a severe course of acute pancreatitis after 7 and 14 days from the moment of hospitalization, which indicates the acute phase of the disease. The correlation between immunoglobulin M and procalcitonin was strong (r=0.87; p=0.0001), but the relationship between these indicators was not linear, but closer to exponential (y=1.1543-2.7292*x +2.1604*x^2). Conclusions. The results of a screening study of Helicobacter pylori in patients with acute pancreatitis allow us to consider this microorganism as one of the factors in the pathogenesis of this disease (82.9% of cases). For patients with severe acute pancreatitis, the content of immunoglobulin M to Helicobacter pylori in blood serum ≥1.24 IU/ml can be considered as a likely predictor of the development of purulent-septic complications (sensitivity 86.4%, specificity 100.0%).

The role of biomarkers in the early diagnosis of acute kidney injury associated with acute pancreatitis: Evidence from 582 cases.

One of the systemic complications of acute pancreatitis (AP) is acute kidney injury (AKI). AKI development in patients with AP increases mortality, morbidity, and the cost of treatment. Therefore, early diagnosis and prevention of AKI is important. The purpose of our study was to present biomarkers and case management of AKI developing in patients with AP. The participants of this retrospective study consisted of 582 patients who were followed up with the diagnosis of AP. Atlanta classification was used for the diagnosis and the identification of severity of AP. The laboratory values of patients at the time of first application to the emergency room were recorded. Blood tests were checked 48 h/l. Their blood tests were monitored daily until the day of discharge. Of the 582 patients who were admitted with the AP diagnosis, 344 were female. AKI was detected in 147 patients (25.2%) of the patients admitted with AP diagnosis. The mean age of patients developing AKI was higher than those who did not develop AKI. The albumin and calcium levels in patients developing AKI were significantly lower than the group without AKI. The C-reactive protein (CRP)/albumin and neutrophil/lymphocyte ratios were statistically significantly higher in the group with AKI than the group without AKI. The increase values in AST and ALT levels between the group with AKI and the group without AKI were not statistically significant. The mean leukocyte, CRP, procalcitonin levels, and immature granulocyte percentage (IG%) ratio were higher in patients with AKI in comparison to the patient group without AKI. The decrease in the lymphocyte, hematocrit, and platelet levels was higher in the patient group with AKI compared to the patient group without AKI. Urea and creatinine levels of the group with AKI at the time of admission were higher than the group without AKI. The clinical picture in 13 of the patients we followed up with AP diagnosis was mortal. The values of hematocrit, platelet, leukocyte, lymphocyte, albumin, CRP, CRP/albumin ratio, neutrophil/lymphocyte ration, IG%, procalcitonin, urea, and creatinine that were examined at the time of hospital admission can be useful biomarkers in predicting the development of AKI in patients with AP. In addition, accompanying diseases and age are among the factors affecting AKI development.

Early prediction of acute respiratory distress syndrome complicated by acute pancreatitis based on four machine learning models

BackgroundAcute Respiratory Distress syndrome (ARDS) is a common complication of Acute Pancreatitis (AP) and is associated with high mortality. This study used Machine Learning (ML) to predict ARDS in patients with AP at admission. MethodsThe authors retrospectively analyzed the data from patients with AP from January 2017 to August 2022. Clinical and laboratory parameters with significant differences between patients with and without ARDS were screened by univariate analysis. Then, Support Vector Machine (SVM), Ensembles of Decision Trees (EDTs), Bayesian Classifier (BC), and nomogram models were constructed and optimized after feature screening based on these parameters. Five-fold cross-validation was used to train each model. A test set was used to evaluate the predictive performance of the four models. ResultsA total of 83 (18.04%) of 460 patients with AP developed ARDS. Thirty-one features with significant differences between the groups with and without ARDS in the training set were used for modeling. The Partial Pressure of Oxygen (PaO2), C-reactive protein, procalcitonin, lactic acid, Ca2+, the neutrophil:lymphocyte ratio, white blood cell count, and amylase were identified as the optimal subset of features. The BC algorithm had the best predictive performance with the highest AUC value (0.891) than SVM (0.870), EDTs (0.813), and the nomogram (0.874) in the test set. The EDT algorithm achieved the highest accuracy (0.891), precision (0.800), and F1 score (0.615), but the lowest FDR (0.200) and the second-highest NPV (0.902). ConclusionsA predictive model of ARDS complicated by AP was successfully developed based on ML. Predictive performance was evaluated by a test set, for which BC showed superior predictive performance and EDTs could be a more promising prediction tool for larger samples.

Necrotizing Pancreatitis: A comprehensive review of the presentation, management, and complications

Necrotizing pancreatitis (NP) is a life-threatening complication of acute pancreatitis. It requires an extended hospital stay, aggressive management, and has a higher risk of mortality. Risk factors such as comorbidities in the patient’s history including history of coronary artery disease and cerebrovascular disease can increase the risk of developing necrotizing pancreatitis. The presentation of necrotizing pancreatitis is similar to acute pancreatitis, but specific labs such as hematocrit level can be monitored to anticipate the development of necrotizing pancreatitis. In addition, diagnostic imaging must be obtained to classify necrotizing pancreatitis and aid in management choice. Fluid hydration, adequate pain management, and nutritional support are the principles of treating necrotizing pancreatitis. Deciding whether to drain the necrotic collection or not is usually determined based on the type of necrosis present and whether it is infected. Infected necrotizing pancreatitis can also occur, and patients usually need to be monitored closely with appropriate antibiotics for a long duration. Patients affected by necrotizing pancreatitis can potentially develop complications that can lead to devastating outcomes. Necrotizing pancreatitis complications can occur due to an inflammatory reaction on the adjacent structure such as splanchnic vein thrombosis, gastrointestinal fistula or inflammatory reaction within the pancreas leading to an exocrine and an endocrine pancreatic insufficiency. We present here a literature review of necrotizing pancreatitis and the complications that can arise from it.

Sanitation Effect of Gaseous Ozone in the Treatment of Experimental Infected Pancreatic Necrosis: Microbiological Evaluation

Introduction. Search for new means and methods of sanitation of the abdominal cavity remains significant related to growing antibiotic resistance of bacterial pathogens in surgical infection. This challenge is of particular relevance in the development of purulent complications of acute pancreatitis due to the complexity of radical control of the inflammation source.The aim of the study was to evaluate outcomes of microbiological examination of peritoneal exudate, biopsies of the pancreas, arterial blood in the topical application of gaseous ozone for the treatment of experimental infected pancreatic necrosis.Methods. This prospective experimental study included 43 laboratory animals - Soviet Chinchilla rabbits. Group 1 consisted of 13 animals, groups 2 and 3 consisted of 12 animals each. All animals were infected with pancreatic necrosis simulated using a clinical strain of A. baumannii. Sanitation relaparotomies were performed in 24 hours and 60 hours under anesthesia: with 0.9% sodium chloride solution in animals of group 1, with 0.02% aqueous solution of chlorhexidine bigluconate in animals of group 2, with ozone-oxygen gas mixtures in animals of group 3. The control group included six sham-operated animals. Animals were withdrawn from the experiment in 96 hours with taking samples for microbiological investigations.Results. Animals of group 1 showed an increased frequency (from 23.1 to 100.0%, p=0.003) and degree (from 3.5 (3.0; 4.5) to 7.0 (5.5; 7. 5) lg COE/ml, p0.001) of bacterial contamination of peritoneal exudate within 24 to 96 hours. Most parameters in animals of group 2 were not significantly different from those achieved in animals of group 1. Notably, the bacterial count of A. baumannii in the peritoneal exudate in 60 hours (6.0 (5.7; 6.7) lg COE/ml), and the degree of secondary (enterogenic) contamination of the pancreas (5.5 (5 .0; 6.7) lg CFU/g) and peritoneal exudate in 96 hours (7.7 (7.0; 8.0) lg CFU/ml) in animals of group 2 significantly exceeded those in animals of group 1 (p 0.010). Intraperitoneal application of a directed flow of gaseous ozone in 24 and 60 hours allowed achieving elimination of A. baumannii in 80.0% of pancreatic biopsy samples by the end of the fourth day (p=0.002 and p=0.007 when compared with results of groups 1 and 2, respectively), prevent its spread into the peritoneal exudate and systemic circulation. The treatment with gaseous ozone was also accompanied by the decreased bacterial count of A. baumannii and the degree of secondary (enterogenic) contamination by other opportunistic microorganisms in the analyzed samples.Conclusion. Perspectives for translating the results obtained into clinical practice determine the relevance of studying modern molecular methods of bacteriological analysis. This should be combined with an adequate assessment of the safety of various targeted treatment options of the abdominal tissues and organs with an ozone-oxygen gas mixture.

Polymorphism of the proinflammatory and anti–inflammatory cytokines genes in patients with an acute pancreatitis in the Northern–Eastern region of Ukraine

Objective.To determine the influence of the genes polymorphism of proinflammatory – interleukin–8 A–251T (rs 4073) and antiinflammatory – interleukin–10 C–592A (rs 1800872) cytokines on course of an acute pancreatitis.&#x0D; Materials and methods. The genes polymorphism of proinflammatory – interleukin–8 A–251T (rs 4073) and antiinflammatory – interleukin–10 C–592A (rs 1800872) cytokines were studied in 83 patients with an acute pancreatitis, using the method of polymerase chain reaction (PCR). The control group have consisted of 60 healthy persons without an acute pancreatitis in anamnesis.&#x0D; Results. The rate of the genes polymorphism of interleukin–8 A–251T (rs 4073) and interleukin–10 C–592A (rs 1800872) was determined in oedematious and destructive forms of an acute pancreatitis, as well as in patients operated on.&#x0D; Conclusion. The acute pancreatitis transition into necrotic form was not connected with the kind of the genes polymorphism of proinflammatory – interleukin–8 A–251T (rs 4073) and antiinflammatory – interleukin–10 C–592A (rs 1800872) cytokines. Operative interventions for an acute pancreatitis complications were performed statistically significantlymore frequently in carriers of the T/T gene genotype of interleukin–8 A–251T (rs 4073). The favorable, noncomplicated course of an acute pancreatitis was associated with polymorphism of the A/T gene interleukin–8 A–251T (rs 4073) and, possibly, – with polymorphism of the A/T gene interleukin–10 C–592A (rs 1800872).

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review.

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

219: EVALUATION OF HIGH-DOSE INSULIN FOR THE TREATMENT OF HYPERTRIGLYCERIDEMIC PANCREATITIS

Introduction: Acute pancreatitis is a common inflammatory condition with several underlying etiologies, including hypertriglyceridemia induced. The risk for acute pancreatitis increases when the serum triglyceride levels exceeds more than 1000 mg/dL. Insulin therapy is a feasible therapeutic option to help lower triglyceride levels to minimize the complications of acute pancreatitis. The aim of this medication use evaluation is to characterize the use of high-intensity insulin to assess its use in hypertriglyceridemia induced acute pancreatitis. Methods: A single-center, retrospective, observational study at a large academic medical center will be conducted. All patients admitted to the medical intensive care unit from September 1st, 2018 to September 30th, 2021 who received high-dose insulin drip for hypertriglyceridemia-induced acute pancreatitis will be eligible for inclusion. The primary objective of this study is to assess the efficacy of using high-dose insulin drip for the treatment of hypertriglyceridemic pancreatitis with a secondary objective to evaluate the safety of high-dose insulin in this setting. Results: Only 27 patients met inclusion criteria. Twenty patients reached a triglyceride goal of less than 500 with only 9 patients experiencing hypoglycemic episodes. Each patient evaluated in this study had some reduction of their triglycerides after starting an insulin infusion. Seven patients received insulin plus plasmapheresis episodes. The average duration of insulin infusion was 70 hours with an average total insulin use of 435 units. Conclusions: All patients who received high-dose insulin infusion for hypertriglyceridemia-induced acute pancreatitis had reduction in their triglyceride levels after starting insulin infusion with 74% of patients reaching a goal triglyceride level less than 500. Only 7 patients evaluated in this study received insulin infusion plus plasmapheresis episode and the duration, total average units, and average units/hr of insulin were lower in the insulin plus plasmapheresis group compared to insulin alone group, however, no comparable data available in the literature at this time. Future studies comparing insulin and insulin in addition to plasmapheresis are needed to further analyze optimal treatment for hypertriglyceridemia induced pancreatitis.

1097A: THERAPEUTIC PLASMA EXCHANGE FOR THROMBOTIC MICROANGIOPATHY ASSOCIATED WITH PANCREATITIS IN A CHILD

Introduction: Thrombotic microangiopathy (TMA) is characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). These features reflect the presence of an active microvascular endotheliopathy. TMA has been reported as a rare complication of acute pancreatitis in adults, with good outcomes after therapeutic plasma exchange (TPE). Sparse pediatric literature addresses the association of TMA and pancreatitis, or the merit of TPE for this indication. Description: A 13-year-old obese male with no previous medical history was admitted to the pediatric intensive care unit for management of acute pancreatitis and kidney injury after two days of abdominal pain, nausea, emesis, and decreased urine output. After fluid resuscitation, his initial labs revealed a lipase of 8520U/L, AST 153U/L, ALT 150U/L, Hgb 14g/dL, WBC 23,000/uL, Platelets 58,000/uL, INR 1.3, BUN 37mg/dL and Cr 4.06mg/dL. A non-contrast CT scan confirmed radiographic evidence of acute pancreatitis. He was afebrile, with stable hemodynamics and a reassuring neurological exam. His hemoglobin decreased to 10.8g/dL 24 hours after admission with subsequent workup suggestive of hemolysis (haptoglobin < 30mg/dL, LDH 4898U/L, schistocytes on peripheral blood smear). A diagnosis of MAHA with thrombocytopenia was established and TPE was initiated. Common underlying conditions associated with TMA such as disseminated intravascular coagulation, infection, drug-induced, autoimmune disorders and malignancy were addressed and ruled out. Complement levels (C3 and C4) were normal, direct/indirect Coombs were negative and ADAMTS13 activity was normal (>60%). The patient received three days of TPE with improvement in platelet counts to 102,000/uL and decrease in LDH to 486U/L after the third session. Renal replacement therapy (RRT) was required for nine days after TPE with good recovery of renal function. He was discharged on hospital day 19 with downtrending Cr 0.78mg/dL and lipase 53U/L. He was tolerating a regular diet without volume restriction prior to discharge. Discussion: Thrombocytopenia and MAHA should raise a suspicion for TMA in children presenting with acute pancreatitis. Acute renal failure requiring RRT is a frequent comorbidity. TPE with RRT may be effective and lifesaving in these patients.