Postoperative Acute Pancreatitis Research Articles

Pancréatite aiguë après traitement chirurgical des anévrismes de l’aorte abdominale

Introduction: Acute pancreatitis after surgical treatment of non ruptured aneurysm of abdominal aorta is a rare complication, considered to be due to pancreatic ischemia or peroperative trauma of pancreas. The aim of this study is to describe 4 new cases of this complication and to discuss its etiology. Patients and methods: From January 1995 to November 2000, 365 patients underwent elective surgery for a non ruptured abdominal aorta aneurysm. Four (1.1%) men, aged 66 to 79 years and operated for an aneurysm which diameter ranged from 60 to 77 mm, developed postoperative acute pancreatitis. The abdominal approach was a midline incision in 3 cases and a retroperitoneal lombotomy in one case. Superior pole of the aneurysm always adjoined or involved the right renal artery. The aortic clamping was supra-renal in 3 cases and celiac in one case. Diagnosis of acute pancreatitis was established at days 2, 4, 12, and 23 after surgery on abdominal computed tomography in 3 cases and at reoperation in one case. Results: Three patients died, including 2 from early multiple organ failure and one peroperatively during surgical attempt to treat a prostheto-digestive fistula. One patient was alive and asymptomatic with a 2-years follow-up. Conclusion: Acute pancreatitis is a rare and serious complication after surgical treatment of abdominal aorta aneurysm. Its diagnosis is often delayed. The main etiological factor of this complication could be trauma of pancreas during supra-renal clamping through a midline incision.

Risk factors for postoperative pancreatitis associated with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography

OBJECTIVE: To investigate the risk factors for postoperative pancreatitis following endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting. METHODS: Four hundred and twelve patients referred to the endoscopy unit were divided into seven groups: (i) double ducts (pancreatic duct and biliary duct) contrast media filling group (ERCP group); (ii) biliary duct contrast media filling group (ERC group); (iii) pancreatic duct contrast media filling group (ERP group); (iv) ERCP plus biliary stenting group (ERCP + stent group); (v) ERC plus stenting group (ERC + stent group); (vi) ERCP plus EST and stone extraction (SE) group (ERCP + EST + SE group); and (vii) ERC plus EST and SE group (ERC + EST + SE group). Differences in postoperative serum amylase at 4 and 24 h, as well as clinical symptoms, were compared among the different groups. RESULTS: The incidence of postoperative hyperamylasemia at 4 and 24 h was 17.7 and 4.4%, respectively. The overall incidence of postoperative acute pancreatitis was 3.9% and the ERP group had the highest incidence of postoperative acute pancreatitis among the seven groups. CONCLUSIONS: Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis and therapeutic ERCP, such as EST, stenting and SE, does not increase the incidence of postoperative pancreatitis.

Treatment of pancreatic pseudocyst and pancreatic abscess using a therapeutic endoscopic ultrasound device.results in 18 patients

The purpose of this study is to evaluate a new technic of cystogastro or duodenostomy for pancreatic pseudo-cyst (PPC) or pancreatic abscesses (PA) entirely guided by endoscopic ultrasound (BUS) and using interventional echoendoscopes. Patients and methods : A cystogastrostomy was performed in 17 patients and a cystoduodenostomy in 1 patient for 7 PPC and II PA. For 16/17 patients, the gastroscopy did not reveal extrinsic compression allowing selection of the puncture site. The origin of the PPC was an alcoholic chronic pancreatitis in 3 cases and an acute pancreatitis due to lithiasis in 2 cases and a hyperlipidemia in 2 cases. The origin of the 11 PA was post-operative acute pancreatitis. The mean size of the 17 pancreatic cysts was respectively 7.5 ern (410 cm).The EUS device was the FG 38X manufactured by Pentax-Hitachi. The FG 38X is an interventional echoendoscope with a working channel of 3.2 mm of diameter .Technique of EUS guided cystogastrostomy : 1/locating the PPC and the contact zone between the gastric wall and the cyst wall. 2/ Color doppler assessment of the stomach wall showed no vascularization in this contact zone 3/ A needle-knife was introduce through the working channel and used to performed EUS guided transgastric puncture of the cyst 4/ The metal part of the needle-knife was withdrawn leaving the teflon catheter in the cyst 5/ A guide wire is introduce through the teflon catheter in the cyst 6/ Under this guide-wire a 6.5 or 7 F naso-cystic drain or a 8.5 F stent was placed within the cyst. Results : No complication occurred. The placement of the nasocystic drain or the 8.5 F stent was successful respectively in 11/12 cases and 5/5 cases. The drain was removed after 5 -10 days and the stent 3 months later. In one case, it was no possible to place the drain and only an aspiration was performed. One recurrence of the 7 pseudo-cyst and 2 relapses of the 11 PA have been observed with a mean follow-up of 24 months (14-32 months).Conclusion : This experience suggest that this technique allows more accurate drainage of the PPC or PA without extrinsic compression with a lower risk of perforation and haemorrhage.

Acute pancreatitis after gynecologic and obstetric surgery

Objective: Our goal was to evaluate the prevalence and comorbidity of acute postoperative pancreatitis after gynecologic and obstetric surgery. Study Design: We reviewed the Mayo Medical Center surgical database (January 1953–January 1997) to identify all confirmed cases of acute pancreatitis occurring within the standard 6-week postoperative convalescence after obstetric and gynecologic surgical procedures. Pancreatitis as a result of concurrent pancreatic or biliary surgery was excluded. Pertinent clinical data were reviewed. Results: Eleven cases of postoperative pancreatitis were identified, with an overall incidence of 1 in 17,000 surgical procedures. Postoperative pancreatitis was more common after obstetric surgery. Identifiable risk factors were noted in 45% of cases, with occult cholelithiasis the predominant factor. Presenting signs and symptoms were primarily epigastric pain, oliguria, and ileus. Significant morbidity or mortality was noted in 27% of the cases. Conclusions: Acute postoperative pancreatitis is a rare complication after gynecologic and obstetric surgery. Signs and symptoms of pancreatitis are nonspecific in the postoperative setting. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality. (Am J Obstet Gynecol 1999;181:542-6.)

Acute Pancreatitis after Cardiac Transplantation and Other Cardiac Procedures: Case-Control Analysis in 24,631 Patients

Previous series have identified an increased risk of developing acute postoperative pancreatitis in heart transplant recipients and other cardiac surgical patients, and some suggest that mortality is significantly increased when pancreatitis occurs in the transplant setting. We conducted a retrospective case-control analysis of adult patients undergoing orthotopic heart transplant or other cardiac procedures from April 1985 through June 1996 at our medical center. Specific risk factors for outcome were assessed including low cardiac output, intra-aortic balloon pump usage, exogenous calcium repletion, immunosuppression, cytomegalovirus infection, cholelithiasis, prior pancreatitis, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. There was a 30-fold increase in the incidence of pancreatitis in the heart transplant group [12 of 394 (3%) vs 27 of 24,237 (0.1%); P < 0.01]. Compared with the nontransplant cardiopulmonary bypass patients, the transplant patients experienced a statistically significant increased incidence of immunosuppression and three or more risk factors. Transplant patients with pancreatitis demonstrated a significant increase in APACHE II scores and the incidence of three or more risk factors compared with their transplant control group. Patients undergoing nontransplant cardiac procedures and developing pancreatitis had significantly increased cross-clamp times, incidence of low cardiac output, APACHE II scores, and incidence of three or more risk factors compared with their nontransplant cohort. In conclusion, there is a significant increase in the incidence of pancreatitis after orthotopic heart transplant compared with other cardiac procedures. Analysis demonstrates the additive effect of multiple individual risk factors. Immunosuppression confers significant additional risk for pancreatitis in the orthotopic heart transplant patient.

Arterial Complications of Pancreatitis

Hemorrhage from pseudoaneurysm complicating pancreatitis is an infrequent but very severe condition. In most cases, acute, massive gastrointestinal bleeding is typical at onset, and prognosis of these cases is usually poor. Nine cases of arterial lesions secondary to pancreatic inflammation are presented, eight related to chronic pancreatitis and one to acute postoperative pancreatitis. Five patients were evaluated during emergency episodes because of acutely gastrointestinal bleeding (four cases), and pseudocyst acute bleeding (one case). Four patients were selectively evaluated: three had a history of self-limiting gastrointestinal hemorrhage, whereas one had experienced no episodes of gastrointestinal hemorrhage. Angiography was performed in all cases and was always diagnostic, even in the two cases of very small pseudoaneurysms. Transcatheter arterial blockade was attempted in five patients and failed to control the hemorrhage in one acutely bleeding patient because of irreversible shock. Two cases of pancreatic hemorrhage not related to a pseudocyst were effectively and permanently treated by embolization. A case of a pseudoaneurysm associated with a pseudocyst required surgery in addition to embolization for a definite treatment. Nevertheless, when a pseudoaneurysm or a pseudocyst hemorrhages acutely, transcatheter arterial blockade can control the hemorrhage and improve the hemodynamic status of the patient before surgery.

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.

Jejunal Infarction as a Complication of Postoperative Pancreatitis

Intestinal infarction is a rare complication of acute pancreatitis. The authors report a clinical case of segmental jejunal infarction, diagnosed 8 weeks after the onset of an acute postoperative pancreatitis secondary to a cholecystectomy in a patient with α1-antitrypsin deficiency.

Sphincteroplasty of the Sphincter of Oddi in the Treatment of Benign Distal Obstructions of the Bile Duct

Seventy patients in whom sphincteroplasty was performed by an original technique are presented. In 65 cases the indication was stenosis of the sphincter of oddi, associated or not with cholelithiasis or hepatic hydatid disease. There were relative indications in another 5 patients. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 28 mm. In the immediate postoperative period there was one case of acute postoperative pancreatitis, one duodenal fistula and an upper digestive haemorrhage; also a residual stone was detected. All these complications have responded favourably to conservative treatment. There was a single death in an old patient with bronchopneumonia. The late results were very good or good with the exception of two cases: one which presented with cholangitis episodes maintained by duodenal stasis, and one female patient, who after one year from sphincteroplasty had to be reoperated on for an hepatic abscess.

An Autopsy Case of Postoperative Acute Pancreatitis with Shock Lung Terminating in Pseudomembranous Colitis

An Autopsy Case of Postoperative Acute Pancreatitis with Shock Lung Terminating in Pseudomembranous Colitis

ヒト尿中α‐１，４‐グルコシダーゼ活性の変動とその意義

Activities of α-1, 4-glucosidase of urine collected over 24 hr were investigated with reference to various diseases. The enzyme activity per ml urine varied according to individuals from whom the urine were sampled. :However, as far as the healty adults are concerned, their total enzyme activities estimated for total volume of urine collected over 24 hr were less variable as 24.32±12. 15 units per day (one unit was the enzyme activity that produced 1 pmole of glucose from maltotriitol as substrate per min at 60°C). The total a-1, 4-glucosidase activities of urine from patients with disorder of liver function and malignat tumor were 20.77±12.97 and 22.37±12.81 units per day, respectively. But, those of urine from acute pancreatitis and postoperative pancreatitis were 46.25±21.07 units per day. Also, those of urine of the patients subjected to major operative aggression were 49.22±19.00 units per day. No corelations between the activities of α-1, 4-glucosidase and a- .amylase were observed in any case described above. Of the organs examined, kidney tissue showed the highest activity of α-1, 4-glucosidase and it was suggested that a part of the increase in α-1, 4-glucosidase activity of urine from paitients of acute pancreatitis and postoperative pancreatitis might be attributed to renal disorders accompanied thereby.

FURTHER STUDIES ON POSTOPERATIVE PANCREATITIS.

ACUTE PANCREATITIS sometimes occurs after upper abdominal operations and it may occasionally occur after operations remote from the pancreas. Although serum amylase levels are valuable in the diagnosis of acute pancreatitis, the amylase level may rise in conditions other than pancreatitis. This fact adds to the difficulties of interpreting acute abdominal pain in the immediate postoperative period. The etiology of acute postoperative pancreatitis is seldom clear and both this and the incidence of the complication require clarification. The current study represents such a continuing effort to define the problem. It consists of a study of the serum levels of the pancreatic enzymes in the pre- and postoperative period in patients undergoing various operations and a correlation of these enzyme changes with the clinical observations. Materials and Methods A total of 199 patients, chiefly on the surgical ward service, were selected for study. The operative procedures performed on these patients are

ACTH in the treatment of acute postoperative pancreatitis.

ACTH in the treatment of acute postoperative pancreatitis.

Acute postoperative pancreatitis.

ACUTE pancreatitis as a complication of surgical operations on organs adjacent to the pancreas has been recognized for many years. Because it has been regarded generally as a rare occurrence attributable to direct injury to the pancreas or, in operations on the biliary tract, to reflux of bile into the pancreatic duct, the subject has not received adequate attention in the literature. Our attention was drawn to this problem by an experience with 8 cases over a two-year period and by the excellent studies of Millbourn1 and Warren.2 The latter author's data are of particular interest because they demonstrate that . . .