Cases Of Pancreatitis Research Articles

Clinical outcomes of minimally invasive duodenum-preserving pancreatic head resection

BackgroundThe procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study.Materials and methodsFrom October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications).ResultsAll 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea.ConclusionRA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.

Endoscopic retrograde cholangiopancreatography as a single-modality 'gold-standard' treatment for common bile duct stones in the elderly.

There are more octogenarians presenting with gallstone disease each year. Many are not suitable for surgical intervention. An alternative treatment option for common bile duct stones in the elderly is endoscopic retrograde cholangiopancreatography (ERCP) with or without stent insertion. We conducted a retrospective study using a prospectively collected database, analysing the outcomes of consecutive patients >80 years old who underwent an ERCP in a single centre for the treatment of common bile duct stones. In total, 156 patients, with a median age of 91 years, underwent an ERCP for choledocholithiasis over a 3-year period. ERCP was successful in 90% of patients but a proportion required repeat intervention. Forty-six (29%) patients had a concurrently inserted stent due to incomplete stone extraction. Six (4%) patients required a post-ERCP cholecystectomy due to ongoing symptoms. The overall ERCP complication rate was 7% (4% Clavien-Dindo 1 and 3% Clavien-Dindo 2), with no cases of post-ERCP pancreatitis or death. Patients were followed up over 5 years following index ERCP. There was a 60% 3-year survival and 30% 5-year survival rate following index ERCP. Importantly, of those who did not survive, only four patients (2.6%) had a death attributable to a biliary cause and none were fit for definitive surgery. ERCP can be considered as a possible definitive management option for treating common bile duct stones in the elderly, particularly in the comorbid population. Concurrent stenting is an effective temporizing strategy and mitigator of biliary-related readmission, but routine stent changes should be considered. Key messages What is already known on this topic Current guidelines advocate for laparoscopic cholecystectomy and common bile duct exploration in patients with choledocholithiasis. What this study adds Endoscopic retrograde cholangiopancreatography with or without stent insertion is a safe, alternative single-treatment modality for choledocholithiasis in the elderly comorbid population. How this study might affect research, practice, or policy Studies and guidelines evaluating treatment options for choledocholithiasis may be altered to accommodate patient-specific factors, including age and comorbid status, and the concurrent use of stenting as a either a temporizing or longer-term measure for complex stone disease.

Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study

BackgroundThis study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. MethodsA prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75–79 years old; group 2: 80–84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. ResultsOverall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). ConclusionsNo significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.

Multistate Model of the Natural History of Inflammatory Pancreatic Diseases: A Nationwide Population-based Cohort Study

Understanding the nature of inflammatory pancreatic diseases is essential for planning health care system requirements and interventions. The aim of this study was to quantify the trajectories of inflammatory pancreatic diseases and their association with pancreatic cancer in a population-based setting. National health registries were used to identify all Danish residents (18 years or older) in the period from 2000 through 2018 with incident cases of acute pancreatitis (AP), recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), and pancreatic cancer. We used a multistate model to examine transitions from a healthy state to intermediate states of acute pancreatic inflammation (AP and RAP) to chronic states (CP and pancreatic cancer) and, ultimately, death. Results were reported as transition incidence rates per 1000 person-years with 95% CIs. There were 4,663,864 individuals included (mean age, 46 years; 51% were women). During a mean follow-up of 16.8 years, 31,396 individuals were diagnosed with incident AP, 5546 with RAP, 8898 with CP, and 18,182 with pancreatic cancer. The cumulative incidence of pancreatitis (acute and chronic) during the study period was 0.80% (95% CI, 0.79%-0.80%). The transition incidence rates to CP were 12.1 (95% CI, 8.1-18.1) from AP, 46.8 (95% CI, 31.6-69.3) from RAP, and 0.07 (95% CI, 0.04-0.13) from a healthy state. Similar patterns were observed for transitions to pancreatic cancer. Most patients diagnosed with CP (64.2%) and pancreatic cancer (96.4%) transitioned directly from a healthy state. Among patients with pancreatitis, 41.0% (95% CI, 40.5%-41.5%) died during follow-up. The study findings revealed an increased risk of CP and pancreatic cancer in patients with a history of AP. However, most patients with CP and pancreatic cancer transitioned directly from a healthy state.

Levetirasetam induced acute pancreatitis : an uncommon case report

Acute pancreatitis is an acute inflammatory event involving the pancreas and causes significant mortality and morbidity. The most common causes are gastrointestinal stones and alcohol abuse, but well-known drugs used in daily practice can also cause acute pancreatitis. In this rare case report, we aimed to present a case of levetiracetam-associated acute pancreatitis.

A rare case of acute destructive pancreatitis in a patient with chronic kidney disease on peritoneal dialysis: diagnostic and treatment challenges

Patients with chronic kidney disease are susceptible to developing acute pancreatitis. We present a rare clinical case of acute pancreatitis with the formation of pancreatic necrosis in a patient on peritoneal dialysis (PD), debuted with PD–associated peritonitis. On hospitalization, there were no diagnostic criteria for acute pancreatitis; treatment for dialysis peritonitis was ineffective. Repeated ultrasound examination revealed signs of diffuse changes in the pancreas and multi-chamber formation of the small pelvis. Refractory peritonitis, inadequate ultrafiltration, and unclear nature of formation in the pelvic were the grounds for diagnostic laparoscopy and removal of the peritoneal catheter. Abdominal inspection revealed spots of stearin necrosis over the entire surface of the peritoneum and the greater omentum; in the pelvis there were adhesions between the uterus and the rectum. Development of pancreonecrosis was confirmed by abdominal CT scan. Treatment of acute pancreatitis was without effect, type 2 myocardial infarction developed, and with increasing symptoms of multiple organ failure, death occurred.

Unusual Case of Acute Recurrent Pancreatitis in an Adolescent; A Case Report

Unusual Case of Acute Recurrent Pancreatitis in an Adolescent; A Case Report

ThTP8.8 Ambulatory management of acute pancreatitis

Abstract Aim Acute pancreatitis is a common pathology with a spectrum of disease from mild to life-threatening. It is standard practice for all patients to be admitted due the inability to accurately predict severity. However, both considering the wellbeing of patients and pressures on acute hospitals, it may be the time to consider the role of ambulatory care. We retrospectively reviewed patients with pancreatitis managed ambulatorily, and assessed for trends in their presentation. Methods Retrospective review of a prospectively maintained database between 2019-2022 identifying patients with acute pancreatitis with initial ambulatory management. Results There were 19 cases of pancreatitis with planned ambulatory management, with only one representing and requiring admission for 36 hours for symptom control. Of those who had successful ambulatory management, 12 were male (67%). Median age was 55 (range 24-81). Median duration of symptoms at time of review was 5 days (range 1-21). Median number of comorbidities was 1 (0-6), with only a third (6/18) reporting no comorbidities. Median CRP was 11 (<1-153) and WCC 9 (3-25); no patients had acute kidney injury. All patients had a NEWS<2. All but two patients (with a background of pancreatitis) had imaging performed in an ambulatory setting; five had CT scans. Conclusion Patients successfully managed ambulatory were a very heterogeneous group. Our data would support that trial of ambulatory management can be considered in the absence of organ failure (renal function, or physiological instability). This should be supported by adequate safety netting, and plans for further review as appropriate.

Recurrent upper gastrointestinal bleeding in chronic pancreatitis since childhood: a case report

Chronic pancreatitis is a progressive inflammatory disease of the pancreas. Causes of gastrointestinal (GI) bleeding in chronic pancreatitis are bleeding into the pseudocyst, pseudoaneurysm of peripancreatic vessels, and thrombosis of portal vein and splenic vein. We are presenting a rare case presentation of recurrent GI bleed in chronic pancreatitis since childhood and its management. A seventeen-year-old female patient presented with recurrent attacks of upper abdominal pain, hematemesis, bleeding per rectum, and melena since 1 month of age. She was diagnosed with a case of chronic calcific pancreatitis with pseudoaneurysm of common hepatic artery, and portal vein thrombosis with splenomegaly at the age of 2 years. She underwent angioembolization of the common hepatic artery pseudoaneurysm at the age of 2 years. However, she continued to have recurrent episodes of upper GI bleeding which required multiple hospital admissions and blood transfusions in the past. Contrast-enhanced computed tomography of abdomen was suggestive of chronic calcific pancreatitis with status post coil embolization of common hepatic, gastroduodenal, and proper hepatic arteries. She underwent modified Frey’s procedure in view of recurrent symptoms. Currently, the patient is doing well after 18 months of follow-up, with no further episodes of GI bleed. Angioembolization or surgical ligation of pseudoaneurysm of involved vessels in chronic pancreatitis can control GI bleed. However, in cases where the source of bleeding is not localized by imaging/ endoscopy, drainage of pseudocyst or local resection of pancreatic tissue can reduce inflammation in and around the pancreas and prevent further GI bleed in chronic pancreatitis.

Validation of the Revised Atlanta Criteria in determining the severity of acute pancreatitis.

Determining the severity of acute pancreatitis (AP) is crucial for patient management. The aim of our study was to assess the accuracy and limitations of the Revised Atlanta Criteria (RAC) in determining the severity of AP. The study was retrospectively conducted on AP patients admitted to the Gastroenterology Department of Sakarya University Faculty of Medicine. The severity, morphology and local complications of AP were evaluated according to the RAC. Laboratory parameters, clinical scores predicting disease severity and Computer Tomography Severity Index scores were assessed. The study group included 113 patients. Ninety-eight (86.7%) had interstitial edematous, and 15 (13.3%) had necrotizing pancreatitis. AP pancreatitis was mild in 69 (61.1%), moderate in 33 (29.2%), and severe in 11 (9.7%). Compared to the moderate group, patients in the severe group had a higher hematocrit, creatinine, SIRS and BISAP scores at admission and more length of hospital stay, more ICU requirements, and higher mortality rates ( P < 0.05). Eleven patients had single or multiple persistent organ failure (POF). The mortality rate of patients who developed early POF (n = 6) was higher compared to the group of patients who developed late POF (n = 2) (83.3% and 40%, respectively). Severity assessment using the RAC in patients with AP is consistent with laboratory parameters and scoring systems predicting severity. Severe pancreatitis cases who develop early POF may be classified separately.

A Case of Severe Pancreatitis with Hyperlipidemia Successfully Treated by Integrated Chinese and Western Medicine

A Case of Severe Pancreatitis with Hyperlipidemia Successfully Treated by Integrated Chinese and Western Medicine

Pediatric Drug-Associated Pancreatitis Reveals Concomitant Risk Factors and Poor Reliability of Causality Scoring: Report From INSPPIRE.

Drug-associated acute pancreatitis (DAP) studies typically focus on single acute pancreatitis (AP) cases. We aimed to analyze the (1) characteristics, (2) co-risk factors, and (3) reliability of the Naranjo scoring system for DAP using INSPPIRE-2 (the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort study of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children. Data were obtained from ARP group with ≥1 episode of DAP and CP group with medication exposure ± DAP. Physicians could report multiple risk factors. Pancreatitis associated with Medication (Med) (ARP+CP) was compared to Non-Medication cases, and ARP-Med vs CP-Med groups. Naranjo score was calculated for each DAP episode. Of 726 children, 392 had ARP and 334 had CP; 51 children (39 ARP and 12 CP) had ≥1 AP associated with a medication; 61% had ≥1 AP without concurrent medication exposure. The Med group had other risk factors present (where tested): 10 of 35 (28.6%) genetic, 1 of 48 (2.1%) autoimmune pancreatitis, 13 of 51 (25.5%) immune-mediated conditions, 11 of 50 (22.0%) obstructive/anatomic, and 28 of 51 (54.9%) systemic risk factors. In Med group, 24 of 51 (47%) had involvement of >1 medication, simultaneously or over different AP episodes. There were 20 ARP and 4 CP cases in "probable" category and 19 ARP and 7 CP in "possible" category by Naranjo scores. Medications were involved in 51 of 726 (7%) of ARP or CP patients in INSPPIRE-2 cohort; other pancreatitis risk factors were present in most, suggesting a potential additive role of different risks. The Naranjo scoring system failed to identify any cases as "definitive," raising questions about its reliability for DAP.

The role of delta neutrophil index in early identification of severe acute pancreatitis in adult patients: a prospective diagnostic accuracy study

Objective: The primary outcome of this study is to evaluate the diagnostic performance of the initial delta neutrophil index (DNI) for early identification of severe acute pancreatitis (SAP). Material and Methods: All diagnoses and definitions were made according to the revised Atlanta classification. DNI (delta neutrophil index) was measured automatically using a hematology analyzer. The study included patients aged 18 years and older who were admitted with abdominal pain consistent with acute pancreatitis. The exclusion criteria encompassed patients with a known diagnosis of pancreatic malignancy, iatrogenic endoscopic pancreatitis, those presenting with abdominal trauma, and those experiencing exacerbation of chronic pancreatitis. Results: The median DNI for patients who developed SAP was 0.5 (0.29-1.1), while for non-severe patients, it was 0.2 (0.1-0.41). The difference between the two outcome groups was found to be statistically significant (p&lt;0.001). The area under the curve (AUC) for DNI in predicting SAP was 0.727, with a 95% Confidence Interval (CI) of 0.628-0.825. At the optimal cut-off point, the sensitivity of DNI was determined to be 74.3%, with a 95% CI of 56.7%-87.5%. The specificity was calculated as 68.2% (95% CI=61.6%-74.3%). The positive likelihood ratio (LR+) was 2.34, with a 95% CI of 1.78-3.08, and the negative likelihood ratio (LR-) was 0.38, with a 95% CI of 0.21-0.67. Conclusion: Based on the results, the delta neutrophil index (DNI) shows promise as an essential inflammatory marker for the early diagnosis of SAP. While it may not demonstrate high performance as a standalone marker, our study indicates that DNI could serve as an independent predictor for this outcome. The significant difference observed in DNI values between patients who developed SAP and non-severe patients suggests its potential clinical significance in identifying severe acute pancreatitis cases at an early stage. Further investigations and validation studies are warranted to strengthen the reliability and generalizability of DNI as a diagnostic tool for SAP. Integrating DNI with other relevant clinical and laboratory parameters may enhance its diagnostic accuracy and contribute to more effective patient management strategies. With appropriate intervention and follow-up, the early identification of SAP using DNI may lead to improved patient outcomes and reduced complications, benefiting both the patients and the healthcare system.

Endoscopic Retrograde Cholangiopancreatography in Children: Nine Years' Experience at Santa Fe Foundation in Bogota, Colombia.

Experience in the use of diagnostic and/or therapy of endoscopic retrograde cholangiopancreatography (ERCP) in children is limited. This is due to the underdiagnosis of pancreaticobiliary disease in the pediatric population and specialist personnel in this procedure. To determine the safety and success rate of ERCP in children at Hospital Fundación Santa Fe de Bogotá between January 2007 and June 2015. This was an observational, descriptive, retrospective case series study of patients under 18 years, who underwent ERCP between January 2007 and June 2015. The following variables were analyzed: indication, duration, type of procedure, rate of success, and complications. A total of 30 patients were included, in whom 65 ERCP procedures were performed. Successful cannulation was achieved in 52 of the 65 procedures (80%). Among the complications that occurred, there were four cases of pancreatitis (6.2%), two cases of bleeding (3.1%), and one case of bacteremia (1.5%), and in most cases (58 in total, 89.2%), there were no complications. The pediatric gastroenterology group of the Fundación Santa Fe de Bogotá has obtained good results in performing ERCP in the pediatric population with a success rate of 80% associated with a null mortality rate. There is enough literature available to conclude that performing ERCP in the pediatric population maintains an adequate success rate and a low complication rate. In all the studies evaluated, a null mortality rate was found, so it is considered that this procedure is safe in patients under 18 years of age.

Evaluation of the Role of Computer Tomography Imaging Findings in Determining the Prognosis in Acute Pancreatitis Case by Comparison with Ranson Criteria

Evaluation of the Role of Computer Tomography Imaging Findings in Determining the Prognosis in Acute Pancreatitis Case by Comparison with Ranson Criteria

Clinical characteristics of patients with colon complications after necrotizing pancreatitis: a retrospective cohort study

Objective: To investigate the clinical characteristics of colon complications in patients with necrotizing pancreatitis(NP). Methods: The clinical data of 403 patients with NP admitted to the Department of General Surgery,Xuanwu Hospital, Capital Medical University from January 2014 to December 2021 were retrospectively analyzed. There were 273 males and 130 females,aged (49.4±15.4) years(range: 18 to 90 years). Among them,there were 199 cases of biliary pancreatitis,110 cases of hyperlipidemic pancreatitis,and 94 cases of pancreatitis caused by other causes. A multidisciplinary diagnosis and treatment model was used to diagnose and treat patients. Depending on whether the patients had colon complications,they were divided into colon complications group and noncolon complications group. Patients with colon complications were treated with anti-infection therapy,parental nutritional support,keeping the drainage tube unobstructed,and terminal ileostomy. The clinical results of the two groups were compared and analyzed using a 1∶1 propensity score match(PSM) method. The t test,χ2 test, or rank-sum test was used to analyze data between groups,respectively. Results: The incidence of colon complications was 13.2%(53/403),including 15 cases of colon obstruction,23 cases of colon fistula,and 21 cases of colon hemorrhage. After PSM,the baseline and clinical characteristics at admission of the two groups of patients were comparable (all P>0.05). In terms of clinical outcome,compared to patients with NP without colon complications,the number of patients with colon complications who received minimally invasive intervention(88.7%(47/53) vs. 69.8%(37/53),χ2=5.736,P=0.030),the number of minimally invasive interventions (M(IQR))(2(2) vs. 1(1), Z=4.638,P=0.034),the number of patients with multiple organ failure(45.3%(24/53) vs. 32.1%(17/53),χ2=4.826,P=0.041),and the number of extrapancreatic infections(79.2%(42/53) vs. 60.4%(32/53),χ2=4.476,P=0.034) increased significantly. The time required for enteral nutrition support(8(30)days vs. 2(10) days, Z=-3.048, P=0.002), parental nutritional support(32(37)days vs. 17(19)days, Z=-2.592, P=0.009),the length of stay in the ICU(24(51)days vs. 18(31)days, Z=-2.268, P=0.002),and the total length of stay (43(52)days vs. 30(40)days, Z=-2.589, P=0.013) were also significantly prolonged. However,mortality rates in the two groups were similar(37.7%(20/53) vs. 34.0%(18/53),χ2=0.164,P=0.840). Conclusions: Colonic complications in NP patients are not rare,which can lead to prolonged hospitalization and increased surgical intervention. Active surgical intervention can help improve the prognosis of these patients.

A rare case of acute pancreatitis due to scrub typhus: A case report

Abstract Scrub typhus is an acute febrile sickness, also known as tsutsugamushi fever, which is brought on by Orientia tsutsugamushi, a tiny, obligate intracellular gram-negative bacteria whose polysaccharides have an antigenic connection to proteus OX-K, which is utilised in serologic tests to confirm scrub typhus. The larva of trombiculid mites (chiggers), which are almost minute and frequently brilliantly colourful (red), bite people to transmit O. tsutsugamushi. The signs of onset include fever, headache, myalgia, coughing, and gastrointestinal symptoms after an incubation period of 6–21 days. The primary papular lesion, which the chigger fed on and can appear anywhere on the body, enlarges, experiences core necrosis, and crusts to create a flat black eschar. Regional lymphadenopathy and later generalised lymphadenopathy can be found. A macular rash may develop on the trunk, and the symptoms gradually worsen. In untreated cases, complications may develop and patient may have meningoencephalitis and at times, multiple cranial nerve deficits.

A case of gallstone pancreatitis due to cholesterol stones in which magnetic resonance cholangiopancreatography was useful

A case of gallstone pancreatitis due to cholesterol stones in which magnetic resonance cholangiopancreatography was useful

Comparison of one-step laparoscopy and two-step endolaparoscopy in the treatment of secondary choledocholithiasis: A multicenter retrospective clinical study.

There are two minimally invasive ways of treating cholecystolithiasis combined with choledocholithiasis, but there remains some controversy regarding which technique is better, since they both have advantages and disadvantages. The one-step method involves laparoscopic cholecystectomy, laparoscopic common bile duct exploration, and primary close (LC + LCBDE + PC), while the two-step procedure consists of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, and laparoscopic cholecystectomy (ERCP + EST + LC). This multicenter retrospective study aimed to analyze and compare the effects of the two techniques. The data of patients who underwent either one-step LCBDE + LC + PC or two-step ERCP + EST + LC treatment for gallstones in the gallbladder and bile duct at the Shanghai Tenth People's Hospital, Shanghai Tongren Hospital, and Taizhou Fourth People's Hospital between January 1, 2015 and December 31, 2019 were collected, and the preoperative indicators of the two groups were compared. The surgical success rate of the one-step laparoscopic group was 96.23% (664/690), the transit abdominal opening rate was 2.03% (14/690), and there were 21 cases of postoperative bile leakage. The success rate of the two-step endolaparoscopic surgery was 78.95% (225/285), the transit opening rate was 2.46% (7/285), and there were 43 postoperative cases of pancreatitis and five of cholangitis. Postoperative cholangitis, pancreatitis, postoperative stone recurrence, postoperative hospitalization, and treatment costs were significantly lower (P< 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. However, the amount of intraoperative bleeding, the postoperative extraction time of the abdominal drainage tube, and the incidence of bile leakage were higher (P< 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. The two methods of treating choledocholithiasis combined with choledocholithiasis that were analyzed in this study were safe and effective, and each method had its own advantages.

Fatal case of acute necrotic pancreatitis secondary to chronic abuse of acetaminophen: a case report

Acetaminophen is a widely used analgesic and antipyretic. It is also known to cause hepatotoxicity and is rarely associated with acute pancreatitis due to overdose. We report the case of a 55-year-old man with no known comorbidities, who presented with severe abdominal pain and vomiting. His medication history revealed chronic abuse of a fixed-dose combination containing 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen 3-6 tablets per day for over 20 years for general body pain without a specific diagnosis. He was diagnosed with acetaminophen-induced acute necrotic pancreatitis after ruling out gallstones and other factors such as alcohol consumption, and family history. Although he got discharged against medical advice, follow-up revealed that he had succumbed to his illness within 15 days. This was a fatal case of acetaminophen-induced pancreatitis due to chronic abuse for over 20 years at a dose of less than 2 g/day. This case highlights the need for periodic monitoring of patients taking acetaminophen at doses within the recommended daily dose.