Complicated Chronic Pancreatitis Research Articles

Large intrathoracic collection secondary to acute chronic pancreatitis displacing large hiatal hernia, an uncommon presentation.

Abstract The case of a 60-year-old woman with a history of chronic alcoholism and chronic liver disease is presented as a clinical case. During a hospitalization, a diagnostic imaging test reveals a possible complicated chronic pancreatitis with multiple abdominal collections. Of note is the displacement of one of the collections at the thoracic level along with a pre-existing large hiatal hernia, which, in turn, is compressed and laterally displaced by the collection, causing abdominal pain and dyspnea in the patient. Literature on intrathoracic collections secondary to complicated chronic pancreatitis is scarce. Therefore, in a patient presenting with typical abdominal pain of pancreatitis and dyspnea, it is mandatory to consider this condition in the broad differential diagnosis that needs to be established.

Physiological stress level and screening for malnutrition as preoperative predictors of postoperative complications in pancreatic surgery: a retrospective study

BackgroundAssessment of ‘physiological stress levels’ and ‘nutritional status’ before surgery is important for predicting complications and indirect interventions on the pancreas. The aim of this study was to determine neutrophil–lymphocyte ratio (NLR) and nutritional risk index (NRI) indicators before surgery to predict 90-day complications and mortality in a cohort of patients with complicated chronic pancreatitis and cancer of the head of the pancreas.MethodsWe evaluated preoperative levels of NLR and NRI among 225 subjects treated at different centres located in three countries. Short-term outcomes included length of hospital stay, postoperative complications, and mortality at 90 days and were appreciated based on NLR and NRI. The level of physiological stress was divided according by the formulas: neutrophil–lymphocyte ratio (NLR) = (neutrophil count, %)/(lymphocyte count, %). The nutritional state of the patients was divided according to the INR: NRI = (1.519 × serum albumin, g/L) + (41.7 × present weight, kg / usual weight, kg)].ResultsAll patients were operated. An analysis of the operations performed in three institutions demonstrated mortality in chronic pancreatitis and pancreatic pseudocysts in 1.4%, in chronic pancreatitis and the presence of an inflammatory mass mainly in the pancreatic head in 1.2%, and in cancer of the pancreatic head in 5.9%. The mean preoperative NLR was normal in 33.8% of the patients, the mild physiologic stress level was 54.7%, and the moderate was 11.5% before surgery. 10.2% of patients had a normal nutritional status, 20% had mild, 19.6% had moderate, and 50.2% had severe malnutrition. In a univariate analysis, at the cutoff of NLR ≥ 9.5 (AUC = 0.803) and the cutoff of NRI ≤ 98.5 (AUC = 0.801), increasing the risk of complications was observed (hazard ratio, 2.01; 95% CI, 1.247–3.250, p = 0.006), but at the cutoff of NRI ≤ 83.55 (AUC = 0.81), we observed a survival difference in operated patients (hazard ratio, 2.15; 95% CI, 1.334–3.477, p = 0.0025).ConclusionsOur study demonstrated that NLR and NRI were predictors of postoperative complications, but only NRI was a predictor of 90-day mortality in patients after surgery.

Methodology of choosing a device for stenting of the pancreatic duct in complicated chronic pancreatitis

Methodology of choosing a device for stenting of the pancreatic duct in complicated chronic pancreatitis

TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMPLICATED BY PANCREATORAGIA.

The aim: To present and share our experience in the treatment of pancreatoragia which could help to prevent pancreatoragia in patients with chronic pan¬creatitis in the pre- and postoperative period. Materials and methods: Surgical treatment of complicated chronic pancreatitis (CP) was performed on 249 patients in the surgical clinic of the medical faculty №2 of National Pirogov Memorial Medical University of Vinnytsia during 2000 - 2021. Pancreatorrhagia occurred in 6 (2.4%) patients, group A - 3 (1.2%) - as disease manifestation, group B - 3 (1.2%) - as complication after surgery. In group A the source of bleeding was the lower pancreato-duodenal artery: 2 (0.8%) had lower pancreaticoduodenal artery aneurysms with bleeding into the cyst, 1 (0.4%) - a year after previously performed pancreato-duodenal resection. In group B pancreatorrhagia developed in 3 (1.2%) patients after the Frey-Izbitsky local resection of the pancreas: 2 (0.8%) - from pancreato-jejuno anastomosis, 1(0.4%) - from pancreatopleural fistula. Conclusions: Pancreatoragia, as a manifestation of chronic pancreatitis, occurred in 6 (2.4%) patients. Bleeding occurred as a manifestation of the disease in 3 (1.2%) patients and in 3 (1.2%) patients - in the postoperative period. It is possible to use fibrin or cyanoacrylate glue to filling the defect of the pancreatic duct or to suture vessels in the parenchyma of the pancreas by PDS for the prevention of pancreatoragia in the postoperative period.

Laparoscopic Sleeve Gastrectomy following Pylorus-Preserving Pancreaticoduodenectomy

Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.

Retrospective assessment of the possibilities of minimally invasive interventions in cases of complicated chronic pancreatitis

The paper presents a description of long-term minimally invasive treatment of a patient with chronic biliary pancreatitis. The treatment consisted in stenting the pancreatic duct with plastic stents, their replacement, bougienage of strictures, drainage of a festering pancreatic pseudocyst, and lithoextraction from the common bile duct. A multidisciplinary assessment of gradually developing complications was not performed. No discussions with pancreatic surgeons on indications for radical resection intervention were held. This treatment strategy led to the syndrome of chronic abdominal pain, recurrent complications after endoscopic minimally invasive treatment, as well as to a significant deterioration in the quality of life. The patient developed depression. Clinical observation clearly demonstrates that it is only possible to determine the optimal timing and indications for resection intervention on the pancreas in complicated chronic pancreatitis within the framework of an interdisciplinary approach.

Experience of using stent grafts in the treatment of patients with arrosive bleeding after pancreatic surgery

Aim. To evaluate inhospital outcomes of endovascular treatment in patients who underwent endoprosthetic replacement of the culprit vessel due to arrosive bleeding after pancreatic surgery.Material and methods. In the period 2012-2021 at the A. V. Vishnevsky National Medical Research Center of Surgery, 821 operations on the pancreas due to tumors and complicated chronic pancreatitis were performed. Seventy-five (9,1%) patients developed postoperative arrosive bleeding. Stent grafts were used to stop bleeding in 14 (18,7%) of them. There were 9 men (64,3%) and 5 women (35,7%). The median age of patients was 60 years (men — 61 years, women — 59 years). Arrosive bleeding occurred after pancreaticoduodenal resection in 13 patients, while in one case — after distal pancreatic resection. In all 14 cases, postoperative bleeding was severe and classified as grade C according to the International Study Group for Pancreatic Surgery (ISGPS) classification.Results. There were following sources of bleeding: gastroduodenal artery — 4 (28,6%) patients, proximal hepatic arteries (right/left) — in 4 (28,6%) patients, proximal superior mesenteric artery — in 2 (14,3%), dorsal pancreatic artery — in 1 (7,1%), false aneurysm of proximal splenic artery — in 1 (7,1%), proximal common hepatic artery — in 2 (14,3%). In 10 (71,4%) patients, endoprosthetic replacement of the proximal segment of culprit artery was performed, while in 4 (28,6%) patients with arrosion of short gastroduodenal artery stump and false aneurysm, endoprosthesis replacement of the common hepatic artery was performed with a transition to the proper hepatic artery. The technical success of endovascular hemostasis (absence of contrast media extravasation) was achieved in 100% of cases. Three (21,4%) of 14 patients developed rebleeding from another arterial source. Inhospital mortality was 28,6% (n=4). The cause of deaths in 3 cases was the direct complications of endovascular hemostasis, while in one patient — progressive postoperative pancreatitis with the outcome in multiple organ failure.Conclusion. Endovascular hemostasis using a stent graft is an effective surgical method for the treatment of arrosive bleeding after pancreatic surgery. The intervention is associated with possible complications, the risk of which must be taken into account before the procedure. We consider arrosive bleeding from a defect in the main vessel (common/ proper/right or left hepatic arteries, superior mesenteric artery) as an indication for performing endoprosthetic replacement.

CLINICAL EXPERIENCE IN THE TREATMENT OF PANCREATORRHAGHIA IN PATIENTS WITH COMPLICATED CHRONIC PANCREATITIS

Bleeding, the source of which is in the pancreas or adjacent structures, is a rare, usually fatal manifestation of chronic pancreatitis.
 The aim of the study was to analyze the clinical experience of treatment of patient with chronic pancreatitis complicated by late pancreatorrhaghia (hemosuccus pancreaticus). 
 Materials and methods. During 2000-2021, surgical treatment of 249 patients with complicated chronic pancreatitis was performed. Pancreatorrhaghia occurred in 6 (2.4%) patients.
 Discussion. A presentation of a clinical case of bleeding in the lumen of the gastrointestinal tract in a patient who underwent pancreatoduodenal resection a year ago for complicated fibro-degenerative chronic pancreatitis. Bleeding arose from the inferior pancreatoduodenal artery, which was cut through the mattress suture after heavy exercise, which caused severe pancreatorrhaghia.
 Conclusions. To prevent the occurrence of pancreatorrhaghia in the postoperative period, the most effective way is to suture the vessels in the parenchyma of the pancreas polydioxanon and filling the defects of the pancreatic duct with fibrin or cyanoacrylic glue. Although this issue needs further study.

Інвазивна та неінвазивна діагностика фіброзу підшлункової залози у хворих з ускладненими формами хронічного панкреатиту

The purpose of the study was to identify the patterns of changes in the state of the parenchyma of the pancreas in patients with complicated forms of chronic pancreatitis with evaluation of the diagnostic effectiveness of shear wave elastometry (graphy). Materials and methods. For the period from 2006 to 2018 58 patients with complicated forms of chronic pancreatitis were examined. The average age of patients is (47.1±3.2) years old. The medical history ranged from 3 to 15 years. The basis of morphological studies were biopsies of the pancreas obtained during surgery. Ultrasound elastometry and pancreatic parenchymal elastography were performed by transcutaneous shear wave approach in Shear Wave Elastography. Software consistency was assessed by the nature of the color mapping. Results and discussion. The morphometry of the volume parts of the structural components of the pancreas showed that with the development of complicated chronic pancreatitis there is an increase in the area of fibrous tissue and a decrease in the area of acinar components. The proof of this is the strong inverse relationship between the degree of fibrosis and the volume fraction of acinar tissue (r= -0.83; р <0.05), as well as the direct relationship between the degree of fibrosis and the volume fraction of connective tissue (r=0.61; р <0.05). If at a fibrosis of the III degree acinar tissue occupied (25.39±2.01)%, connective – (64.33±3.85)%, fatty – (6.42±4.48)%, at a fibrosis of the IV degree noted the following: the proportion of acinar tissue was only (2.86±0.76)%, connective – (74.11±4.17)%, and (20.14±4.29)% was adipose tissue. Such manifestations indicated severe irreversible changes in the external secretory function of the pancreas. When assessing changes in the stiffness of the pancreatic parenchyma with the deepening of fibrosis processes and data from transcutaneous shear wave elastography, it was found that the degree of fibrosis according to morphological data correlated with the degree of fibrosis according to shear wave elastography, r = 0.71; p <0.05. The following patterns were noted. Grade II pancreatic fibrosis was characterized by intralobular fibrosis, which covered 26-50% of the gland area, which corresponded to the shear wave elastography data in green-blue color (5.98-7.05 kPa). Grade III pancreatic fibrosis corresponded to intralobular fibrosis, which covered 51-75% of the gland area in shear wave elastography in green-yellow color (7.06-9.06 kPa). Grade IV pancreatic fibrosis was characterized by intralobular fibrosis, which covered 76-100% of the gland area, which corresponded to shear wave elastography data in yellow-red color (> 9.07 kPa). Conclusion. Thus, the objectification of shear wave elastography indicators of the pancreas based on the correlation of histological evaluation and morphometric indicators of structural changes in the pathological process allows to consider transcutaneous shear wave elastography as a promising and reliable method of non-invasive diagnosis of fibrosis in chronic pancreatitis

An innovative method for the management of complicated chronic pancreatitis

An innovative method for the management of complicated chronic pancreatitis

Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Jagielski M, PiÄ tkowski J, Jackowski M. Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails. Gastroenterology Review/PrzeglÄ d Gastroenterologiczny. 2021. doi:10.5114/pg.2021.106246. APA Jagielski, M., PiÄ tkowski, J., & Jackowski, M. (2021). Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails. Gastroenterology Review/PrzeglÄ d Gastroenterologiczny. https://doi.org/10.5114/pg.2021.106246 Chicago Jagielski, Mateusz, Jacek PiÄ tkowski, and Marek Jackowski. 2021. "Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails". Gastroenterology Review/PrzeglÄ d Gastroenterologiczny. doi:10.5114/pg.2021.106246. Harvard Jagielski, M., PiÄ tkowski, J., and Jackowski, M. (2021). Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails. Gastroenterology Review/PrzeglÄ d Gastroenterologiczny. https://doi.org/10.5114/pg.2021.106246 MLA Jagielski, Mateusz et al. "Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails." Gastroenterology Review/PrzeglÄ d Gastroenterologiczny, 2021. doi:10.5114/pg.2021.106246. Vancouver Jagielski M, PiÄ tkowski J, Jackowski M. Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails. Gastroenterology Review/PrzeglÄ d Gastroenterologiczny. 2021. doi:10.5114/pg.2021.106246.

430 BALLOON TAMPONADE UTILIZATION FOR SEVERE ESOPHAGITIS CAUSING HEMORRHAGIC SHOCK

Abstract Esophagitis as a cause of upper gastrointestinal bleeding (UGIB) is a difficult entity to treat and is associated with significant morbidity. Epidemiologic studies note a 7-18% incidence of significant hemorrhage due to esophagitis. Current existing treatment options for UGIB complicated by hemorrhagic shock secondary to severe esophagitis are limited when there is a lack of response to proton pump inhibitor (PPI) medical therapy. Methods We present a case series of two patients who developed hemorrhagic shock from esophagitis, underwent endoscopic evaluation revealing limited treatment options, and ultimately required balloon tamponade resulting in successful resolution of bleeding and improvement in hemodynamics. A 55-year-old male with history of alcoholism complicated chronic pancreatitis and esophagitis presented with seizures. On admission he experienced hemorrhagic nasogastric tube output, anemia unresponsive to transfusions and hemodynamic instability. A 44-year-old patient with decompensated alcoholic cirrhosis was initially admitted for renal failure, and during the hospitalization developed melena and hemorrhagic shock requiring transfusions and vasopressors. The patients were promptly started on PPI infusion. Results Both patients underwent esophagogastroduodenoscopy revealing severe bleeding esophagitis extending from the gastroesophageal junction to the proximal esophagus and no varices. Active bleeding was not amenable to endoscopic therapy and both patients underwent balloon tamponade placement. The first patient required inflation of both the esophageal and gastric balloons for control of hemorrhage for 6 hours whereas the second patient required just gastric balloon inflation for 12 hours. Bleeding, transfusion requirement, and hemodynamics improved in both patients. Second look endoscopy demonstrated resolution of bleeding and hemostatic spray was applied to the esophagus prophylactically. Neither patient had recurrence of bleeding during the hospitalization. Conclusion UGIB secondary to esophagitis is difficult to control due to the highly vascularized nature of the esophagus. Endoscopic therapies are limited in extensive mucosal injury and risks of complications such as perforation are high. Other therapeutic options such as angiography are restricted due to vascular collateralization and surgical interventions have high morbidity and mortality. Balloon tamponade provides a viable treatment option for severe UGIB secondary to esophagitis that is not responsive to medical therapy.

Serum amphiregulin level and pancreatic adenocarcinoma relation in patients with chronic pancreatitis

Background /Aims : We aimed in our study to determine serum amphiregulin level, which is an indicator of a malignancy, and to foresee pancreatic carcinoma in chronic pancreatitis.Materials and Methods: 42 patients who applied to Department of Gastroenterology and were diagnosed with chronic pancreatitis and 43 healthy patients as the control group were enrolled in the study. Serum amphiregulin levels were studied with an Amphiregulin Human ELISA Kit ab99975 (Abcam, Cambridge, UK) by ELISA(Enzyme-Linked Immunosorbent Assay) method. Results: Patients with chronic pancreatitis compared to healthy control group (p : 0.007) and the group complicated with pseudocyst among chronic pancreatitis patient group, serum amphiregulin level (p : 0.006) and Ca 19-9 (p : 0.03) level are high. We also found that the relationship between the long diameter of the pseudocyst and serum amphiregulin level is statistically significant (p : 0.01) in the complicated chronic pancreatitis group. Conclusion: Patients with chronic pancreatitis and the group complicated with pseudocyst among chronic pancreatitis patient group must be monitored more closely in terms of pancreatic cancer since serum amphiregulin level and Ca 19-9 level are high and the relationship between the long diameter of the pseudocyst and serum amphiregulin level is statistically significant in such patient groups.

Benefits of perioperative enteral nutrition in resectional surgery of complicated chronic pancreatitis

Benefits of perioperative enteral nutrition in resectional surgery of complicated chronic pancreatitis

Quality of life as an efficiency index of surgical treatment of chronic pancreatitis

To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis. There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/m2. HR-QOL was determined using the questionnaires SF-36, QLQ EORTS C30, VAS. Postoperative control was made no earlier than 6 months after surgery. Median follow-up 11.5 months. The data were analyzed using non-parametric methods. Quantitative data are shown as median with interquartile range. Differences between quantitative values were determined using the Mann-Whitney test. Physical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p<0.05). Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.

The use and evaluation of prevention methods to reduce inflammatory and diffuse septic complications in patients undergoing pancreatic resection

Background:Surgery for chronic pancreatitis and pancreatic neoplasms is associated with a risk of acute destructive pancreatitis and pancreaticojejunal anastomotic leakage in the early postoperative period. Despite the availability of multiple surgical and pharmaceutical approaches to prevent these complications, they continue to be associated with high mortality.Aim:To evaluate the efficacy of the clinical use of our original preventive methods of postoperative pancreatitis and diffuse inflammatory and septic complications in patients undergoing pancreatic resection due to its benign and malignant diseases.Materials and methods: We retrospectively analyzed the results of surgical treatment of 524 patients following pancreatic resection. All patients underwent pancreatic surgery in the Rostov Regional Clinical Hospital (Rostov-on-Don, Russia) from February 2005 to April 2018 for the following indications: complicated chronic pancreatitis in 221 patient, pancreatic and major duodenal papilla tumors in 303 patients. Organ-preserving procedures were performed in 250 patients, and radical extended resections of the pancreas in 274 patients. In 489 patients, the procedures were finalized with the formation of anastomosis between the pancreatic duct and jejunum. In 373 patients, the reconstruction step included enterostomal drainage of the pancreatic duct. To prevent acute postoperative pancreatitis and diffuse septic and inflammatory complications, in 298 patients we used our original techniques, while 226 patients underwent conventional procedures.Results:Among 226 patients, who had underwent conventional procedures, the complications occurred in 75 (33.19%), with septic complications in 29.33% (22 patients). Of 298 patients, in whom any of the original prevention techniques had been used, the complications were seen in 67 (22.48%), with septic complications in 13.43% (9 patients). Seventeen (17, or 11.97% of the total number) patients had to be re-operated, with 15 (6.64%) having been initially operated without additional preventive measures, and 2 (0.67%) with the use of the original prevention techniques. Overall postoperative mortality was 2.48%. The causes of death were: peritonitis in 4 patients, arrosive bleeding from visceral arteries in 4, bleeding from pancreatic head stump into the omental sac in 2, bleeding at the pancreaticojejunal anastomosis in 1, and cardiac disorders in 2.Conclusion:The study results have shown that the use of techniques to prevent the spread of inflammation and septic in the abdominal cavity and decreasing the rates of postoperative necrotic pancreatitis in pancreatic resections allows for a reduction of these complications and related mortality.

Surgical treatment of patients with compressive complications of chronic pancreatitis

Background. Treatment of patients with chronic pancreatitis complications remains one of the complex problems in modern gastroenterology. Surgical treatment of these patients is not always effective, the risk of postoperative complications is significant. Surgical treatment of such patients has special features, since the use of traditional resective organ preservation techniques has certain limitations. Material and methods. The experience of surgical treatment of 185 patients with complicated chronic pancreatitis has been analyzed for the last 7 years. The clinical efficacy of surgical treatment of 31 patients with compressive complications of chronic pancreatitis was studies. Results. The main types of interventions performed in compression forms of chronic pancreatitis were drainage operations (in 12 patients) and pancreatic resections (in 8 patients), as well as surgeries with the formation of various cystodigestive anastomoses (5 patients). When radical interventions are impossible (6 episodes), the formation of bypass gastroenteroanastomosis, biliodigestive anastomosis or bile ducts external drainage were performed. The indications to the operations, their efficacy and complications were considered. Conclusions. Standard pancreatic organ preservation surgeries in most cases can eliminate the phenomena of subcompensated forms of biliary and portal hypertension, as well as duodenal obstruction. The obtained results proved the reasonability of pancreatic duct drainages in all types of resection that ensures the aggressive compounds removal from the place of anastomosis during its healing and reduces hydrostatic pressure in the pancreatic duct system.

Хірургічна тактика лікування ускладнених форм хронічного панкреатиту з огляду на функціональний стан хворих

Вступ. Хронічний панкреатит (ХП) - поліетіологічне захворювання. Важливою проблемою абдомінальної хірургії є лікування ускладнених форм ХП.&#x0D; Матеріали і методи. Проаналізований досвід хірургічного лікування 185 хворих з приводу ускладненого ХП за 7 років. У 109 хворих проаналізований функціональний стан, на підставі чого обирали тактику хірургічного лікування.&#x0D; Результати. При хронічному запаленні проксимальних частин підшлункової залози (ЗП), а особливо її головки, у 64,5% хворих виявлені порушення нормального пасажу жовчі у дванадцятипалу кишку (ДПК). Портальна гіпертензія вторинного ґенезу внаслідок стискання ретропанкреатичних венозних судин відзначена у 25,9% хворих; у 61,5% - діагностована кістозна трансформація протокової системи ПЗ, справжні та псевдокісти; у 10,1% - нориця ПЗ.&#x0D; Висновок. При розробці тактики оперативного лікування хворих з приводу ХП сформульовані абсолютні й відносні показання та протипоказання, засновані на об’єктивному аналізі стану всіх систем і органів пацієнтів. За наявності вираженої внутрішньоорганної дисфункції виконання оперативного втручання можливе за умови компенсації функціонального стану шляхом проведення інтенсивної фармакотерапії до операції.

Colonoscopic Extraction of Swallowed Partial Denture Impacted in the Ileocecal Valve

INTRODUCTION: Ingestion of dental prostheses is not an uncommon phenomenon with most complications resulting from esophageal impaction. We present a rare case of impaction in the distal gastrointestinal tract and provide the first video submission of such an extraction. CASE REPORT: A 62-year-old male with past medical history of coronary artery disease with stent placement in 2015, gout, and alcohol abuse complicated chronic pancreatitis was admitted to our medical center for acute on chronic pancreatitis in setting of continued alcohol abuse. While being treated, he accidentally ingested his lower mandibular dentures. Upper endoscopy (EGD) was performed, but the foreign body was not seen. Abdominal x-rays demonstrated the dentures had migrated to the mid jejunum without evidence of obstruction. Serial imaging revealed that the dentures were in the right lower quadrant, presumably in the cecum or terminal ileum (Figure 1) and remained there for four consecutive days by imaging, again without obstruction clinically nor by imaging. The decision was made to pursue colonoscopy for foreign body retrieval, which revealed the foreign body protruding from the ileocecal valve (Figure 2A). The protruding end of the denture was retrieved using an endosnare and removed without incident (Figure 2B-2C).Figure: KUB showing denture in right lower quadrant of the abdomen.Figure: Denture at the ileocecal valve (A); denture ensnared (B); denture after removal (C).DISCUSSION: The accidental ingestion of dental prostheses is not uncommon, especially in adults with old and/or poorly maintained dentures. Case series have demonstrated that 11.5-17.6% of impacted foreign bodies involved dental prostheses. The most common site of impacted dentures is in the esophagus, and while many are passed spontaneously with no need for endoscopic or surgical intervention, there are rare cases of impaction at the level of the ileocecal valve, cecum, appendix, ascending colon, and transverse colon, and sites of frequent perforation include the ileocecum and rectosigmoid colon, owing to the acute angulation or physiologic narrowing of the tract. Endoscopic removal via colonoscopy is typically successful in these cases.Figure: Fluoroscopic image prior to removal of denture (Left). Fluoroscopic image after removal (Right).

INTRAOPERATIVE PANCREATOVIRUSUNGOGRAPHY AS COMPLEX DIAGNOSTIC OF COMPLICATIONS OF CHRONIC PANCREATITIS

The experience of surgical treatment of 106 patients with complicated chronic pancreatitis occurrence. Depending on the type of complications localization process, state-biliary pancreatic area using our proposed intraoperative puncture pancreatovirsungography, performed invasive diagnostics of the ductal system and pancreatic tissue. This enabled us to diagnose the various complications of CP, and implement the most optimal surgery, with minimal postoperative complications. In 28 (41%) patients (first group) performed external or internal drainage of cysts. In 40 (59%) patients (study group) performed intraoperative puncture pankreatovirsungographiya that allowed in 28 (41%) of them reveal cyst, which combined with duct and a significant ductal hypertension. So intraoperative puncture pancreatovirsungography is informative and effective method of invasive ductal system software research in patients complicated forms of CP, allowed to use the most effective method of surgical treatment for a particular patient. Applications developed intraoperative diagnosis of ductal system of the pancreas, namely pancreatovirsungography puncture, ensured the reduction of the frequency of complications in the early postoperative period, severity of pain and improve quality of life (by questionnaire MOS SF-36).