Complication Of Acute Pancreatitis Research Articles

Complicated Severe Acute Pancreatitis: Open and Laparoscopic Infracolic Approach

IntroductionThe heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. Central solid collections at the root of the mesentery are difficult to access with traditional techniques. Here we describe a case series of laparoscopic infracolic necrosectomy (ICN) and open or laparoscopic infracolic necrosectomy with Roux-en Y cystjejunostomy (ICN-RYCJ) for the management of complicated SAP. Materials and MethodsA retrospective analysis of a prospectively maintained database identified all patients treated with infracolic necrosectomy or drainage of pancreatic collections for complicated SAP between 2012 and 2021 inclusive at a single institution. ResultsForty patients were identified (median age 53 years)—ICN group 9 patients (median time to intervention—22 days) and ICN-RYCJ group 31 patients (median time to intervention—99 days). Two patients in ICN group underwent interval fistula-tract jejunostomy. Thirty-one patients had laparoscopic surgery and 9 patients underwent an open approach. Four patients required intervention post-operatively. Nineteen patients were discharged from follow-up at two years. ConclusionInfracolic approach with selective Roux-en Y cystjejunostomy, as a single or staged intervention, is an effective and safe operative option to add to the armamentarium of the pancreatic surgeon when dealing with complicated SAP not amenable to drainage/debridement by traditional techniques.

A study of splanchnic vein thrombosis in cases of acute pancreatitis and its outcome in a tertiary care center

Splanchnic veins thrombosis(SVT) is one of the rare but known complications of Acute Pancreatitis(AP). It mostly involves Splenic vein(SPV), Superior mes enteric vein(SMV) and often Portal vein(PV) either individually or in combination. Though the cause is thought to be multi-factorial, a direct inflammatory process is implicated in the pathogenesis of SVT in AP. SVT can be sometimes an incidental finding in the radiological evaluation, but it also presents with severe pain, portal hypertension, hepatic dysfunction and bowel ischemia in a life-threatening scenario. Present study aims at understanding incidence, pattern, therapy initiated, complications and outcome of SVT in AP.A serial study of 89 cases of acute pancreatitis who underwent Contrast Enhanced Computed Tomography was conducted at tertiary care centre, department of general surgery, Mysore Medical College and Research Institute, Mysore, Karnataka from the period of January 2021 to June 2021. Out of 89 cases studied, 62 were male, 27 were female with mean age of 39.5 years. Most common cause of AP was Ethanol abuse, followed by Gallstones, Main pancreatic duct (MPD) anamoly, Anamoly of duodenal papillae and idiopathic. 37(41.57%) Patients had SVT. 31(83.78%) were male, 6 (16.22%) were female. 29 patients received anti-coagulation therapy, out of which 24 showed good response. Out of 8 patients who didn’t receive therapy 3 showed reduction in size of clot by 75%. Hence, anticoagulation has a therapeutic role in treatment of SVT (p- 0.0157). SVT is one of the known complications in AP with increase in incidence severity and with presence of peripancreatic collection. Spontaneous resolution of SVT is seen in about 40% of patients whereas anticoagulation therapy has a good role.

“Mediastinal Pseudocyst: A Case Report and Review of Literature”

A mediastinal pseudocyst is the extension of pancreatic pseudocyst into the posterior mediastinum through esophageal or aortic hiatus or rarely through the foramen of Morgagni. It is a rare complication of acute or chronic pancreatitis. We report a rare case of mediastinal pseudocyst of a 35-year-old male alcoholic who was presented with dyspnea, hemoptysis.

Management of Complicated Acute Pancreatitis: The Role of Hub-and-Spoke Model.

To determine the primary and secondary outcomes of patients with complicated acute pancreatitis (CAP) of moderate to severe intensity managed by using the hub-and-spoke model. An observational study. Department of Surgery, North Cumbria Integrated Care, Carlisle, UK, from January 2014 to December 2018. Retrospective analysis of 496 episodes of acute pancreatitis managed in 405 patients was done. Data for demographic features and clinical outcomes were analysed. In patients with recurrent admissions, only index admission was considered for analysis. Complicated acute pancreatitis was defined by using the revised Atlanta classification and included all the acute pancreatitis patients with local and or systemic complications. Results: The frequency of CAP was 21.7% (88/405). The mean patients' age was 62.11 ± 17.90 years. The intensive therapy unit (ITU) admission rate was 33% (n = 29), whereas the overall intervention rate was 43.2% (n = 38). The in-hospital mortality rate was 10.2% (n = 9), and the overall mortality rate was 14.8% (n = 13). A comparative analysis of clinical outcomes according to the revised Atlanta classification showed that the rate of complications, need for ITU admission, duration of hospital stay, in-hospital mortality and overall mortality were significantly higher in patients with moderately severe AP (MSAP) and severe AP (SAP). The rate of progression from mild AP to MSAP and SAP remains high. Patients with CAP are at higher risk of ITU admission, prolonged hospital stay, in-hospital mortality and overall mortality. To improve clinical outcomes, the progression of AP to severer forms should be prevented by developing newer strategies, and in cases where complications have already developed, the mortality rate needs to be improved by developing innovative treatment modalities. Acute pancreatitis, Complicated acute pancreatitis, Revised Atlanta classification, Morbidity, Mortality, Survival analysis, Hub and spoke model.

Machine Learning-Assisted Ensemble Analysis for the Prediction of Acute Pancreatitis with Acute Kidney Injury.

PurposeAcute kidney injury (AKI) is a frequent complication of severe acute pancreatitis (AP) and carries a very poor prognosis. The present study aimed to construct a model capable of accurately identifying those patients at high risk of harboring occult acute kidney injury (AKI) characteristics.Patients and MethodsWe retrospectively recruited a total of 424 consecutive patients at the Gezhouba central hospital of Sinopharm and Xianning central hospital between January 1, 2016, and October 30, 2021. ML-assisted models were developed from candidate clinical features using two-step estimation methods. The receiver operating characteristic curve (ROC), decision curve analysis (DCA), and clinical impact curve (CIC) were performed to evaluate the robustness and clinical practicability of each model.ResultsFinally, a total of 30 candidate variables were included, and the AKI prediction model was established by an ML-based algorithm. The areas under the ROC curve (AUCs) of the random forest classifier (RFC) model, support vector machine (SVM), eXtreme gradient boosting (XGBoost), artificial neural network (ANN), and decision tree (DT) ranged from 0.725 (95% CI 0.223–1.227) to 0.902 (95% CI 0.400–1.403). Among them, RFC obtained the optimal prediction efficiency via adding inflammatory factors, which are serum creatinine (Scr), C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-albumin ratio (NAR), and CysC, respectively.ConclusionWe successfully developed ML-based prediction models for AKI, particularly the RFC, which can improve the prediction of AKI in patients with AP. The practicality of prediction and early detection may be greatly beneficial to risk stratification and management decisions.

Rifaximin in gut microbiota modification in acute pancreatitis: 15 years of retrospective clinical study.

Gut decontamination could have some benefits in preventing infectious complications in acute pancreatitis (AP). To investigate whether the administration of rifaximin could have an impact on the outcomes of AP. We conducted a retrospective study on 373 patients with a median age of 50 years that were admitted to our Department of Gastroenterology in the years 2001-2016 with a diagnosis of AP. Patients were subclassified according to the revised Atlanta criteria: mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Thereafter, all the patients were divided into 2 groups: in the 1st group (R0) with MSAP and SAP, patients did not receive rifaximin, and in the 2nd group (R1), in the cases of MSAP and SAP, rifaximin was administered to patients at a dose of 3 × 400 mg (for at least 5 days and up to 7 days). There was no other difference in the treatment between the groups. The median duration of hospital stay, the number of infectious complications and the mortality rate were recorded for both groups. A significant difference was observed between median durations of hospitalization between the groups with (R1) and without (R0) rifaximin treatment (14 days compared to 24 days, p = 0.001) and in the number of patients infected with pancreatic necrosis (7 compared to 1, p = 0.0487). However, there was no statistically significant difference between the R1 and R0 group in terms of mortality rate. The results indicate that rifaximin seems to be a promising novel therapeutic option in MSAP and SAP.

Acute Kidney Injury and Acute Pancreatitis in Patients with Chronic Hypertension and COVID-19: A Case Report

BACKGROUND: Hypertensive patients with Coronavirus Disease 2019 (COVID-19) are facing high morbidity and mortality. These morbidities include acute kidney injury (AKI) and acute pancreatitis, which have an incidence of about 17% each. Severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) virus penetrates cells through the angiotensin-converting enzyme 2 (ACE2) receptor which is widely found in the respiratory tract, gastrointestinal tract, kidneys, pancreas, and other organs. The virus multiplies in the airway and then enters circulation bound to ACE2 receptors in the tissue. CASE REPORT: This case report presents a chronic hypertensive patient with COVID-19 accompanied by complications of AKI and acute pancreatitis. CONCLUSION: AKI is a risk factor for death in COVID-19 patients, where kidney involvement in COVID-19 is thought to be due to direct infection with SARS-CoV2 or through other complicating conditions, where acute pancreatitis occurs due to COVID-19.

Predictors and classifications of the degree of severity of acute pancreatitis

Severe acute panreatitis is a life-threatening disease with mortality rates of about 15%. With the development of infected necrotizing pancreatitis, complicated by the development of organ failure, the mortality rate is 35.2%. Due to the fact that acute pancreatitis is a highly variable pathological process, leading to a wide range of clinical outcomes, predicting the severity of the disease and early identification of patients at risk of developing severe complications is critical to optimize treatment outcomes for this disease. Currently, there are no uniquely accurate and practically available laboratory tests to predict the severity of patients with acute pancreatitis. The review presents literature data on the terminology and classifications of the severity of acute pancreatitis, taking into account the possibilities of their practical application. Information on clinical scale systems for assessing the severity of acute pancreatitis with an assessment of their effectiveness in predicting various treatment outcomes is presented in detail. The characteristics and capabilities of various laboratory markers in the assessment of organ failure and diagnosis of systemic complications of acute pancreatitis are presented. Currently, for the best assessment of the severity of acute pancreatitis, it is necessary to use a multidisciplinary clinical examination of patients and a combination of various predictive tools.

Management of pancreatic fluid collections.

Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).

Role of red-blood-cell distribution width as the predictor of severity and mortality of acute pancreatitis

Background In the USA, acute pancreatitis (AP) was the third most prevalent gastrointestinal disease and it is the commonest pancreatic disease worldwide. It is critical to identify individuals at a higher risk of developing severe AP early to improve their prognosis. Several scoring systems to assess the severity of AP (e.g. Ranson’s criteria and acute physiologic assessment and chronic health-evaluation II) were developed. Aim The goal of this study was to see whether red-cell distribution width (RDW) could be used to predict the severity and mortality of AP. Patients and methods This prospective observational study included 50 patients admitted at Tanta University Emergency Hospital with AP. During the study, 46 patients survived, while four patients died, 31 patients discharged without complications, and 15 patients had complications. Results RDW had a significant relationship with complications of AP (P=0.005), also, RDW had a strong relationship to mortality (P=0.049). RDW had a sensitivity of 61.11% and a specificity of 84.37% in predicting complications. While RDW had a sensitivity and specificity of 75.0 and 95.65%, respectively, in predicting mortality. We also found that Ranson’s criteria had a significant relationship with complications and mortality of AP (P=0.024). The sensitivity and specificity of Ranson’s criteria to predict complications was 72.22 and 62.50%, respectively. While the sensitivity and specificity of Ranson’s criteria to predict mortality was 75.0 and 71.74%, respectively. Conclusion RDW seems to be a good test used to determine the severity of AP.

Management of severe acute pancreatitis in 2019.

Pancreatic fluid collections (PFCs) are frequent complications in severe acute pancreatitis that are the result of damage to the pancreas to include but not limited to trauma, surgery, autoimmune diseases, alcohol abuse, infections, medications, gallstones, metabolic disorders, and premalignant or malignant conditions. The majority of these collections resolve spontaneously; however, if the collection is infected or causes symptoms to include abdominal pain, nausea, vomiting, diarrhea, fevers, and tachycardia, drainage is indicated. Drainage of PFCs can be accomplished surgically, percutaneously, or endoscopically and should be approached in a multidisciplinary fashion for best overall patient care and outcomes. Before the introduction of endoscopic procedures, surgical and percutaneous drainage was the preferred modality. Today a minimally-invasive "step-up" approach is generally accepted depending upon the specific characteristics of the PFC and clinical presentation. Endoscopic ultrasound-guided PFC drainage is favored due to high success rates, shorter hospital stays, and lower cost. Direct debridement of walled-off pancreatitis can now be performed endoscopically with higher success rates with larger caliber fully covered metal stents. At large, the field of endoscopic techniques has evolved, and more specifically, the management of PFCs continues to evolve with increasing experience and with the advent of new stents and accessories, leading to increased efficacy with less adverse events.

Microbial Spectra and Clinical Outcomes from Endoscopically Drained Pancreatic Fluid Collections: A Descriptive Cohort Study.

Pancreatic pseudocyst (PC) and walled-off necrosis (WON) are dreaded complications of acute pancreatitis. Standard therapy consists of endoscopic ultrasound-guided transmural placement of stents to expedite resolution through internal drainage of fluids or necrotic material. Either double pigtail plastic stents (DPPS) or lumen-apposing metal stents (LAMS), or a combination of both, are available for this purpose. The objective of this study was to examine the impact of different stent types on infection rates in addition to clinical outcome measures such as periprocedural adverse events. We conducted a retrospective study comprising 77 patients who had undergone endoscopic drainage for PC or WON in a pancreatitis tertiary referral center. Analysis revealed that both bacterial and fungal infections occurred more frequently in patients treated with LAMS with or without DPPS compared to DPPS only. The use of antibiotics and antimycotics followed the same pattern. Furthermore, a prolonged length of hospital stay and a higher likelihood of transfer to an intermediate care unit were observed in patients with LAMS with or without DPPS. These differences were eliminated if only WON patients were analyzed. Our data imply that the clinical course is primarily influenced by the complexity of the pancreatic fluid collection (PFC) itself rather than the stent type. Prospective large-scale cohort studies are mandatory to underpin these findings.

Tetrad of DKA, Hypertriglyceridemia induced Pancreatitis and Splenic vein thrombosis

Patients with diabetes mellitus have diabetic dyslipidemia that occurs due to disturbances in glucose metabolism and can lead to hypertriglyceridemia (HPTG). Severe HPTG is associated with significantly increased risk of developing acute pancreatitis (AP). Acute pancreatitis (AP) is characterized as an inflammatory condition where inactive digestive enzymes become activated causing pancreatic tissue destruction. Hypertriglyceridemia and the inflammatory state that ensues therein also gives rise to a hypercoagulable state in patients with AP. Splenic vein thrombosis (SVT) is a rare complication of both AP and chronic pancreatitis (CP). We report a Case of 55-year-old Filipino male with past medical history of hypertension and uncontrolled type 2 diabetes mellitus (T2D), who presented with abdominal pain and was found to have diabetic ketoacidosis (DKA), and severe HPTG which led to acute pancreatitis, further complicated by SVT requiring anticoagulation. Our case highlights the importance of strict glycemic control among diabetic patients, the prompt management of AP in the setting of HPTG, and treatment of SVT.

Encapsulated necrotic pancreatitis

This study presents a rare clinical case of encapsulated necrotic pancreatitis, which was a complication of acute pancreatitis that arose against the background of alimentary disorders. The aspects of the semiotics of radiation diagnostic methods in the follow-up control of these pathologies were presented.
 This case is notable for the manifestation of diseases upon hospital admission, as in the classical edematous form of acute pancreatitis, with a further increase in negative dynamics. This demonstrated the possible stepwise disease development, accompanied by a series of follow-up computed tomography between the clinical and morphological phases of acute pancreatitis and before the formation of pancreatic necrosis, which was complicated by sequestration of the pancreatic body with peripancreatic abscess formation. Afterward, the therapeutic paradigm was changed, and the place of the conservative approach was taken by active surgical tactics, followed by repeated manipulations and follow-up computed tomography and magnetic resonance until the improvement of the patients condition.

Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Treatment of Local Complication and Necrotizing Pancreatitis

In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis.

Hemocoagulation factors of hemorrhagic complications in acute pancreatitis

A feature of the severe condition of acute pancreatitis is the high risk of complications occurring in 50% of patients. The most dangerous are thrombohemorrhagic complications and arrosive bleeding, with late diagnosis of which mortality can reach more than 85%. The aim of the study was to determine early diagnostic criteria for the onset and development of bleeding in acute pancreatitis. The results of treatment of 82 patients with severe acute pancreatitis were analyzed. The patients were divided into the main group (with bleeding) (30 people) and the comparison group (without bleeding) (52 people). The parameters of hemocoagulation, α-amylase activity in peritoneal exudate and intra-abdominal pressure were assessed. The tPA activity and the level of TAT in the main group were of normative value and are vital for the group of individuals who are in the range of norms, as well as candidates for early markers for the diagnosis of bleeding. From the ROC analysis, the analysis determined the informativeness of the proposed indicators in the predicted bleeding. For tPA activity, the area under the ROC-curve (AUROC) became 0.942 (95% CI 0.889-0.995), the point of change is 4,5 IU/ml, for the TAT area under the ROC-curve (AUROC) it became 0.945 (95% DI 0.871-0.998), the change point is 11.5 ng/ml. We conclude that in patients with severe acute pancreatitis, a tPA activity level ≥4.5 IU/ml (sensitivity 90.2%, specificity 83.3%) and/or a TAT level ≥ 11.5 ng/ml (sensitivity 92.2%, specificity 83.3%) can be considered as a possible predictor of bleeding.

Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study

Aims: We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP).Methods: In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant (n = 30) or normal saline (n = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat.Results: We enrolled 60 participants and randomly assigned them to the FMT (n = 30) or control (n = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (−0.6, 0.5) vs. 0.2 (−0.2, 0.6); P = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference (P = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [−0.3 (−3.7, 0.8) vs. 0.4 (−1.1, 0.9); P = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively (P = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (−3.6, 0.9) vs. 0.8 (−1.7, 1.0); P = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT.Conclusion: FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).

The Use of Prophylaxis Antibiotics to Prevent Acute Pancreatitis Complications: Meta-Analysis of Clinical Trials

Background: Acute pancreatitis (AP) is an inflammation of the pancreas, a serious emergency with no definitive treatment. It may progress to infected necrosis, non-pancreatitis infection, also death that may occur within the first 1 to 2 weeks. The use of prophylactic antibiotics in AP to prevent complications remains a controversy. The objective of this meta-analysis is to assess the benefit of prophylaxis antibiotics administration to prevent the complication.Method: Trials were identified by searching the medical database. Literature range is within the year 1975 to 2021. Review Manager 5.4.1 was used to analyse data extraction and risk of bias of included studies were elaborated. Risk ratio (RR) was calculated with 95% confidence interval (CI). P 0.05 was considered significant.Results: Twenty trials with a total of 1.287 patients of AP were analysed; 646 patients treated with antibiotic prophylaxis and 641 patients treated with placebo. Prophylaxis antibiotics were found to have significant difference between the two groups. The administration of prophylaxis antibiotics lower the risk of non-pancreatic infections (RR = 0.77; 95% CI: 0.62–0.95; p 0.05) and infected pancreatic necrosis (RR = 0.74; 95% CI: 0.58-0.94; p 0.05). Meanwhile, prophylaxis antibiotics were found to be insignificant to lower the risk of mortality (RR = 0.75; 95% CI: 0.54-1.03; p 0.05). Conclusion: Prophylaxis antibiotics lower the risk of non-pancreatic infections and infected pancreatic necrosis, but did not lower the risk of mortality.

A Hybrid VARD Approach to Infected Acute Necrotic Collections

Infected acute necrotic collections (ANC) are a complication of acute pancreatitis that routinely require early drainage procedures. The “step up” approach has gained acceptance as the preferred paradigm for infected ANC. With this approach, open necrosectomy is avoided in favor of percutaneous drainage followed by video assisted retroperitoneal debridement (VARD). We describe a novel hybrid VARD technique. For patients meeting criteria for step-up procedure, a percutaneous drain is placed into the collection using a left retroperitoneal approach. If serially upsizing this drain does not resolve the infection, a VARD is performed. Traditionally this is done by cutting down along the drain tract with a small incision until the necrotic cavity is reached, allowing VARD. However, a majority of patients at our institution have a high BMI, making approaching the collection via a minimally invasive cutdown difficult. We made 2 modifications to the existing technique. First, we use a 12 mm optiview® trocar loaded with a 0-degree camera inserted alongside the drain track through an small incision. The camera is advanced into the collection using the drain as a horizon. Pneumoperitoneum is insufflated, additional trocars placed, and necrosectomy completed. Second, for complex geographic collections we upsize to a 15 mm trocar and use a flexible endoscope to delineate the edges of the necrosis and remove free necrosum using a Roth net device. Closure is accomplished with drains and occasionally vacuum assisted devices. Using these techniques, we have been able to manage complex infected necrosis in morbidly obese patients with good results.

Comparison of Intra-abdominal pressure monitoring vs APACHE-II and Ranson’s scoring in predicting the outcome of Acute Pancreatitis

Introduction: Intra-abdominal pressure is important risk factor for predicting mortality and morbidity in the early phase of acute pancreatitis. World Society on the abdominal compartment syndrome defines Intra-abdominal hypertension as a sustained increase in pressure above 12 mm of Hg and abdominal compartment syndrome is a sustained increase in intra-abdominal pressure above 20 mm of Hg with new onset organ failure. However, even values of lower than 15 mm of Hg may cause organ dysfunction. Material and Methods: Intra-abdominal pressure was indirectly determined by measuring urinary bladder pressure with a 16 gauge Foley’s catheter in situ. The bladder was drained completely and the tubing of the collecting bag was clamped and then the catheter will be connected to a saline manometer. Intra-abdominal pressure was measured on day 1st, 3rd, 7th and 14th after controlling the severe pain by analgesics. Result: In our study 50 patient of acute pancreatitis was taken. Patient was categorized in low risk and high risk group according to Ranson’s, APACHE and IAP criteria. It was observed that there is a positive correlation between IAP with APACHE and Ranson’s score, positive predictive value for assessment of mortality (4%), Ranson’s (4%), APACHE scoring (4%). It was observed that as the grade of Ranson’s and APACHE increases in patients of acute pancreatitis, IAP also increases. Similarly for morbidity most of the local complication occurs in moderate to severe grade of IAP 1st day (>15 mm), severe grade of APACHE score (>13) and severe grade of Ranson’s score (>3). Common systemic complication were gastrointestinal (98%), circulatory (52%), respiratory (68%), metabolic (56%), renal (24%), MODS (10%), ARDS (8%), DIC (4%). Most of the systemic complication occurs in moderate to severe grade of IAP 1st day (>15), severe grade of APACHE score (>8) and severe grade of Ranson’s score (>3). Conclusion: IAP measurement is cheap, easy, bedside, minimally invasive prognostic modality, cheaper alternative to Ranson’s and APACHE scoring. Early IAP monitoring can be very useful in assessment of mild to severe acute pancreatitis, hospital stay, determines local and systemic complication.