Complication Of Acute Pancreatitis Research Articles

Nomogram for the Prediction of In-Hospital Incidence of Acute Respiratory Distress Syndrome in Patients with Acute Pancreatitis

BackgroundAcute respiratory distress syndrome (ARDS) associated with high mortality is the common complication in acute pancreatitis (AP). The aim of this study was to formulate and validate an individualized predictive nomogram for in-hospital incidence of ARDS in Patients with AP. MethodsFrom January 2017 to December 2018, 779 individuals with AP were involved in this study. They were randomly distributed into primary cohort (n = 560) and validation cohort (n = 219). Based on the primary cohort, risk factors were identified by logistic regression model and a nomogram was performed. The nomogram was validated in the primary and validation cohort by the bootstrap validation method. The calibration curve was applied to evaluate the consistency between the nomogram and the ideal observation. ResultsThere were 728 patients in the non-ARDS group and 51 in the ARDS group, with an incidence of about 6.55%. Five independent factors including white blood cell counts (WBC), prothrombin time (PT), albumin (ALB), serum creatinine (SCR) and triglyceride (TG) were associated with in-hospital incidence of ARDS in Patients with AP. A nomogram was constructed based on the five independent factors with primary cohort of AUC = 0.821 and validation cohort of AUC = 0.823. Calibration curve analysis indicated that the predicted probability was in accordance with the observed probability in both primary and validation cohorts. ConclusionsThe study developed an intuitive nomogram with easily available laboratory parameters for the prediction of in-hospital incidence of ARDS in patients with AP. The incidence of ARDS for an individual patient can be fast and conveniently evaluated by our nomogram.

The Involvement of Renal Capsule Is Associated With Acute Kidney Injury in Patients With Acute Pancreatitis

Background: Acute pancreatitis (AP) is characterized by pancreatic/peripancreatic inflammation. Involvement of renal capsule refers to peripancreatic inflammation extending beyond the Gerota fascia and disappearance of renal rim sign (+) on CT images. However, its association with acute kidney injury (AKI), an important complication of AP, was rarely studied.Aim: This study aimed to assess the relationship between the involvement of renal capsule and AKI in a cohort of patients with AP.Methods: We retrospectively screened all the patients admitted for AP from January 2018 to December 2019. The involvement of renal capsule was judged by experienced radiologists according to the CT imaging. Propensity score matching (PSM) was used to control for biases in group sizes and baseline characteristics. The primary outcome was the development of AKI during the index admission. We also categorized the pararenal inflammation with the renal rim grade (RRG) and compared the incidence of AKI among different grades.Results: Involvement of renal capsule was identified in 71 of 503 patients (14.1%). The incidence of AKI was significantly higher in these patients when compared with the matched controls (43/71, 60.6% vs. 12/71, 16.9%, p < 0.001). Moreover, mortality also differed between groups (12.7% vs. 1.4%, p = 0.017). Multivariable logistic regression showed that renal capsule involvement is an independent risk factor of AKI (odds ratio, 4.355; 95% confidence interval, 1.434, 13.230, p = 0.009). Patients with RRG grade III had a significantly higher incidence of AKI than the other two grades (60.6% for Grade III, 17.1% for Grade II, and 3.8% for Grade I, p < 0.001).Conclusion: Involvement of renal capsule is associated with higher AKI incidence and mortality.

S1588 Extra Pancreatic Pseudocyst (EPP) as an Initial Presentation in an Alcoholic Woman With No Previous Medical History

Introduction: Pseudocyst of pancreas is the most common complication of Acute and chronic pancreatitis. Pseudocysts can be intrapancreatic, peripancreatic and extra pancreatic. EPP in liver is a rare complication of Acute and chronic pancreatitis and only 26 cases have been reported so far. Here we are presenting a case of extra Pancreatic Pseudocyst located in the gall bladder fossa. Case Description/Methods: A 59-year-old female with history of Chronic alcohol use presented with severe abdominal pain of 10 days duration. The pain was sudden in onset, sharp, constant located diffusely throughout her abdomen but was noted to be worse on the right upper (RUQ), radiating to her lower back and right shoulder. She drinks at least 2 glasses of wine daily for several years. Vital signs are stable on admission. On physical exam, the abdomen was soft, rigid with rebound tenderness in RUQ. Labs showed an elevated C-Reactive Protein 20.6, Sedimentation Rare 123, WBC 18.2, platelets 637, lipase 906. Ultrasound showed hepatic steatosis with complex fluid collection adjacent to the gallbladder in the right hepatic lobe. Computed Tomography scan demonstrated a severe colitis along with 4.8 cm x 3.3 cm complex fluid collection in the gallbladder fossa and an enlarged pancreatic head with loss of adjacent fat planes and tracking of fluid into the mesentery, and a 7 mm fluid collection within the pancreatic head. Patient was started on IV antibiotics along with continuous IV fluids for sepsis and questionable pancreatitis due to fever spikes (102.3F) and Interventional radiology (IR) placed a drain. The appearance of the fluid with elevated enzymes (Fluid Lipase and Amylase: 5104 and 605) was consistent with pancreatitis. MRI/MRCP showed a 2.7 cm fluid collection in the pancreaticoduodenal groove and marked inflammatory changes around hepatic flexure of the colon and a persistent fluid collection posterior to the gallbladder. IR drained collection regional to the liver and gallbladder. Resolution of the fluid collection following drainage was noticed. All cultures were negative, antibiotics were discontinued. Patient improved clinically. Discussion: Most common location for EPP is lesser sac and least common site is Liver. Pathophysiology behind it is inflammatory disruption causing leakage of pancreatic fluid that migrates along hepatogastric, hepatoduodenal or by digesting tissue in the hepatic parenchyma. EPP are important to identify and surgical drainage would be mainstay of treatment to prevent severe complications.Figure 1.: CT scan showing collection in Gall Bladder fossa.

To study the clinical profile of patients with acute pancreatitis and to study it's aetiology. A hospital based cross sectional study

Aim: To study etiology and complications of acute pancreatitis, to assess the clinical profile of acute pancreatitis. Material and Methods: The study was a cross sectional study which was carried in the Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India for the period of 1 year. Total 100 patients who were diagnosed for acute pancreatitis were include in this study and data collection on admission included age, sex, address and clinical presentation with respect to pain vomiting, gallstones trauma and drugs was noted. Results: 56 men and 44 women were among the 100 patients. Patients aged 30-40 (42%) followed by 40-50 (33%). All patients (100%) had abdominal discomfort, 84 % had nausea/vomiting, 45% had fever, and 28% had jaundice. Acute pancreatitis is most often caused by biliary pancreatitis (46%) in patients. Alcoholism was the second reason (35%). Hyperlipidemia (4%) and traumatic pancreatitis (4%) were detected in 4 patients each. Idiopathic patients had no known aetiology (11%). Males had the greatest alcohol-induced pancreatitis, followed by biliary aetiology. Diabetes mellitus was found in 59% of the study population. Obesity was seen in 41%. Conclusion: Acute pancreatitis is one of the most common causes of increased morbidity and death in the general population. The clinical evaluation, in conjunction with laboratory indicators, was highly linked with death and morbidity.

S71 Prevalence and Outcomes of Local Complications in Acute Pancreatitis: A Review of Nationwide Inpatient Data

S71 Prevalence and Outcomes of Local Complications in Acute Pancreatitis: A Review of Nationwide Inpatient Data

I CANNOT SEE YOUR FACE! A CASE OF PURTSCHER DISEASE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Purtscher-like retinopathy is an acquired form of retinopathy due to hemorrhagic or vasoocclusive vasculopathy associated with acute pancreatitis and other systemic diseases 1. It is associated with severe vision. Recent studies suggested ophthalmoscopy performed within first 24 hours of developing acute pancreatitis was a good indicator for predictor of disease evolution, outcome and overall poor prognosis 2. We present a rare case of a young African American male who had experienced acute vision loss in the setting of severe alcoholic pancreatitis. CASE PRESENTATION: 34-year-old African American male with a history of alcoholic dependence presents with abdominal pain. His last drink was 36 hours ago. It's described as sharp and radiating to his back. He denies any other ingestions or drug use. On presentation, vital signs show that he is mildly hypertensive, but otherwise within normal limits. Physical exam reveals epigastric tenderness on palpation with positive bowel signs, negative murphy sign, cullens sign and gray turners sign. Labs were significant for an elevated lipase as well as liver enzymes. No significant osmolar gap. Intravenous fluids were provided as well as pain control and patient was placed on a withdrawal assessment scale. Within 12 hours of admission, he started to experience alcoholic hallucinosis with decreased visual acuity and inability to recognize facial features. Fundoscopy revealed retinal whitening bilaterally, Intraretinal flame heme along inferior arcade of the right eye, cherry red spot of the left eye within the macula, consistent with Purtscher-like retinopathy in the setting of acute pancreatitis declaring him legally blind. Patient signed a 302 to receive further inpatient psychiatric care. DISCUSSION: The patient's acute psychosis from alcohol compounded his complaint of acute vision loss. Purtscher retinopathy is a rare complication of acute pancreatitis. The etiology is unclear, however in relation to pancreatitis, the condition may be caused by complement induced granulocyte activity causing cotton wool spots, retinal hemorrhages, and papilledema [2]. It should be suspected if patients voice concern of decreased visual acuity. Previously high dose steroids have been used but there is no evidence that this treatment improves morbidity. Recovery of visual acuity is variable with some patients regaining vision with mild loss of acuity and others remain legally blind. Certainly, a rare and interesting complication of acute pancreatitis. CONCLUSIONS: Evaluation and treatment of patients with acute pancreatitis with visual complaints should raise concern for Purtcher's retinopathy. There are no current evidence-based treatment options. Close follow up with a retinal specialist is required. Further clinical studies are required to investigate treatment options for Purtcher's retinopathy. REFERENCE #1: Bissonnette B. Purtscher Disease. AccessAnesthesiology 2019. REFERENCE #2: C; CDRABFB. [Retinopathy in severe acute pancreatitis]. Oftalmologia (Bucharest, Romania : 1990). REFERENCE #3: Buckley, S. and James, B., 2020. [online] Pmj.bmj.com. Purtschers Retinopathy. [Accessed 7 July 2020]. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Melissa Chrites, source=Web Response No relevant relationships by Erica OKane, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response

Sitagliptin activates the p62\u2013Keap1\u2013Nrf2 signalling pathway to alleviate oxidative stress and excessive autophagy in severe acute pancreatitis-related acute lung injury

Acute lung injury (ALI) is a complication of severe acute pancreatitis (SAP). Sitagliptin (SIT) is a DPP4 inhibitor that exerts anti-inflammatory and antioxidant effects; however, its mechanism of action in SAP-ALI remains unclear. In this study, we investigated the effects of SIT on SAP-ALI and the specific pathways involved in SAP-induced lung inflammation, including oxidative stress, autophagy, and p62–Kelch-like ECH-associated protein 1 (Keap1)–NF-E2-related factor 2 (Nrf2) signalling pathways. Nrf2 knockout (Nrf2−/−) and wild-type (WT) mice were pre-treated with SIT (100 mg/kg), followed by caerulein and lipopolysaccharide (LPS) administration to induce pancreatic and lung injury. BEAS-2B cells were transfected with siRNA-Nrf2 and treated with LPS, and the changes in inflammation, reactive oxygen species (ROS) levels, and autophagy were measured. SIT reduced histological damage, oedema, and myeloperoxidase activity in the lung, decreased the expression of pro-inflammatory cytokines, and inhibited excessive autophagy and ROS production via the activation of the p62–Keap1–Nrf2 signalling pathway and promotion of the nuclear translocation of Nrf2. In Nrf2-knockout mice, the anti-inflammatory effect of SIT was reduced, resulting in ROS accumulation and excessive autophagy. In BEAS-2B cells, LPS induced ROS production and activated autophagy, further enhanced by Nrf2 knockdown. This study demonstrates that SIT reduces SAP-ALI-associated oxidative stress and excessive autophagy through the p62–Keap1–Nrf2 signalling pathway and nuclear translocation of Nrf2, suggesting its therapeutic potential in SAP-ALI.

S1620 A Symptomatic Posterior Mediastinal Space Pseudocyst Managed by Cystgastrostomy Through a Hiatal Hernia

Introduction: Pseudocysts are seen after acute pancreatitis (AP) and consist of collections of pancreatic secretions surrounded by a fibrous wall. Mediastinal extension of pseudocysts is a rare complication of AP. Here we describe the unique case of a large pseudocyst that extended along a hiatal hernia sac resulting in chest pain and dysphagia, requiring cystgastrostomy in the posterior mediastinal space. Case Description/Methods: A 64-year-old female with a history of a large hiatal hernia (HH) presented to the emergency room (ER) with gradual onset retrosternal pain and associated dysphagia of 1 week duration. She had a recent hospitalization for AP two months earlier. In the ER, vital signs were within normal limits. Cardiac evaluation, complete blood count, and comprehensive metabolic panel were unremarkable. Abdominal computed tomography revealed a 7 x 6.2 cm peripancreatic fluid collection extending through the diaphragm in the posterior mediastinal space, resulting in mass effect on the distal esophagus and HH sac (Figure 1A-C). Upper endoscopy revealed extrinsic-appearing narrowing in the distal esophagus immediately proximal to a 5 cm Hill grade IV HH. Endosonography (EUS) guided cystgastrostomy was successfully performed using a 10 mm x 10 mm electrocautery enhanced lumen apposing metal stent (LAMS). Post-procedure the patient reported symptomatic relief and was admitted for overnight observation. Repeat cross sectional imaging revealed significant reduction in the size of the pseudocyst (Figure 1D). EUS two weeks later revealed complete pseudocyst resolution and the LAMS was removed. Discussion: Mediastinal extension of a pseudocyst is a rare complication of acute pancreatitis. In prior reports, mediastinal pseudocysts have been managed by endoscopic aspiration, placement of plastic stents, or surgical drainage. To our knowledge, this is the first case of a cystgastrostomy performed through a hiatal hernia to drain a pseudocyst in the posterior mediastinum.Figure 1.: Axial (A) and coronal (B and C) views of the CT scan revealed a large pseudocyst extending into the posterior mediastinal space. The sagittal view (D) showed the lumen-apposing metal stent draining the pseudocyst into the hiatal hernia sac.

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

Определение риска осложненного течения острого панкреатита по результатам клинического ответа пациента на стартовую инфузию

Актуальность. Стратегия жидкостной ресусцитации при остром панкреатите (ОП) базируется на своевременной оценке исходного волемического статуса пациента и обоснованной коррекции жидкостных нарушений, что обеспечивает эффективную системную и органную циркуляцию и тканевую перфузию, устраняя ишемию поджелудочной железы, предупреждая полиорганную недостаточность — возникновение и манифестацию синдрома системного воспалительного ответа (Systemic Inflammatory Response Syndrome — SIRS). Цель: определить риски дальнейшего осложненного течения ОП по результатам клинического ответа пациента на стартовую жидкостную ресусцитацию. Материалы и методы. Представлены результаты когортного проспективного наблюдения, проведенного в 2015–2018 гг. Проанализированы клинические данные 61 пациента с ОП, возраст — 47,1 ± 6,4 года; из них 25 (41 %) женщин и 36 (59 %) мужчин; средняя масса тела — 79,4 ± 5,1 кг. Исходная α-амилаза — 213 ± 34 Ед/л, диастаза мочи — 1019 ± 65 Ед/л. Выборка стратифицирована методом случайного отбора: 1-я группа — алиментарный ОП — 53 пациента (76,8 %) с различной тяжестью течения, 2-я группа — билиарный ОП — 14 пациентов (20,3 %). Тяжесть ОП определена согласно классификации Atlanta-2012. Не включены пациенты в критическом декомпенсированном состоянии. Результаты. При поступлении в отделение интенсивной терапии (ОИТ) у пациентов доминировала гиповолемия из-за потери плазмы на фоне острой хирургической дегидратации II–III степени. В дальнейшем определено течение ОП всех степеней тяжести в 1-й группе: I — n = 12/23 %, II — n = 26/49 %, III — n = 15/28 %. При не-осложненном течении ОП (подгруппа I) изначально развивался нормотонический тип дегидратации, при тяжелом течении панкреонекроза (подгруппа ІІІ) — гипертонический. Клинический ответ на проводимую стартовую инфузию ассоциирован с тяжестью дальнейшего течения в соответствии с этиологическим фактором ОП и достоверным клинически значимым (16 ± 2 %; р &lt; 0,01) уменьшением ЧСС и Ht относительно исходных значений, в то же время оставаясь за верхней границей референтного диапазона. При неосложненном течении ОП (І подгруппа) органная недостаточность не формировалась, в конце вторых суток восстанавливался спонтанный диурез (до 0,8–1,0 мл/кг • ч), кишечная перистальтика на фоне энтерального питания и уменьшения объема инфузии. При средней тяжести ОП (II подгруппа) доминировали проявления транзиторной гепатоспланхнической недостаточности с усугублением SIRS, Acute Physiology And Chronic Health Evaluation (АРАСНЕ) II — до 5 [5; 6] баллов, Multiple Organ Dysfunction Score (MODS) — 1 [1; 2], предельно уменьшался уровень общего белка. Ремобилизация депонированной жидкости проходила отсрочено. При тяжелом течении ОП (ІІІ подгруппа) после стартовой ресусцитации ЧСС и Ht превышали (до 20 %; р &lt; 0,001) значения в I и II подгруппе; усугублялась органная недостаточность: АРАСНЕ II — 8 [7; 10] баллов, MODS — 3 [2; 4], прогрессировал SIRS, своевременно не восстанавливалась перистальтика, спонтанный диурез — отсрочено до 24–32 ч, нарастала гипопротеинемия — 59,2 ± 2,3 г/л, креатинин сыворотки — 147 ± 14 мкмоль/л, мочевина — 9,8 ммоль/л. Глюкоза крови повышена (9,1 ммоль/л) при отсутствии сахарного диабета. Персистировала преимущественно гепатоспланхническая недостаточность, формировались очаги секвестрации, не происходила ремобилизация депонированной жидкости, обусловливая вторичную гиповолемию, гипергидратацию интерстициального пространства и рефрактерность к консервативному лечению. При остром билиарном панкреатите доминировали висцеральные нарушения с воспалением желчных путей, билиарной гипертензией и холестазом, обусловленных преимущественно холедохолитиазом. Выводы. После стартовой инфузии в раннюю фазу острого панкреатита осложненное и тяжелое течение клинически прогнозируется по вторичным системным нарушениям в жидкостных компартментах на фоне SIRS и транзиторной или персистирующей, преимущественно гепатоспланхнической, органной недостаточности различной тяжести, что усугубляется формированием секвестрированных образований и препятствует надлежащей ремобилизации секвестрированной и депонированной жидкости.

Prehospital stabilization of acritically ill patient with telemetric medical guidance

Es wird über die präklinische Versorgung eines 82-jährigen Patienten im septischen Schock bei akuter Pankreatitis berichtet. Initial wurde nur ein Rettungswagen alarmiert, dessen Besatzung nach der ersten Einschätzung einen Notarzt per Hubschrauber an die Einsatzstelle nachforderte. Die Besatzung entschied sich, bei absehbar langem notarztfreien Intervall, telemedizinische Unterstützung anzufordern. Trotz initialer massiver Zentralisierung und schwierigen Bedingungen vor Ort gelang es dem Team, in ständiger Rücksprache mit dem Telenotarzt, den Patienten bis zum Eintreffen des Hubschraubers so zu stabilisieren, dass ein sofortiger und komplikationsloser Transport möglich wurde.

Imaging diagnostics in acute pancreatitis

Abdominal imaging is an important component of the diagnostics of acute pancreatitis. In addition to the clinical features and the laboratory constellation, it serves to establish the diagnosis or the exclusion of other diseases and also the identification and assessment of the course of local complications and vascular changes that can arise during the course of acute pancreatitis. Due to the numerous imaging examination methods that are available, their combination options and the different examination times, there are diverse application options that have to be taken into account, such as the severity and duration of the disease, concomitant diseases and complications of acute pancreatitis. Arational use of imaging is an important prerequisite for high quality and at the same time cost-effective patient care. This review summarizes the current importance of imaging in acute pancreatitis, with particular reference to the updated S3 guidelines on acute pancreatitis.

Technical aspects of minimally invasive percutaneous approach for local complications of acute pancreatitis

Aim. To improve the results of treatment for patients with acute pancreatitis by optimizing the technique of performing percutaneous methods of drainage and sequestrectomy.Material and methods. We have considered experience of treating pancreatic necrosis in 257 patients, confirmed by computed tomography, intraoperatively, and postmortem examinations. Moderate severity pancreatitis was detected in 159 (61.9%) patients, severe – in 98 (38.1%) cases.Results. Small focal pancreatic necrosis was detected in 99 (62.3%) patients with moderate pancreatitis, large focal pancreatitis – in 60 (37.7%). Small-focal pancreatic necrosis was in 23 (23.5%) patients, large-focal – in 43 (43.9%), subtotal – in 29 (29.6%), total – in 3 (3.1%) among patients with severe acute pancreatitis. Percutaneous approach was used in combination with transluminal and open surgery in 59 (23%) patients. Infected necrosis was detected in 6 (3.8%) patients with acute moderate pancreatitis and in 44 (44.9%) patients with severe pancreatitis, sepsis – in 12 (12.2%) patients. 27 (10.5%) patient have died from septic shock in the first phase of pancreatitis, included 14 (5.4%) cases after surgery. Overall 41 (16%) patients with pancreatic necrosis have died.Conclusion. Compliance of stages in surgical treatment technology allows optimally combine it with transluminal sequestrectomy, reduces surgical trauma, eliminates additional risks of open approach associated with complications and deaths.

51-Year-Old Man With Ascites and Abdominal Pain

51-Year-Old Man With Ascites and Abdominal Pain

Trajectories of Lymphocyte Counts in the Early Phase of Acute Pancreatitis Are Associated With Infected Pancreatic Necrosis.

INTRODUCTION:Infected pancreatic necrosis (IPN) is an important complication of acute pancreatitis (AP). Absolute lymphocyte count (ALC) was reported to be associated with immunosuppression and the development of IPN. The aim of this study was to describe the trajectory of ALC during the early phase of AP and assess its association with IPN.METHODS:We retrospectively screened patients with AP admitted to our center between January 2016 and July 2019. The ALC levels for the first 7 days after admission were collected. Group-based trajectory modeling was performed to detect the trajectories. Cox proportional hazards regression model was adopted to identify potential risk factors of IPN.RESULTS:Overall, 292 patients were enrolled for analysis. A triple-group trajectory model was developed, assigning 116 patients to the low-level ALC group, 133 to the medium-level ALC group, and 43 to the high-level ALC group. There was no overall significant difference regarding the incidence of IPN among the 3 groups (P = 0.066). In pairwise comparison, patients in the low-level ALC group had significantly higher incidence of IPN than those in the high-level ALC group (hazard ratio: 3.50; 95% confidence interval: 1.22–10.00, P = 0.020). Length of hospital stay and intensive care unit stay differed significantly among patients with different trajectories (P = 0.042 and 0.033, respectively).DISCUSSION:Despite the fact that the trajectories of ALC is overall insignificant for the development of IPN, patients with persistent low ALC trajectories during the early phase of AP are more likely to develop IPN when compared with patients with high ALC trajectories.

English

A frequent cause for patient presentation to the emergency department and the most serious gastrointestinal condition resulting in admission is acute pancreatitis. Pancreatitis is an inflammatory process within the pancreas. Although the disease is mostly mild, the mortality rate of severe forms may be up to 30 percent. Two of the following three criteria are required for diagnosis: epigastric abdominal pain, elevated lipase, and pancreatic inflammation on imaging.1 The occurrence of acute pancreatitis is approximately 1 in 1000 to 5000 births and is commonly seen in the last weeks of gestation or in post-partum period. Cholelithiasis, which accounts for more than 65 percent of cases, is the most common cause of acute pancreatitis in pregnancy.2 Pancreatic ascites results from persistent leakage of pancreatic secretions in the peritoneum from pancreatic duct injury. The extent of pancreatic ascites varies, depending on the site and degree of ductal damage and infection.3 The complications of acute or chronic pancreatitis are pancreatic pseudocysts. Initial diagnosis is mostly done by imaging. Endoscopic ultrasound with fine needle aspiration cytology (FNAC) has become the standard test to help differentiate pseudocyst from other cystic lesions of the pancreas. With supportive treatment, most pseudocysts resolve spontaneously. Poor predictors for the potential of pseudocyst resolution or complications are the size of the pseudocyst and the length of time the cyst has been present, but larger cysts in general are more likely to be symptomatic or cause complications.4 We report a case of young female presenting with jaundice and ascites two days post-partum, who was eventually diagnosed as a case of pancreatic ascites with large pancreatic pseudocyst.

Signal Pathways and Markers Involved in Acute Lung Injury Induced by Acute Pancreatitis.

Acute pancreatitis (AP) is a common acute abdominal disease with a mortality rate of about 30%. Acute lung injury (ALI) is a common systemic complication of acute pancreatitis, with progressive hypoxemia and respiratory distress as the main manifestations, which can develop into acute respiratory distress syndrome or even multiple organ dysfunction syndrome (MODS) in severe cases, endangering human health. In the model of AP, pathophysiological process of the lung can be summarized as oxidative stress injury, inflammatory factor infiltration, and alveolar cell apoptosis. However, the intrinsic mechanisms underlying AP and how it leads to ALI are not fully understood. In this paper, we summarize recent articles related to AP leading to ALI, including the signal transduction pathways and biomarkers of AP-ALI. There are factors or pathway aggravating ALI, the JAK2-STAT3 signaling pathway, NLRP3/NF-κB pathway, mitogen-activated protein kinase, PKC pathway, neutrophil protease (NP)-LAMC2-neutrophil pathway, and the P2X7 pathway, and there are important transcription factors in the NRF2 signal transduction pathway which could give researchers better understanding of the underlying mechanisms controlling AP and ALI and lay the foundation for finally curing ALI induced by AP.

Immediate and Long-Term Outcomes of Percutaneous Radiological Interventions for Hemorrhagic Complications in Acute and Chronic Pancreatitis

PurposeTo evaluate and compare the immediate and long-term outcomes of radiological interventions for hemorrhagic complications in patients with acute and chronic pancreatitis. Materials and MethodsThis retrospective study, conducted between January 2014 and June 2020, included all patients with acute and chronic pancreatitis presenting with hemorrhagic complications who underwent angiography and/or embolization. Their clinical, angiographic, and embolization details were evaluated and correlated with procedure success, complications, recurrence, and mortality. The patients were subgrouped into groups A (acute pancreatitis) and C (chronic pancreatitis), and comparisons were made. ResultsThe study included 141 patients (mean age, 36.3 ± 11.2 years; 124 men), of whom 106 patients had abnormal angiography findings and underwent embolization. Of them, group A had 50 patients (56 lesions) and group C had 56 patients (61 lesions). All the patients in group A had severe acute pancreatitis, with a mean computed tomography severity index of 7.6. The technical and clinical success rates of embolization, complications, recurrence, and long-term outcomes were not significantly different between the groups. Group A had significantly higher mortality due to sepsis and organ failure. Embolic agents did not have any significant association with complications, recurrence, and mortality. After a mean follow-up of 2 years, 72.5% of the patients were asymptomatic, and none had symptoms attributable to embolization. ConclusionsSuccess, complications, and recurrence after embolization for hemorrhagic complications were comparable between acute and chronic pancreatitis. Acute pancreatitis was associated with significantly higher mortality. Embolic agents did not significantly influence the outcomes. None had long-term adverse effects attributable to embolization.

Decreased circulating retinol binding protein is an independent risk factor for local complications of acute pancreatitis

Decreased circulating retinol binding protein is an independent risk factor for local complications of acute pancreatitis

MiR155 Disrupts the Intestinal Barrier by Inducing Intestinal Inflammation and Altering the Intestinal Microecology in Severe Acute Pancreatitis.

Intestinal dysfunction is a common complication of acute pancreatitis. MiR155 may be involved in the occurrence and development of intestinal dysfunction mediated by acute pancreatitis, but the specific mechanism is not clear. To investigate the effect of miR155 on severe acute pancreatitis (SAP)-associated intestinal dysfunction and its possible mechanism in a mice model. In this study, SAP mice model was induced by intraperitoneal injection of caerulein and LPS in combination. Adeno-associated virus (AAV) was given by tail vein injection before the SAP model. The pancreatic and intestinal histopathology changes were analyzed. Cecal tissue was collected for 16S rRNA Gene Sequencing. Intestinal barrier proteins ZO-1 and E-cad were measured by Immunohistochemistry Staining and Western Blot, respectively. Intestinal tissue miR155 and inflammatory factors TNF-α, IL-1β, and IL-6 were detected by Q-PCR. The expression levels of protein associated with TNF-α and TLR4/MYD88 pathway in the intestinal were detected. In miR155 overexpression SAP group, the levels of tissue inflammatory factor were significantly increased, intestinal barrier proteins were significantly decreased, and the injury of intestinal was aggravated. Bacterial 16S rRNA sequencing was performed, showing miR155 promotes gut microbiota dysbiosis. The levels of TNF-α, TLR4, and MYD88 in the intestinal were detected, suggesting that miR155 may regulate gut microbiota and activate the TLR4/MYD88 pathway, thereby affecting the release of inflammatory mediators and regulating SAP-related intestinal injury. After application of miR155-sponge, imbalance of intestinal flora and destruction of intestinal barrier-related proteins have been alleviated. The release of inflammatory mediators decreased, and the histopathology injury of intestinal was improved obviously. MiR155 may play an important role in SAP-associated intestinal dysfunction. MiR155 can significantly alter the intestinal microecology, aggravated intestinal inflammation through TLR4/MYD88 pathway, and disrupts the intestinal barrier in SAP mice.