Complication Of Acute Pancreatitis Research Articles

DIFFERENTIAL DIAGNOSIS OF STERILE AND I NFECTED PANCREONECROSIS

Summary. Introduction. The search for objective methods for diagnosing the form and severity of acute pancreatitis, accurate prediction and timely prevention of infectious complications in this surgical pathology is of great practical importance for modern medicine.
 Materials and methods. According to clinical, morphological and bacteriological data, groups of patients were selected. The first group included 33 patients with sterile pancreatic necrosis (SP), the second group consisted of 29 patients with infected pancreatic necrosis (IP).
 Results and discussion. The program of differential diagnosis of sterile and infected pancreatic necrosis with calculation of the index of differential diagnosis (IDD) for each clinical-laboratory and instrumental indicator used in this system is developed. The development and evaluation of diagnostic possibilities of the method of verification of purulent-septic complications of acute pancreatitis and the transition of a sterile form of pancreatic necrosis to an infected one was carried out.
 Conclusions. The use of the developed method of diagnosis of sterile and infected pancreatic necrosis with the calculation of the index of differential diagnosis allowed in 93% of cases to distinguish sterile pancreatic necrosis from infected and timely determine the scope and tactics of treatment.

German Terminology of the Revised Atlanta Classification of AcutePancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis

The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3 %. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J et al. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909 - 918.

English

BACKGROUND Acute pancreatitis (AP) is described as acute inflammation of the pancreas with or without peripancreatic abnormalities. The present study describes the role of computed tomography in the evaluation and grading of acute pancreatitis. Acute pancreatitis is a dynamic disease having biphasic mortality peaks due to two overlapping phases, which include early and late due to increased obesity, ageing of population, alcohol abuse, increased gall stone incidence, the worldwide AP incidence is increasing. Most important causes of AP in developing countries such as India include increased alcohol consumption. Contrast enhanced computed tomography plays an important role in diagnosis of the disease and helps in determining the prognosis of the disease. Modified CT severity index scoring system is the most commonly used scoring system for assessment of the severity of the disease. METHODS The present study is a prospective study of patients presenting with signs and symptoms of acute pancreatitis referred to the Department of Radio Diagnosis at Katuri medical college. This study comprised of 50 patients with clinical suspicion / diagnosis of acute pancreatitis, raised pancreatic biochemical parameters like serum amylase and serum lipase. Contrast enhanced computed tomography was performed in these patients, findings reported, and the disease was classified using modified CT scoring index system (MCTSI). RESULTS The mean age of the patients in the present study was 42.3 ± 12.28 years. Most of the patients presented with abdominal epigastric pain, abdominal distension. Acute pancreatitis was divided into acute oedematous pancreatitis and necrotising pancreatitis, the former being common. Complications included, ascites, pleural effusions, splenic vein thrombosis, portal venous thrombosis, and haemorrhages. CONCLUSIONS Contrast enhanced CT is useful to differentiate between oedematous and necrotising types of pancreatitis. The MCTSI helps in better evaluation of pancreatic necrosis grading. The modified computed tomography score index correlation with the development of local and systemic complications in acute pancreatitis is well established. Ideally, conducting contrast enhanced computed tomography (CECT) after 48 - 72 hours of acute attack, increases the probability of identifying necrotising pancreatitis. CT in particular has an overall accuracy of about 87 % and sensitivity and specificity of 100 % in the recognition of pancreatic necrosis. KEYWORDS Computed Tomography, Acute Pancreatitis, Pseudocyst, Modified CT Score Index

A242 THE AIR BETWEEN US: A CASE OF PSEUDOCYST PERFORATION POST-ENDOSCOPIC CLIPPING OF A BLEEDING PANCREATIC-COLONIC FISTULA

Abstract Background Pancreatic fistula is an uncommon complication of pancreatitis and is associated with increased morbidity. We discuss a case of pancreatic-colonic fistulization followed by the first reported case of pseudocyst perforation post-colonoscopy. Aims Case Methods A 51 year-old female with decompensated alcoholic cirrhosis admitted with hepatic encephalopathy developed large volume hematochezia during admission. Past medical history includes pancreatic pseudocyst, GERD and remote hernia repairs. For the hematochezia, she was investigated with an EGD and colonoscopy. In the distal descending colon, a bleeding lesion was identified and treated with clips and epinephrine injection (Figures 1 and 2). Five hours post-procedure, she developed abdominal distention. CT abdomen pelvis revealed large volume of free air and simple fluid within the abdominal cavity likely secondary to rupture pseudocyst rupture. The previously visualized pseudocyst was filled with gas plastered against the descending colon. She remained medically stable with conservative management. Results Discussion Conclusions Pancreatic-colonic fistula is an uncommon but potentially life-threatening complication of acute pancreatitis associated with high risk of complications. They are found in 4% of admitted inpatients with acute pancreatitis. There are three proposed mechanisms for their development: firstly, inflammation and activated pancreatic lytic enzymes; secondly, pressure necrosis from a contiguous mass; thirdly, localized portal hypertension. Classically, pancreatic-colonic fistulas present with diarrhea, fever and hematochezia. Gastrointestinal bleeding occurs in 60% of cases. The source of bleed has been described to be originating most commonly from the splenic artery and to a lesser extent, the margin of the fistula or, rarely, erosion of splenic parenchyma. Reported therapeutic management strategies include: hemoclippings and Greenplast sprayings, endoscopic pancreatic stent, transgastric nasocystic drainage catheter placements, injection of N-butyl-2-cyanocrylate and transpapillary nasopancreatic drainage. Pseudocysts arise in 25% of patients with chronic pancreatitis. Pseudocysts may regress through a variety of mechanisms: spontaneously after inflammation from pancreatitis resolves, natural drainage through the pancreatic duct into the duodenum, or through a complicating fistulous tract connecting to the gastrointestinal tract. Rarely, the pseudocyst can resolve as it leaks or perforates into the abdominal cavity. Pancreatic pseudocysts may perforate spontaneously into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, or through the abdominal wall. We report the first case, to our knowledge, of pancreatic pseudocyst perforation post-clipping of bleeding pancreatic-colonic fistula. Funding Agencies None

Case of Gastric Intramural Hematoma; Rare Complication of Acute Pancreatitis

Case of Gastric Intramural Hematoma; Rare Complication of Acute Pancreatitis

Early complications and prognosis with multiple organ system failure score

Background: Acute pancreatitis is a common surgical entity with a wide clinical spectrum ranging from mild pancreatitis to severe acute pancreatitis with lethal complications. A number of scoring systems have been devised to predict and manage complications associated with severe acute pancreatitis. The objective of this study was to study the demographics, early complications of acute pancreatitis with their outcome, and to assess the efficacy of multi organ system failure score. Methods: This was a descriptive study including 120 patients of acute pancreatitis done over a period of 2 years. The management of complications and their outcome were recorded in detail. A multi organ system failure score was used to predict and assess the severity of acute pancreatitis. Results: Total 120 patients were evaluated with mean age of 40 years and male preponderance. Alcohol consumption was the most common etiological factor. Acute fluid collection was the most common local complication while shock was the most common systemic complication. MOSF scoring system had a sensitivity, specificity and positive predictive value of 96%, 92.8% and 90.5% respectively. Mortality was 5.8% seen in patients with MOSF score above 5.Conclusions: The management of early complications of acute pancreatitis is mainly conservative, with surgical management limited to only a few selected patients. MOSF score is a valuable tool to predict and assess the severity of acute pancreatitis and should be used for monitoring of high risk patients.

Whole-exome Sequencing Identifies SLC52A1 and ZNF106 Variants as Novel Genetic Risk Factors for (Early) Multiple-organ Failure in Acute Pancreatitis.

The aim of this study was to identify genetic variants associated with early multiple organ failure (MOF) in acute pancreatitis. MOF is a life-threatening complication of acute pancreatitis, and risk factors are largely unknown, especially in early persistent MOF. Genetic risk factors are thought to enhance severity in complex diseases such as acute pancreatitis. A 2-phase study design was conducted. First, we exome sequenced 9 acute pancreatitis patients with early persistent MOF and 9 case-matched patients with mild edematous pancreatitis (phenotypic extremes) from our initial Dutch cohort of 387 patients. Secondly, 48 candidate variants that were overrepresented in MOF patients and 10 additional variants known from literature were genotyped in a replication cohort of 286 Dutch and German patients. Exome sequencing resulted in 161,696 genetic variants, of which the 38,333 non-synonymous variants were selected for downstream analyses. Of these, 153 variants were overrepresented in patients with multiple-organ failure, as compared with patients with mild acute pancreatitis. In total, 58 candidate variants were genotyped in the joined Dutch and German replication cohort. We found the rs12440118 variant of ZNF106 to be overrepresented in patients with MOF (minor allele frequency 20.4% vs 11.6%, Padj=0.026). Additionally, SLC52A1 rs346821 was found to be overrepresented (minor allele frequency 48.0% vs 42.4%, Padj= 0.003) in early MOF. None of the variants known from literature were associated.Conclusions: This study indicates that SLC52A1, a riboflavin plasma membrane transporter, and ZNF106, a zinc finger protein, may be involved in disease progression toward (early) MOF in acute pancreatitis.

Spectrum of vascular complications in acute pancreatitis - challenges in management

Background: Vascular complication of pancreatitis is a rare entity. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the spectrum of manifestations, challenges in the diagnosis and management of vascular complications of acute pancreatitis. Methods: Patients who were managed for vascular complication of acute / chronic pancreatitis were retrospectively analysed from the year 2000 to 2019. Results: There were a total of 79 patients ( 71 Male:8 Female) with a mean age of 34.8 years . 27 patients had chronic alcoholic pancreatitis 27- Tropical pancreatitis , 18- acute pancreatitis , 3- idiopathic and 1 had post traumatic pancreatitis. 8 patients were managed conservatively. Selective arterial embolization was attempted in 55 of 70 (78.5%) patients and was successful in 44 of the 55 (80 %). 27 of 76 (31.5%) patients required surgery. Overall mortality was 7.8 %. Conclusion: Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.Tabled 1Table showing the statistics of the patient managed

Combined minimally invasive management of infected peripancreatic necrosis: two cases report

Infected peripancreatic necrosis (IPN) is the most threatening complication of severe acute pancreatitis. Surgical necrosectomy is still the procedure of choice in the treatment of IPN and debridement is usually performed through laparotomy. Case 1: A 40-year-old man was referred for the complication of the acute pancreatitis after endoscopic ampullectomy due to tubular adenoma with severe dysplasia. CT scans revealed a diffuse acute necrotic collection (ANC) involving the body and tail of the pancreas which extended anterior and inferior to the pelvic cavity. The patient received maximal conservative treatment including intensive fluid replacement, enteral and parenteral nutrition after endoscopic pancreatic duct insertion. The patient's clinical condition deteriorated during the 4 week of the disease with fever and increased serum C-reactive protein of 28.mg/dL despite of antibiotics, endoscopic pancreatic drainage and two times of ultrasono-guided PCD. He underwent laparoscopic pancreatic necrosectomy through mesocolic window. The postnecrosectomy cavity was thoroughly irrigated and closed suction drains were left for negative pressue drainage. Patient was discharged on the 35th days after laparoscopic surgery and patient remains asymptomatic for 4 years. Case 2: Fifty six year-old man was admitted for abdominal pain after heavily alcoholic drinking. An abdominal CT showed diffuse infiltrating inflammation around the pancreas suggesting acute pancreatitis. Despite of conservative treatment, follow up CT showed huge infected peripancrtic necrotic abscess. H received multiple procedures for percutaneous cavity drainage(PCD) but failed in persistent fever. So he underwent laparoscopic peripancreatic necrosectomy and multiple drainages. He was improved with almost complete resolution during 3 month period.

Elevated Serum Triglyceride Level as a Predictor of Local and Systemic Complications in Acute Pancreatitis

Elevated Serum Triglyceride Level as a Predictor of Local and Systemic Complications in Acute Pancreatitis

Lack of association between postoperative acute pancreatitis and postoperative complications following pancreaticoduodenectomy: a secondary analysis from a randomized trial

Objective: To evaluate the association between postoperative acute pancreatitis (POAP) and postoperative complications including postoperative pancreatic fistula (POPF) in patients undergoing PD. Summary background data: Prediction of post-PD morbidity is difficult especially in the early postoperative period when CT scans are not available. Elevated serum amylase and lipase in postoperative day 0 or 1 may be used to define POAP, but existing literature do not agree on whether POAP is significantly associated with POPF. Methods: We analyzed the data obtained from a previously published randomized controlled trial. POAP was defined as elevations in serum amylase above 110 U/L on postoperative day 0 or 1. Clinically relevant POAP (CR-POAP) was defined as elevations in CRP on postoperative day 2 in those with POAP. Postoperative complications including severe complications (Clavien-Dindo ≥ IIIa), POPF, and clinically relevant POPF (CR-POPF; grades B or C) were analyzed. For a robust selection of variables for multivariable analysis, 500 bootstrap samples were drawn from the original data and backward elimination was performed while forcing POAP to be included. Results: In 246 patients, POAP did not show significant associations with total postoperative complications (odds ratio [OR] 0.697; 95% CI, 0.360-1.313; P = 0.271), severe complications (OR 0.647; 95% CI, 0.258-1.747; P = 0.367), and CR-POPF (OR 0.998; 95% CI, 0.310-3.886; P = 0.998) in multivariable analysis. Conclusions: In patients undergoing PD, POAP was not significantly associated with postoperative complications including POPF. Caution should be taken when using POAP as a predictor of POPF.

ACUTE COMPLICATED PANCREATITIS AND DIABETES MELLITUS: THE ROLE AND SIGNIFICANCE OF THE BIOCHEMICAL INDICATORS OF CARBOHYDRATE AND LIPID METABOLISM AS A PROGNOSTIC CRITERION FOR THE SEVERITY OF THE DISEASE CLINICAL COURSE

The aim: A clinical evaluation of biochemical parameters especially carbohydrate and lipid metabolism, their effect on the treatment program in patients with acute complicated pancreatitis. Material and methods: The results of complex treatment of a sample group of 127 patients with acute pancreatitis were studied. A moderately severe clinical course of the disease was found in 42 patients (33.1%) and severe in 85 patients (66.9%), the ethanol genesis of the disease was stated in 73 (57.5%), biliary genesis - in 54 (42.5%) patients. The evaluation of the treatment effectiveness was based on the analysis of the dynamics of disease clinical manifestations and the monitoring of laboratory biochemical parameters and glucose levels. Results: It was stated, that the clinical course of the disease, severity, and prognosis of the patient's condition correlate with the dynamics of markers of endotoxicosis and hepatic insufficiency, and glucose level is one of the most sensitive criteria. The carbohydrate metabolism dynamics analysis in the blood of patients has shown that in most patients glucose levels increase notably with the increase in pancreatic swelling and reaches a peak by its destruction. Conclusions: The incidence of diabetes mellitus due to primary inflammation of the pancreatic parenchyma in ACP has a linear dependence on the frequency and duration of the disease; with the probability of developing diabetes with an exacerbation of the process during 5-8 years is 17.5%. The level of blood glucose in patients with ACP can be a reliable indicator of the severity of the disease course and correlates with other indicators of metabolism.

Purtscher's-like retinopathy as a rare complication of acute alcoholic pancreatitis.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA M. Wieczorek M, Caban M, Fabisiak A, Małecka-Panas E. Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(2):170-173. doi:10.5114/pg.2021.106669. APA M. Wieczorek, M., Caban, M., Fabisiak, A., & Małecka-Panas, E. (2021). Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(2), 170-173. https://doi.org/10.5114/pg.2021.106669 Chicago M. Wieczorek, Michalina, Miłosz Caban, Adam Fabisiak, and Ewa Małecka-Panas. 2021. "Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis". Gastroenterology Review/Przegląd Gastroenterologiczny 16 (2): 170-173. doi:10.5114/pg.2021.106669. Harvard M. Wieczorek, M., Caban, M., Fabisiak, A., and Małecka-Panas, E. (2021). Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(2), pp.170-173. https://doi.org/10.5114/pg.2021.106669 MLA M. Wieczorek, Michalina et al. "Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 16, no. 2, 2021, pp. 170-173. doi:10.5114/pg.2021.106669. Vancouver M. Wieczorek M, Caban M, Fabisiak A, Małecka-Panas E. Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(2):170-173. doi:10.5114/pg.2021.106669.

A Global Survey of Splanchnic Venous Thrombosis Directed Treatment in Association with Acute Pancreatitis (LORDS-PANC)

Introduction: Splanchnic venous thrombosis (SpVT) is a rare but important complication of severe acute pancreatitis (AP). A literature review has demonstrated a lack of high-quality studies and evidence-based guidelines for the treatment of SpVT in AP. The aim of this study was to determine the current approaches to the management of SpVT in patient with AP. Methods: The on-line survey was constructed by a group of international experts in the management of acute pancreatitis. The 23 questions covered respondent's demography, seniority, and experience with the management of SpVT with a specific focus on approaches to therapeutic anticoagulation. Results: There were 224 respondents from 25 HPB units globally (Fig. 1). 92% of responders were from tertiary hospitals and predominantly consultants (86%) who regularly manage patients with AP. There were 85% of respondents who routinely prescribe prophylactic anticoagulation in patients with AP. Only 36% ‘routinely’ prescribe therapeutic anticoagulation for SpVT, while 25% ‘often’ prescribe and 32% ‘never’ prescribe therapeutic anticoagulation. There were 83% respondents to the questions regarding the need for higher-level evidence. 92% of responders considered a clinical trial was justified and 88% were willing to contribute patients to the trial. Their reasons for not being willing to contribute were concern about bleeding risk and/or logistic concerns. Conclusion: There is global variation in the use of therapeutic anticoagulation for SpVT associated with AP. The majority of respondents agree on the need for high-quality evidence and were prepared to participate in a clinical trial.

Surgical strategy for suppurative complications of pancreatic necrosis

Improving the results of treatment of patients with infected pancreatic necrosis by applying a step by step surgical approach and comprehensive correction of endotoxicosis. The study was retrospectively prospective. All patients were divided into two clinical groups. The control group for the period from 2018 to 2019 included 31 patients for whom the standard surgical tactics of treating pancreatic necrosis were used: laparotomy, necrsecestrectomy and drainage of parapancreatic fluid accumulations, and, if necessary, repeated sanation. The main group included 26 patients, treated from 2019 to 2020. According to the developed step-by-step approach with the application of the correction of endogenous intoxication and enteral insufficiency syndrome. The choice of surgery for the patients of the main group depended on the type of parapancreatic fluid accumulation and included minimally invasive interventions in the first stage and, if necessary, the expansion of the amount of interventions (puncture and drainage under ultrasound control + video assisted retroperitoneal debridement, or ultrasound-controlled puncture and drainage + laparotomy). The effectiveness of the treatment in both groups was determined by changes in blood leukocyte and C-reactive protein values on the day of the operation, as well as on the 2nd, 4th, 6th day of the post-operative period. By the fourth day after the surgery, the main group patients' white blood cell and CRP blood levels were positively lower than in the control group: p=0.0001, t=9.65 and p=0.0001, t=9.02, respectively. Forty-eight hours after the operation, the dynamics of the EIS were determined. In the control group, where standard methods of treating enteral insufficiency were used, there was an increase in the number of patients with II and III degrees of severity, in comparison with patients of the main group (p<0.05). The number of complications of pancreonecrosis of IIIb and IVb of degrees on the Clavien-Dindo scale in patients of the major group was lower than in the control group: χ2=0.00021, p<0.05 and χ2=0.01553, p<0.05, respectively. 10 (32.3%) died in the control group, 2 (7.7%), χ2=0.04739, p<0.05. The choice of surgical intervention for pancreonecrosis should be determined taking into account the development phase of the disease, the type of location of the purulent-necrotic sinuses, and its delimitation from surrounding tissues. Phased surgical treatment with the initial application of minimally invasive technologies affects the number and severity of post-operative complications as well as the early start of correction of enteric insufficiency syndrome - the early relief of endogenous intoxication.

Fistula of a pancreatic pseudocyst into the superior mesenteric and portal veins causing erythema nodosum and aseptic polyarthritis - case report and review of literature

Introduction. Extra-pancreatic complications of acute and chronic pancreatitis that do not relate to vital organs are rare. The most common include subcutaneous paniculitis, arthritis, bone marrow fat necrosis, and vasculitis. These associated conditions have been termed pancreatic disease syndrome (PDS), which can occur not only with pancreatitis but also in other pancreatic diseases. PDS is believed to be caused by circulating pancreatic enzymes, which can occur when the pancreas is in direct communication with the circulation. Pancreatic pseudocyst erosion into the superior mesenteric and portal veins is extremely rare; and there have only been 22 previously reported cases in literature. The authors endeavoured to describe a manifestation of PDS with formation of a pseudocystic-portal fistula, its complications, and propose adequate surgical management. Case outline. We present a 37-year-old man with chronic alcoholic pancreatitis and a pancreatic pseudocyst within the head of the pancreas which communicated with the main pancreatic duct on one side and eroded into the superior mesenteric and portal veins on the other, causing erythema nodosum-like vasculitis, and polyarthritis. The patient was initially treated conservatively, but subsequently required multiple arthrotomies and finally underwent pylorus preserving duodenopancreatectomy and direct repair of the affected veins. Conclusion. The majority of cases required aggressive surgical intervention due to heightened risk of hemorrhage. In patients who develop disseminated fat necrosis, an earlier surgical intervention can be justified. The authors would recommend that, where practical, a pylorus-preserving pancreaticoduodenectomy should be performed.

The relationship between lymphopenia and development of late complications in severe acute pancreatitis.

In this study we aimed to predict patients who would develop late stage acute pancreatitis related complications. So we would be able to ease the decision making process about the timing of cholecycstectomy. On the other hand we also suggest a possible insight into the mechanisms which lead development of lyphopenia in severe acute pancreatitis and its possible effects on prognosis. In this study, 163 severe acute pancreatitis case who has been treated as inpatient between January 2013 and January 2018 has been involved. Patients charts and all documented data has been analysed retrospectively. According to the existence or absence of late complications of severe acute pancreatitis, patients have been divided into two groups; Group 1 had no late complication, Group 2 had either pseudocyst or WON (Walled of Necrosis) at 1st month CT. The difference between two groups in terms of 48th hour lymphocyte percentage was significant (p=0.000; p<0.05). Group 2 had remarkably longer duration of hospital stay (p=0.000; p<0.05). 48th hour CRP level of group 2 was significantly higher than of group 1 (p<0.000). There is a statistically significant relation between the presence of lymphopenia, at 48th hour of presentation in severe biliary pancreatitis patients and development of delayed complications. We can strongly say that there would be no late term pancreatitis related complications if there was no lymphopenia at 48 hour and an early cholecystectomi can be performed in such cases. Lymphopenia seen around 48. hr of admission is highly related to development of late complications in severe acute pancreatitis.

Effects of sildenafil citrate on pancreatic and lung complications in an experimental L-arginine-induced acute pancreatitis model.

AimIn this study, we aimed to investigate the effects of sildenafil citrate on acute pancreatitis and pulmonary complications of the disease.Material and methodsIn this study, we used 21 male Wistar-Albino rats weighing between 185 and 230 g. The rats were divided into 3 groups. Group 1 rats (control group, n = 7) were administered intraperitoneal 0.9% NaCl injection. Group 2 (study group, n = 7) and Group 3 (treatment group, n = 7) rats were given 100 mg/100 gr L-arginine twice, with an interval of 1 h to create acute pancreatitis. Group 3 was also administered intraperitoneal 10 mg/kg/day sildenafil citrate in 2 equal doses, 30 min and 12 h after creation of AP. The pancreas and lungs of all rats were stained with haematoxylin and eosin and examined histopathologically. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), interleukin (IL) 1α (IL-1α), IL-6, tumor necrosis factor α (TNF-α), nitric oxide (NO) and ADMA levels were measured in blood samples.ResultsIn the treatment group, levels of amylase, AST, ALT, LDH, IL-1, IL-6, TNF-α, and NO were lower. In addition, pancreas and lung oedema, and perivascular inflammation were significantly less on histopathological examination when compared to the study group (p < 0.001). The ADMA level was significantly higher in the treatment group when compared to the control and study groups. There was no acinar cell necrosis or haemorrhage in the treatment group. However, the difference was not regarded as statistically significant because sufficient acinar cell necrosis and haemorrhage could not be created in the study group.ConclusionsSildenafil citrate significantly decreases various biochemical and histopathological changes in the early phase of acute pancreatitis and protects pancreatic tissue.

Pancreatic encephalopathy, a little-known complication of acute pancreatitis

A 62-year-old male presented with severe post-endoscopic retrograde cholangiopancreatography (post-ERCP) acute pancreatitis. He required admission to the Intensive Care Unit (ICU) twice due to respiratory and renal failure and neurological deterioration. On the hospitalization ward, he presented a fluctuating alteration of the level of consciousness, with bradypsychia, disorientation and somnolence, which persisted after hemodynamic, metabolic and renal stabilization. A brain magnetic resonance imaging (MRI) was performed showing focal lesions due to small vessel disease, some with cavitations due to necrosis, and mild to moderate subcortical atrophy. A diagnosis of pancreatic encephalopathy was made given the clinical and radiological findings. The patient recovered full cognitive capacity after one week with adequate nutrition supported by protein supplementation.

Use of therapeutic anticoagulation in splanchnic vein thrombosis associated with acute pancreatitis: a systematic review and meta-analysis.

BackgroundSplanchnic vein thrombosis is a well-recognized local vascular complication of acute pancreatitis (AP), estimated to occur in approximately 15% of patients. While splanchnic vein recanalization occurs spontaneously in approximately one third of patients, severe complications such as bowel ischemia and liver failure have also been reported. At present, there is no consensus on whether patients presenting with AP-associated splanchnic vein thrombosis should receive therapeutic anticoagulation.MethodsWe searched multiple databases from inception through December 2020 to collect studies that compared the clinical outcomes of patients with AP and splanchnic vein thrombosis who received therapeutic anticoagulation (AC group) with those who did not (N-AC group). A meta-analysis was performed to calculate the relative risk (RR) of vessel recanalization, bleeding complications, collateral formation and death in the 2 groups.ResultsSeven studies with 8353 patients, 339 of whom had splanchnic vein thrombosis, were included in the final analysis. A total of 154 patients (45.4%) had acute severe pancreatitis. A significantly higher proportion of patients had vessel recanalization in the AC group: RR 1.6, 95% confidence interval 1.17-2.27; I2=0%; P=0.004. There was no difference between the 2 groups in the RR of bleeding complications, collateral formation and death.ConclusionsOur analysis demonstrated that, among patients with AP-associated splanchnic vein thrombosis, therapeutic anticoagulation resulted in recanalization of the involved vessels without significantly increasing the risk of bleeding complications. There was no difference in the RR of death or the rates of collateral vessel formation during the follow up.