Complication Of Pancreatitis Research Articles

S2005 Uncommon Complications of Acute Pancreatitis

S2005 Uncommon Complications of Acute Pancreatitis

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S77 Aspirin Use and Its Association With Severity and Complications of Acute Pancreatitis

S77 Aspirin Use and Its Association With Severity and Complications of Acute Pancreatitis

S3392 Intragastric Balloon Insertion Leading to Rare Complication of Acute Pancreatitis

S3392 Intragastric Balloon Insertion Leading to Rare Complication of Acute Pancreatitis

S1995 Disconnected Duct Syndrome – A Rare Complication of Pancreatitis

S1995 Disconnected Duct Syndrome – A Rare Complication of Pancreatitis

S3381 Pancreaticopleural Fistula: A Rare Complication of Pancreatitis Successfully Treated with Endotherapy

S3381 Pancreaticopleural Fistula: A Rare Complication of Pancreatitis Successfully Treated with Endotherapy

S2226 Pancreatic Pseudocyst: A Presentation of Post-Acute Pancreatitis Complications: Summary and Recommendations in Management

S2226 Pancreatic Pseudocyst: A Presentation of Post-Acute Pancreatitis Complications: Summary and Recommendations in Management

Managing Splenic Artery Pseudoaneurysms-An Experience from a Developing Country. A Retrospective Review.

Objectives: Splenic artery pseudoaneurysm is a rare but potentially fatal condition. Early diagnosis and intervention are the key steps in the management of this condition. We have reviewed our institution's 4-year data regarding the presentation and management of this condition. Methods: We conducted a prospective review of the records of 10 patients who presented to our institute from January 2018 to December 2021 with a splenic artery pseudoaneurysm. We found one patient with a true aneurysm, whom we excluded from the study. Results: This study included seven male and two female patients with a mean age of 47.7 years. Six patients presented to the emergency department with bleeding secondary to rupture aneurysm, which is the most common reason for admission. Pancreatitis was found to be the most common cause for splenic artery pseudoaneurysm (five patients). Computed tomography angiogram remained the modality of choice for diagnosing splenic artery pseudoaneurysm. All patients were successfully managed with endovascular intervention. Conclusion: Splenic artery pseudoaneurysm is usually a rare complication of pancreatitis, which is associated with high morbidity and mortality. Timely diagnosis and intervention are the keys to successful management. Endovascular embolization should be the first-line therapy in splenic artery pseudoaneurysm.

Blinding lights: Acute persistent vision loss in pregnancy

Acute persistent vision loss in pregnancy is an emergent presentation with a broad differential and should prompt rapid assessment and treatment of the underlying etiology. In pregnancy, causes can include preeclampsia, severe gestational hypertension, and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Nonobstetrically related etiologies that can exacerbate in pregnancy include optic neuritis, giant cell arteritis, central retinal artery occlusion, or retinal detachment. In this case report, we describe a case of acute vision loss due to Purtscher's-like retinopathy, a rare but serious complication of pancreatitis in pregnancy. To our knowledge, this is the first published case of Purtscher's-like retinopathy in pregnancy unrelated to preeclampsia. Given the impact of permanent visual loss associated with Purtscher's-like retinopathy, more research is needed to determine treatments to substantively improve outcomes.

Kidney morphology and renal expression of aquaporins 2, 3 and 4 during cerulein – Induced chronic pancreatitis in pigs

PurposeChronic pancreatitis (CP) is associated with serious complications and reduced quality of life. Kidney failure is a frequent complication of acute pancreatitis (AP), however limited information is available regarding the impact of CP on this condition. In the kidney, 9 aquaporins (AQPs) are expressed to maintain body water homeostasis and concentrate urine. The purpose of this study was to morphologically assess and analyze the location and expression of AQP2, AQP3 and AQP4 and determine whether CP affects renal structure and expression of AQPs in collecting duct (CD) principal cells. Materials/methodsCP was induced in domestic pigs through intramuscular injections of cerulein (1 ​μg/kg ​bw/day for 6 days; n ​= ​5); pigs without CP (n ​= ​5) were used as a control group. Kidney samples were collected 6 weeks after the last injection and subjected to histological examination. Expression of AQPs was determined by immunohistochemistry and Western blot. ResultsThe kidneys of animals with CP exhibited moderate changes, including glomerular enlargement, increased collagen percentage, numerous stromal erythrorrhages and inflammatory infiltrations compared to control group. Although the total abundance of AQP2 in the CD decreased in pigs after cerulein administration, the difference was not statistically significant. Expression of AQP3 and AQP4 was limited to the basolateral membrane of the CD cells. AQP4 abundance remained relatively stable in both groups, while AQP3 expression increased nearly three-fold in pigs with CP. ConclusionThis study identified morphological alterations and a statistically significant increase in the expression of renal AQP3 when pigs developed CP.

Vascular complications of chronic pancreatitis and its management.

Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.

Predictive value of serum retinol binding protein in severity and complications of acute pancreatitis: a retrospective cohort study

Objectives Retinol binding protein (RBP) is associated with an increased risk of insulin resistance, metabolic syndrome, atherosclerosis and hypertension. This study aimed to evaluate serum RBP levels in patients with acute pancreatitis (AP). Methods The study included 1,871 AP patients, including 1,411 with mild AP (MAP), 244 with moderately severe AP (MSAP), and 186 with severe AP (SAP). Retrospective analysis was conducted on RBP concentrations and other clinical data of AP patients. Results AP patients were subgrouped by RBP level into low RBP (LRBP), normal RBP (NRBP), and high RBP (HRBP) groups. The LRBP group showed a significantly higher proportion of SAP patients than NRBP and HRBP groups. Additionally, the LRBP group had the highest BISAP and CTSI scores among the three groups; WBC and CRP levels in the NRBP group were significantly lower than those in the LRBP and HRBP groups. RBP was better at predicting acute necrotic collection (ANC) than other local complications, with an area under the curve (AUC) of 0.821. RBP was also an independent risk factor for acute lung injury (ALI) and ANC in AP patients. The AUC of RBP for predicting ALI was 0.829, with 30.45 mg/L as the optimal cutoff value, and the sensitivity and specificity were 59.70% and 96.50%, respectively. The AUC of RBP for predicting ANC was 0.821, with 28.35 mg/L as the optimal cutoff value, and the sensitivity and specificity were 61.20% and 95.50%, respectively. Conclusions Serum RBP had predictive value for AP severity, local and systemic complications.

147 Walled- off pancreatic necrosis mimicking a pancreatic cancer

Abstract Introduction Walled-off pancreatic necrosis is a late complication of acute pancreatitis and can mimic a pancreatic cancer. Case Summary A 20 years old male patient was referred to us with a suspicion of pancreatic mass. He gave an inconsistent history of pain epigastrium and jaundice about 3 months back. An ultrasound abdomen showed a solid mass measuring about 47 x 52mm in head of pancreas having enhanced vascularity on doppler. Computed tomography scan done showed a mass lesion of 5cm in head of páncreas, solid and enhancing in nature with no separation from duodenum. Based on radiological findings and a history of weight loss of 5 kg in 2 months, patient was referred to us with suspicion of pancreatic mass. Current admission baseline investigations were normal. CA 19-9 levels were 6.23 U/ml. Dynamic three phase CT scan of abdomen showed diffuse smooth circumferential gall bladder wall thickening without any fat stranding and preserved pericholecystic fluid planes suggestive of chronic cholecystitis. There was a hypodensity along the body of pancreas measuring 11mm in size. MRCP was done which also showed a small pancreatic cyst. After thorough discussion, a presumptive diagnosis of walled off necrosis of páncreas was made that has now regressed. Patient was assured and follow up was advised to monitor the cystic lesión. Conclusion Infected pancreatic necrosis may be present and can be confused with pancreatic malignancy in an early stage of development. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important.

Long-Term Treatment of Lipoprotein Lipase Deficiency with Medium-Chain Triglyceride-Enriched Diet: A Case Series.

Background: Lipoprotein lipase (LPL) deficiency is a genetic condition. Affected individuals typically develop symptoms related to severe and persistent hypertriglyceridemia, such as abdominal pain and recurrent pancreatitis, before 10 years of age. No pharmacological treatment sustainably lowering triglycerides (TGs) in LPL deficiency patients has been proven to be effective. This study investigated whether a long-chain triglyceride (LCT)-restricted, medium-chain triglyceride (MCT)-supplemented diet enables a meaningful reduction in TGs and reduces LPL-related symptoms in children with LPL deficiency. Methods: A single-center retrospective case series study of LPL deficiency patients treated at the Hospital of Sick Children between January 2000 and December 2022 was carried out. Data, extracted from hospital charts, included demographics, diagnosis confirmation, clinical and imaging observations, and biochemical profiles. Results: Seven patients with hypertriglyceridemia > 20 mmol/L suspected of an LPL deficiency diagnosis were included. Six patients had a confirmed molecular diagnosis of LPL deficiency, and one had glycogen storage disease type 1a (GSD1a). Clinical presentation was at a median of 30 days of age (range 1-105), and treatment start, excluding one late-treated patient, was at a median of 42 days (range 2-106). The observation and treatment period of the LPL patients was 48.0 patient years (median 7.1, range 4.3-15.5). The LCT-restricted and MCT-supplemented diet led to an immediate drop in TGs in six out of six LPL patients. TGs improved from a median of 40.9 mmol/L (range 11.4-276.5) pre-treatment to a median of 12.0 mmol/L (range 1.1-36.6) during treatment, total cholesterol from 7.6 mmol/L (4.9-27.0) to 3.9 mmol/L (1.7-8.2), and pancreatic lipase from 631 IU/L (30-1200) to 26.5 IU/L (5-289). In 48 patient years, there was only one complication of pancreatitis and no other disease-specific manifestations or complications. Catch-up growth was observed in one late-treated patient. All patients maintained normal growth and development. As expected, the diet failed to treat hypertriglyceridemia in the GSD1a patient. Conclusions: The dietary restriction of LCT in combination with MCT supplementation as long-term management of pediatric patients with LPL deficiency was feasible, well tolerated, and clinically effective in reducing TG levels and in preventing LPL-related complications.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Increasing trend of endoscopic drainage utilization for the management of pancreatic pseudocyst: insights from a nationwide database.

The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed. The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes. Endoscopic drainage was the most commonly used drainage modality in 2018-2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001). Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.

Clinical Characteristics, Drug Resistance, and Risk Factors for Death of Klebsiella pneumoniae Infection in Patients with Acute Pancreatitis: A Single-Center Retrospective Study from China.

Infection is a common complication of acute pancreatitis (AP). Klebsiella pneumoniae (KP) is one of the most common pathogens associated with nosocomial infections. Our study focuses on investigating the clinical characteristics and risk factors for death of Klebsiella pneumoniae infections in AP patients, further to quantify the prognosis of the patients, and provide evidence for guiding antibiotic use and improving prognosis. The data of epidemiology, clinical manifestations and drug resistance rate with K. pneumoniae infections in AP patients from January 1, 2012 to August 30, 2022 were retrospectively collected. Logistic regression model and Cox regression model were, respectively, used to determine the risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) acquisition and death. The nomogram prediction model was built by RMS software package to predict the 90-day survival rate. One hundred and twenty-six AP patients combined with K. pneumoniae infections, with a mortality rate of 34.9%. The most common infection sites were pancreas and peri-pancreas (54.8%), followed by lung (20.6%) and blood stream (18.3%). The resistance rate of K. pneumoniae to commonly used antibiotics in clinical practice was high, especially CRKP, which was only sensitive to sulfamethoxazole-trimethoprim (SMZ-TMP) and tigecycline (TGC) (resistance rates were 37.57% and 17.57%, respectively). Independent risk factors for CPKP acquisition were male (OR = 1.655, 95% CI 0.642-4.265, P = 0.017) and PICC/CVC implantation (OR = 3.157, 95% CI 1.223-8.147, P = 0.021). Independent risk factors for mortality included carbapenem resistance (HR = 2.556, 95% CI 1.011-6.462, P = 0.047), hemorrhage (HR = 2.392, 95% CI 1.104-5.182, P = 0.027), septic shock (HR = 3.022, 95% CI 1.312-6.959, P = 0.009), age >60 years (HR = 2.977, 95% CI 1.303-6.799, P = 0.01), creatinine >177μmol/L (HR = 2.815, 95% CI 1.075-7.369, P = 0.035). K. pneumoniae infection has become a serious threat for AP patients, which recommends us more attention and active new strategies seeking.

Pancreatitis and Its Relationship to Diabetes

Background In recent years, post-pancreatitis diabetes mellitus (PPDM), also known as type 3 diabetes mellitus, has received a great deal of attention from researchers. PPDM is one of the long-term sequelae of pancreatitis, and PPDM is now the second most common cause of new onset diabetes in adults after Type T2DM beyond type (T1DM), the aim of this study was to find out the proportion of patients who developed secondary diabetes mellitus as a complication of pancreatitis. Methods A cross-sectional study in Damascus Hospital, in the Department of Gastroenterology included 215 cases from 2017 to 2023. Results The percentage of males was 116 (54%), and the average age of the sample was approximately 45 years. Reef Dimashq had the largest percentage, reaching 108 (50.2%). More than half of the sample were non-alcoholics, and their percentage was 194 (90.2%), and non-smokers, and their percentage was 117 (54.4%). %), and the percentage of those who had complications of pancreatitis reached 114 (53%), and those who had symptoms of diabetes reached 59 (27.4%), and it was found that there is a real, statistically significant relationship between pancreatitis and the occurrence of diabetes as a complication of it, as the percentage of patients reached of those who had symptoms of diabetes 50 (23.3%).

Post-acute pancreatitis diabetes: A complication waiting for more recognition and understanding.

Post-acute pancreatitis diabetes (PAPD) is the second most common type of diabetes below type 2 diabetes mellitus. Due to the boom in research on this entity carried out during the last decade, its recognition has increased. However, much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis (AP). Recent prospective cohort studies show that its incidence is about 23% globally and 34.5% in patients with severe AP. With the overall increase in the incidence of AP this complication will be certainly seen more frequently. Due to its high morbidity, mortality and difficult control, early detection and treatment are essential. However, its risk factors and pathophysiological mechanisms are not clearly defined. Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes. This review will show the evidence published so far on the incidence and prevalence, risk factors, possible pathophysiological mechanisms, clinical outcomes, clinical characteristics and preventive and corrective management of PAPD. Some important gaps needing to be clarified in forthcoming studies will also be discussed.

Local complications of acute pancreatitis and methods of their instrumental diagnosis

The literature review considers the characteristics of local complications in the classifications of acute pancreatitis, as well as analyzed the effectiveness of modern methods of their diagnosis. Understanding the morphology of changes occurring in the pancreas and parapancreatic tissue in acute pancreatitis is of great importance, as it often determines the tactics of surgical treatment. Modern diagnostic methods for local complications of acute pancreatitis, such as contrast-enhanced ultrasound, endoscopic ultrasound, computed tomography, magnetic resonance imaging and cholangiopancreatography are highly informative, but the effectiveness of their use depends on the duration of the disease and the type of local complications, which makes to apply the differentiated approach to their use.