Complication Of Pancreatitis Research Articles

Spontaneous Pancreatic Pseudocyst-Superior Mesenteric Vein Fistula

ABSTRACT Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We present a case of a 50-year-old man who was found to have a pancreatic pseudocyst-superior mesenteric vein fistula after being evaluated for several months of abdominal pain and weight loss. The patient was treated with endoscopic stenting of the pancreatic duct along with early enteral nutrition and suppressive antibiotics, which resulted in improvement in his condition. This case report highlights clinical presentation and the complexity of treatment of this rare diagnosis.

The Spectrum of Tigecycline-Induced Pancreatitis in Clinical Characteristics, Diagnosis, and Management.

Tigecycline-induced acute pancreatitis (AP) has been frequently increasingly reported in solid organ transplant patients. This review aimed to summarize the characteristics, possible mechanisms, and management of tigecycline-induced AP. Case reports of tigecycline-induced AP published in Chinese or English were collected until February 2023 for retrospective analysis. Thirty-four patients from 29 articles were included. Fifteen patients (46.9%) had solid organ transplantation, and 4 patients (12.5%) had malignant tumors. Twenty-five patients (89.3%) received a recommended maintenance dose of tigecycline (50 mg q12 h). The median age was 50 years (range 9-87). Compared to the nontransplant patients, the median age of the transplant patients was significantly younger, 44 years (range 12.5-61) versus 57.5 years (range 9-87) (P=0.03). The median time of symptom onset was 7 days (range 2-29), and 91.2% (31/34) were less than 14 days. Typical initial symptoms included abdominal pain (90.6%), nausea (46.9%), vomiting (43.8%), and abdominal distention (21.9%). Most cases were accompanied by elevated levels of pancreatic enzymes. The main radiological features included edematous infiltrate and acute pancreatitis on computed tomography (CT) scan and abdominal ultrasound. Except for one patient who continued tigecycline treatment, all patients discontinued treatment and received symptomatic support such as fasting, acid suppression, and enzyme suppression. The median time to recover pancreatic enzymes to the normal range was 5 days (range 1-43), and the median time to relieve symptoms was 4 days (range 1-12). Four patients died, of whom two died of severe pancreatitis complications and two of cardiogenic shock and septicemia. Tigecycline-induced AP was a rare and serious complication that occurred mainly within two weeks of the medication. This serious side effect should be kept in mind while treating severe infections especially in transplant recipients.

Pancreatopleural fistula as a complication of necrotizing pancreatitis (clinical case)

Acute pancreatitis is a disease that is accompanied by systemic inflammatory response syndrome and polysystemic dysfunction. Often acute pancreatitis leads to damage to various organs, including: pleura, mediastinum, cardiovascular structures. These complications cause difficulties in diagnosing and treating patients. In this review, we discuss the complications of acute pancreatitis, focusing on the diagnosis and treatment of pancreatopleural fistulas. Pancreatopleural fistula is a rather rare complication observed in patients with both acute and chronic pancreatitis due to traumatic or iatrogenic damage to the pancreatic duct. Conservative treatment with ocreatid combined with stenting of the pancreatic duct currently makes it possible to achieve closure of the fistula in 31-45% of cases, surgical intervention – in 80-90% of cases. The clinical case presented in this article demonstrates the successful treatment of this difficult complication of acute pancreatitis. The authors emphasized the need for timely diagnosis of this condition, as delaying adequate treatment can worsen the prognosis of recovery of patients with pancreatopleural fistulae.

Hypertriglyceridemic pancreatitis managed with heparin and insulin: a case report

BackgroundAlcohol and gall stones are common causes of pancreatitis. Other causes of pancreatitis include hypertriglyceridemia, trauma, congenital anomalies, and medications. Hypertriglyceridemic pancreatitis is distinguished, as it is more severe and complicated. The management of hypertriglyceridemic pancreatitis, other than the basic care given to other pancreatitis patients, is to decrease the serum triglyceride level to less than 500 mg/dl as soon as possible. Plasmapheresis, hemofiltration, and other modalities have been proven effective therapies, but, are expensive and not easily accessible. Insulin and heparin which are cheaper alternatives for treatment, have been reported in case reports along with one randomized controlled trial. The number of patients in these reports was small, so, the therapy is not well established. For most African countries like ours, the only option for management is heparin and insulin. Despite this fact, there has not been any publication regarding this issue on our continent.Case reportWe report the case of a 24 years old Ethiopian male who presented with severe central abdominal pain, easy fatiguability, and vomiting of one-day duration. He was tachycardic and tachypneic with diffuse abdominal tenderness, and had tendon xanthomas. His plasma was lactescent with a serum triglyceride level of 4775 mg/dl. His abdominal CT scan showed diffuse pancreatic swelling with a peripancreatic fluid collection, and his serum lipase was elevated. With a diagnosis of hypertriglyceridemic pancreatitis, he was managed with intravenous insulin infusion along with subcutaneous heparin. His random blood sugar was checked hourly with three episodes of hypoglycemia during therapy. His serum triglyceride level dropped to less than 500 mg/dl in three days, and he was discharged with no complications.ConclusionSince our findings are consistent with a prior randomized controlled trial and compilation of case reports, it would strengthen the evidence for safety and efficacy of insulin and heparin therapy. This therapy, which is the only available therapy in most countries of our continent, would decrease most of the complications of hypertriglyceridemic pancreatitis that we face. We believe, our report would be a wake-up call for researchers and clinicians in our continent to change their practice and strengthen the evidence for the treatment.

Time to think prime times for treatment of necrotizing pancreatitis: A pendulum conundrum.

Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of acute pancreatitis patients with potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (matured PFC with necrosis) and pancreatic pseudocysts (matured PFC without necrosis). In the management of necrotizing pancreatitis and walled-off necrosis, endoscopic ultrasound (EUS)-guided transluminal drainage combined with on-demand endoscopic necrosectomy (i.e., the step-up approach) is increasingly utilized as a less invasive treatment modality compared to a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g., lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished, and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of non-interventional supportive treatment (e.g., antibiotics, nutritional support, irrigation of the cavity), there has been only a limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.

Post-intervention complications and management: Following percutaneous catheter drainage

The role of an interventional radiologist in the care of the patent with pancreatitis is twofold – as a diagnostician and as an interventionalist. The diagnostic part includes the role in the diagnosis of pancreatitis, the possible etiology, and associated complications if any. From the therapeutic point of view it includes the management of the various vascular and non-vascular complications of pancreatitis. With increase in the percutaneous management of pancreatitis associated collections, it is prudent to be well versed with the complications that may be encountered. This article focusses on the various complications secondary to percutaneous management of collections in pancreatitis and the management options that are available at the interventional radiologist's disposal. The complications are discussed under different sections including access-related, catheter-related and other non-vascular complications.

Colonic complications in acute pancreatitis: A single institution experience and systematic review

Colonic complications in acute pancreatitis: A single institution experience and systematic review

Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study.

Splanchnic vein thrombosis (SVT) is a major complication of moderate and severe acute pancreatitis. There is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and SVT. To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis. A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette survey. The threshold to assume group agreement was set at 75%. The response rate was 67% (n = 93). Seventy-one pancreatologists (77%) regularly prescribed therapeutic anticoagulation in case of SVT, and 12 pancreatologists (13%) for narrowing of splanchnic vein lumen. The most common reason to treat SVT was to avoid complications (87%). Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation (90%). Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation (76%) and splenic vein thrombosis as the least preferred location (86%). The preferred initial agent was low molecular weight heparin (LMWH; 87%). In the case vignettes, therapeutic anticoagulation was prescribed for acute portal vein thrombosis, with or without suspected infected necrosis (82% and 90%), and thrombus progression (88%). Agreement was lacking regarding the selection and duration of long-term anticoagulation, the indication for thrombophilia testing and upper endoscopy, and about whether risk of bleeding is a major barrier for therapeutic anticoagulation. In this national survey, the pancreatologists seemed to agree on the use of therapeutic anticoagulation, using LMWH in the acute phase, for acute portal thrombosis and in the case of thrombus progression, irrespective of the presence of infected necrosis.

Acute pancreatitis: It can be the first sign of silent gallstones.

The management of asymptomatic cholelithiasis is controversial. Silent gallstones are generally assumed to cause complications after at least one episode of biliary colic. The ratio of those silent stones that had initially caused, -or were diagnosed as the etiological agent of- acute pancreatitis has not been reported in the literature yet. Our study was designed to investigate the ratio of asymptomatic cholelithiasis in acute biliary pancreatitis cases. One hundred and seventy-one patients of 305 cases, who were followed up with the diagnosis of acute biliary pancreatitis, were identified retrospectively. Demographic specifications, laboratory findings and clinical progressions of the patients were inspected. Clinical histories were detailed by phone calls. Gallstones were radiologically detected in 85 out of 171 cases. Those patients were divided as symptomatic and asymptomatic. Clinical findings and follow-ups were evaluated by "Chi-square" test. In the study group, 80% of the patients were asymptomatic (n= 68) and 16.47% of the patients (n= 14) had complicated pancreatitis. Regarding the severity of the clinical course, being symptomatic or not was not identified as a significant factor (p= 0.108). In regard of creating symptoms, the size of the stone was not significant (p= 0.561) and obtained no prediction about the clinical severity of the pancreatitis (p= 0.728). Asymptomatic cholelithiasis patients had a major percentage in acute biliary pancreatitis cases. The "wait and see" approach should be re-evaluated for silent gallstones in prospective trials.

Late Complications of Acute Pancreatitis: A Surgical Approach

Late Complications of Acute Pancreatitis: A Surgical Approach

Immunological Pathways in the Development of Postoperative Hyperamylasemia and Postoperative Pancreatitis – Preliminary Results

Postoperative pancreatitis complications can be separated into two main groups based on literature reviews and clinical and experimental trials. Some authors suggest that postoperative pancreatitis is a severe complication that should be treated conservatively and operatively if needed. Other authors defend an opposite opinion that only postoperative hyperamylasemia exists, which is a transitory condition with no risk of complications.
 At “Alexandrovska” University Hospital for Active Treatment, Clinic of General and Liver-Pancreatic Surgery, a cohort of patients with increased amylase concentrations in the postoperative period between January 2017 and December 2018 were studied and followed with immunological and biochemical tests for interleukin (IL)-6. Regardless of the type of surgery to which they were subjected, all patients who presented with an elevated amylase concentration in the postoperative period were selected. The working hypotheses were the following: i) IL-6 is directly relevant in the development of postoperative pancreatitis; ii) the concentration of IL-6 is a prognostic factor in the early postoperative period and marks the boundary at which patients will develop postoperative pancreatitis and its various clinical manifestations; and iii) the postoperative period is accompanied by transient postoperative hyperamylasemia and absence of complications. To test these hypotheses, the values of IL-6 were statistically analyzed using SPSS v23 software.
 The results show that, with a 95% confidence interval (CI), a statistically significant difference is found in the concentration of IL-6 in patients who developed postoperative pancreatitis versus those with transient hyperamylasemia.
 The present study shows a direct link between the immunological marker, IL-6, and the course of both postoperative pancreatitis and transient hyperamylasemia, making this marker valuable in elucidating the differences in the development of postoperative pancreatitis and transient hyperamylasemia in the early postoperative period. Thus, IL-6 can be used to reach the correct diagnosis and decide effective treatment.

BACTERIAL TRANSMISSION AND ANTIBIOTIC SENSITIVITY OF CAUSATIVE AGENTS IN PURULENT-SEPTIC COMPLICATIONS IN PATIENTS WITH A SEVERE COURSE OF ACUTE PANCREATITIS

Introduction: Acute pancreatitis has emerged as a leading urgent abdominal condition, with a high mortality rate of up to 70% in cases of purulent-septic complications. The identification of specific causative agents during the infection stage of acute severe pancreatitis is challenging due to the various mechanisms by which pathogens can infiltrate parapancreatic fluid collections. However, early antibiotic prophylaxis is essential in the management of this patient population, considering the potential need for prolonged treatment involving multiple antibiotic rotations. This study aims at analyzing the changes in the microbial species spectrum responsible for purulent-septic complications in acute severe pancreatitis during the course of treatment.
 Methods: We investigated 174 bacterial cultures obtained from patients diagnosed with acute severe pancreatitis who were treated at the Surgical Department of M.V. Sklifosovsky Poltava Regional Hospital between 2015 and 2018. Among these cultures, 87 were obtained during the initial surgical intervention (39 after initial ultrasound-guided drainage and 38 during the initial open surgical intervention), and 87 were obtained during the course of treatment.
 Results: Among patients who underwent primary drainage of parapancreatic fluid collections, no aerobic flora was detected in 71.4% of cases, but subsequent bacterial cultures revealed microbial growth in 77.6% of patients. In patients who underwent open surgical intervention, pathological flora was detected in nearly all cases, both during the primary bacterial passage and in subsequent cultures. The species spectrum differed significantly between the primary and repeated bacterial passages. The initial cultures showed a predominance of gram-positive flora (S. epidermidis, Streptococcus spp., Enterococcus spp.), while repeated cultures demonstrated a notable increase in hospital-acquired strains and gram-negative flora (E. coli, Proteus spp., Acinetobacter spp.), along with a nearly three-fold increase in S. aureus. These findings have significant implications for selecting appropriate antibacterial agents throughout the treatment course. Notably, a substantial decrease in the sensitivity of multidrug-resistant strains to reserve antibiotics such as meropenem and trigecycline, by approximately 20%, was observed in subsequent bacterial studies.
 Conclusion: The microbial spectrum and antibiotic sensitivity of pathogens causing purulent-septic complications in acute severe pancreatitis undergo dynamic changes during the course of treatment. These findings underscore the importance of conducting repeated bacterial cultures and adjusting antibiotic therapy accordingly to optimize treatment outcomes.

Determinants and impact of splanchnic vein thrombosis in acute pancreatitis

BackgroundSplanchnic vein thrombosis (SVT) is a well-recognised though little-studied complication in acute pancreatitis (AP). SVT risk factors, its clinical consequences and the role of anticoagulation (AC) therapy is scarce. AimsTo evaluate the incidence and natural history of SVT in AP. MethodsPost hoc analysis of a prospective multicentre cohort study involving 23 hospitals in Spain. AP complications were identified by computer tomography, and patients with SVT were re-evaluated after two years. ResultsA total of 1655 patients with AP were included. The overall incidence of SVT was 3.6%. SVT was significantly associated with male gender, younger age and alcoholic aetiology. Every local complication increased SVT incidence, and this risk rose gradually with larger extension and infection of necrosis. These patients had a longer hospital stay and underwent a greater number of invasive treatments, regardless of AP severity. Forty-six patients with SVT were followed up. SVT resolution rate was 54.5% in the AC group and 30.8% in the non-AC group with lower thrombotic complications in the SVT resolution group (83.3% vs 22.7%; p<0.001). No AC-related adverse events occurred. ConclusionThis study identifies the risk factors and negative clinical impact of SVT in AP. Our results justify future trials to demonstrate the role of AC in this clinical scenario.

Endoscopic ultrasound-guided cystogastrostomy in the treatment of the complicated form of acute pancreatitis in children

Acute pancreatitis is relatively rare in children, with approximately 313 cases per 100,000 populations annually, and complicated forms are three times less common than those in adults. However, recently, the number of acute pancreatitis cases in children has increased, which entails a relatively higher incidence of complicated acute pancreatitis, including parapancreatic acute fluid accumulation, and determines the relevance of this problem for pediatric surgeons.&#x0D; In this study, using two sample observations, parapancreatic pseudocyst puncture under ultrasound and X-ray control was presented, a conductor string was introduced into the cavity of the pseudocyst, and further stenting of this anastomosis was performed with two plastic double-pigtail stents. In the first case, a 12-year-old boy underwent surgery for idiopathic pancreatitis and acute parapancreatic fluid accumulation in the pancreatic tail. In the second case, a 10-year-old girl presented with a parapancreatic pseudocyst, which was caused by drug-induced pancreatitis (a complication of the long-term use of valproic acid, an antiepileptic drug). Both children underwent surgery using this technique. Antisecretory therapy was performed postoperatively. In the catamnesis after 1 year and 6 months, the children had no complaints, and ultrasound and X-ray studies did not reveal any pathology. Endoscopic cystogastrostomy under ultrasound guidance is widely performed in complicated pancreatitis in adults. These observations show its effectiveness in pediatric practice. However, the relatively short observation period of treatment results requires additional research on a much larger number of cases and outcomes of these surgical interventions in children.

Hypertriglyceridemia as a risk factor for complications of acute pancreatitis and the development of a severity prediction model

BackgroundHypertriglyceridemia (HTG) is a major cause of acute pancreatitis (AP). We aimed to determine whether HTG is an independent risk factor for AP complications and construct a prediction model for non-mild AP. MethodsWe conducted a multi-center cohort study including 872 patients with AP and divided them into HTG-AP and non-HTG-AP groups. Multivariate logistic regression was performed, and a prediction model for non-mild HTG-AP was developed. ResultsHTG-AP patients had a higher risk of systemic complications, including systemic inflammatory response syndrome [odds ratio (OR): 1.718; 95% confidence interval (CI): 1.286–2.295], shock (OR: 2.103; 95%CI: 1.236–3.578), acute respiratory distress syndrome (OR: 2.231; 95%CI: 1.555–3.200), acute renal failure (OR: 1.593; 95%CI: 1.036–2.450), and local complications such as acute peripancreatic fluid collection (OR: 2.072; 95%CI: 1.550–2.771), acute necrotic collection (OR: 1.996; 95%CI: 1.394–2.856), and walled-off necrosis (OR: 2.157; 95%CI: 1.202–3.870). The area under curve of our prediction model was 0.898 (95%CI: 0.857–0.940) and 0.875 (95%CI: 0.804–0.946) in the derivation and validation datasets respectively. ConclusionHTG is an independent risk factor for AP complications. We constructed a simple and accurate prediction model for progression of non-mild AP.

Inhibition of angiotensin II type 1 receptor reduces oxidative stress damage to the intestinal barrier in severe acute pancreatitis.

Intestinal barrier injury is a common complication of severe acute pancreatitis (SAP), which is often accompanied by intestinal mucosal barrier injury and results in serious consequences. However, the exact mechanism remains unclear. We aimed to investigate whether angiotensin II type 1 receptor (AT1)-mediated oxidative stress is involved in SAP intestinal barrier injury and assessed the effects of inhibiting this pathway. The SAP model was established by retrograde bile duct injection of sodium taurocholate (5%). The rats were divided into three groups: the control group (SO), the SAP group (SAP), and the azilsartan intervention group (SAP + AZL). Serum amylase, lipase, and other indexes were measured to evaluate SAP severity in each group. Histopathological changes in the pancreas and intestine were evaluated by HE staining. The oxidative stress of intestinal epithelial cells was detected by superoxide dismutase and glutathione. We also detected the expression and distribution of intestinal barrier-related proteins. The results showed that the serum indexes, the severity of tissue damage, and the level of oxidative stress in the SAP + AZL group were significantly lower than in the SAP group. Our study provided hitherto undocumented evidence of AT1 expression in the intestinal mucosa, confirming that AT1-mediated oxidative stress is involved in SAP intestinal mucosal injury, and inhibiting this pathway could effectively reduce intestinal mucosal oxidative stress injury, providing a new and effective target for the treatment of SAP intestinal barrier injury.

Abstract #1385190: Empagliflozin Induced Acute Pancreatitis

Acute pancreatitis is a rapid onset inflammatory process of the pancreas which may have local and systemic manifestations. The most common causes of acute pancreatitis are gallstones and alcohol use. Other causes include drug-induced. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of oral hypoglycemic agents which is approved by the FDA for treating diabetes and for heart failure. 56-year-old, female patient known to have uncontrolled type 2 diabetes. Presented with a complaint of acute epigastric pain radiating to the back and then become a generalized abdominal pain, moderate in severity, not relieved by analgesic, associated with nausea and vomiting. The patient denied any history of alcohol, smoking use. A review of her medication list included sitagliptin 100 mg, metformin 2g, gliclazide 60 mg and more recently, empagliflozin 10 mg which was started seven weeks prior to symptoms onset. Physical examination was significant for tenderness in epigastric area. Laboratory workup revealed an elevated serum lipase 3851 units/L, serum amylase 3755 units\L abdominal CT scan shows mild fatty atrophy and mild peri-pancreatic fat stranding and free fluid adjacent to the tale and body suggesting evidence of acute pancreatitis. Abdominal ultrasound shows the gall bladder was without stones. The patient was admitted with diagnosis of mild acute pancreatitis and underwent conservative management. Patient condition was improved and discharged on same pre-admission antidiabetic medication with OPD follow-up. 3 weeks later she presented to the emergency department complaining from acute epigastric pain radiating to the back and association of nausea and vomiting. With tenderness in epigastric area laboratory workup revealed an elevated serum lipase and amylase. Abdominal CT scan confirmed acute interstitial pancreatitis. After 3 days of conservative management she was improved and discharged but this time her diabetologist discontinue empagliflozin and she was started on insulin. She was following up with her diabetologist in outpatient clinic and there was no history of recurrence of pancreatitis. Drug induce pancreatitis are rare cause but must be considered. It is therefore important to determine the underlying etiology of acute pancreatitis to prevent occurrence, recurrence, and the complications of pancreatitis. FDA and Health Canada have identified a potential safety issue and possible association between SGLT-2 inhibitors and acute pancreatitis but Further studies are required to investigate this association. This case report emphasized the possible association between SGLT2 inhibitors and acute pancreatitis. Physicians must be aware about this side effect as a possible cause of acute pancreatitis after exclusion of most common etiologies. Also, physician should inform the patient about the side effects of SGLT2 and the symptoms of acute pancreatitis and advised them to stop SGLT-2 inhibitors use in case such symptoms occur. Further studies are required to investigate this association.

Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study.

Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. The National Inpatient Sample database was utilized to identify the adult patients (≥ 18years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.

An acute pancreatitis: what is new in surgical tactics after the Atlanta–2012 consensus?

Objective. To delineate new approaches to surgical treatment in patients with an acute pancreatitis as development of principles of the Atlanta–2012 consensus and guidelines of the World Society for Urgent Surgery.&#x0D; Materials and methods. The results of treatment of patients in The Lviv Municipal Pancreatologic Centre were analyzed, using general clinical, the laboratory, biochemical, radiological, pathomorphological, bacteriological, pH–metric, cytomorphological and mathematic–statistical methods.&#x0D; Results. There was established, that local complications of an acute pancreatitis occur as solitary or multiple or coexistent foci of pathological processes. Diagnostic algorithm, taking into account the most informative indices (in accordance to criteria “sensitivity”, “specificity” and “diagnostic efficacy”), was proposed. Own predictors of severity of the disease – visual, pH–metric, cytomorphological and bacteriological – were elaborated. Taking into account the significance of early enteral feeding, the procedures of its transintestinal probe realization was proposed and their efficacy proved. The methods of analgesia without preparations–opiates and minimization of invasive way of the medicines administration were elaborated. Surgical tactics, using application of miniinvasive and standard operative technologies, was depicted.&#x0D; Conclusion. The renewed approaches to diagnosis and treatment of an acute pancreatitis are based on advances and gains of international and Ukrainian surgical pancreatology.

Relationship of computed tomography quantified visceral adiposity with the severity and complications of acute pancreatitis: a systematic review.

Whilst obesity and visceral adipose tissue (VAT) have been reported to be associated with an increased risk of severe AP, the established predictive scoring systems have not yet encompassed the impact of obesity or visceral adiposity. In the acute setting, computed tomography (CT) is often performed to assess AP severity and associated complications. With the added benefit of quantifying body fat distribution, it can be opportunistically used to quantify visceral adiposity and assess its relationship with the course of AP. This systematic review identified fifteen studies evaluating the relationship between visceral adiposity measured on CT and the severity of presentations of acute pancreatitis from January 2000 to November 2022. The primary outcome was to assess the relationship between CT quantified VAT and AP severity. The secondary outcomes were to assess the impact of VAT on patients developing local and systemic complications associated with AP. Whilst ten studies showed there was a significant correlation between an increased VAT and AP severity, five studies found otherwise. The majority of current literature demonstrate a positive correlation between increased VAT and AP severity. CT quantification VAT is a promising prognostic indicator with the potential to guide initial management, prompt more aggressive treatment measures or earlier re-evaluation and to aid disease prognostication in patients with acute pancreatitis.