Diagnosis Of Severe Acute Pancreatitis Research Articles

Fluorescence lifetime imaging of human pancreatic lipase activity using a novel probe for early diagnosis of severe acute pancreatitis

Severe Acute Pancreatitis, a serious condition caused by factors such as gallstones and chronic excessive alcohol consumption, with a very high mortality rate. Human pancreatic lipase (hPL) is a key digestive enzyme and abnormal activity levels of this enzyme are important indicators for diagnosing and monitoring pancreatic diseases. A fluorescent probe, LPP, has been developed to monitor the activity of hPL, especially in cases of SAP. The probe is based on cyanine isoindole derivatives, in vitro experiments confirmed the high specificity and sensitivity of the probe, with a detection limit of 0.012 U/mL, reactions completed within 10 min, and effective monitoring of pancreatic lipase activity in various biological samples. The stability and low cytotoxicity of LPP make it suitable for clinical applications, providing new tools and perspectives for the research and treatment of pancreatic diseases and related metabolic abnormalities. In addition, the change in fluorescence lifetime after the reaction of the probe with lipase allows for fluorescence lifetime imaging (FLIM), effectively monitoring the dynamic changes of hPL and enabling early diagnosis and monitoring of pancreatitis. This research not only enhances the understanding of pancreatic lipase activity detection but also has the potential to improve the diagnostics and treatment of pancreatitis.

Risk Factors for Death in Patients with Severe Acute Pancreatitis in Guizhou Province, China.

To compare the clinical characteristics of survival and nonsurvival patients with severe acute pancreatitis (SAP) and explore the risk of mortality in SAP patients. This was a single-center retrospective study performed in a severe acute pancreatitis diagnosis and treatment center. According to the outcome, SAP patients were divided into survival group and nonsurvival group. One-way ANOVA or independent t-test was used to compare the clinical characteristics of two groups of patients. Multivariate retrospective analysis was used to identify risk factors for mortality in SAP patients. A total of 486 SAP patients were included in the study, and the 90-day mortality for SAP patients was 13.58%. The common etiologies of SAP are biliary tract diseases (69.75%) and hyperlipidemia (17.28%). The most common complications caused by SAP were organ failure (55.14%), ARDS (50.62%), AKI (30.45%), sepsis (27.16%), and abdominal fluid collection (27.57%). There were differences in age, complications, and medical intervention between the nonsurvival group and the survival group. The main causes of death were infection (46.97%), abdominal bleeding (28.79%), and organ failure (9.09%). The binary logistic regression analysis showed that there were significant differences in age, AKI, sepsis, abdominal hemorrhage, organ failure, laparotomy, creatinine, and APTT between the nonsurvival group and the survival group. Age, AKI, sepsis, abdominal hemorrhage, and organ failure are risk factors for mortality in SAP patients. SAP patients with high creatinine and prolonged APTT upon admission require doctors to be vigilant. The main cause of death in SAP patients is pancreatitis-related organ failure and secondary infection.

CONTEMPORARY PERSPECTIVES ON DIAGNOSING ACUTE PANCREATITIS

Acute pancreatitis represents a significant challenge in urgent surgery. It holds a prominent position among urgent surgical diseases, with a rising incidence of severe, complicated forms. The increase in the negative outcomes of acute pancreatitis treatment is linked to delayed diagnosis of severe forms and their complications, owing to the absence of a highly effective severity assessment scale. This deficiency contributes to unjustified surgical interventions. Early severe pancreatitis manifests with a rapidly progressive course leading to organ failure, hypoxia, necrotic foci formation, abdominal sepsis, and abdominal compartment syndrome. Specific scales for early diagnosis include the criteria scale for primary assessment of acute pancreatitis severity, the Ranson scale, and the BISAP scale. The modern diagnosis of severe acute pancreatitis relies on two key international classifications: the Revised Atlanta Classification (2012) and the Determinant-based classification (2012). To assess the intensity of pancreatic inflammation by CT scan, the Balthazar scale is used, which is included in the Computer Tomography Severity Index and enables to determine the area of pancreatic necrosis.
 The purpose of this study is to improve the diagnosis of acute severe pancreatitis.
 The study was carried out by assessing the medical records of 20 patients diagnosed with acute pancreatitis who received treatment at the Surgical Inpatient Department of the 2nd City Hospital, Poltava, from 2021 to 2022.
 The analysis revealed that conducting a computer tomography within the 48-72 hours from the onset of the disease enables a comprehensive assessment of its severity. This assessment significantly influences the subsequent treatment approach, reducing the necessity for surgical intervention and lowering the risk of patient mortality.
 Hence, in alignment with contemporary classifications and diagnostic perspectives on acute pancreatitis, MSCT assumes a pivotal role, significantly influencing the selection of treatment strategies in all cases. This inclusion facilitates timely surgical interventions and allows for adjustments to conservative therapy based on the severity of pancreatic inflammation. It is advisable, however, to conduct computed tomography 48-72 hours after the onset of pain to adequately assess the pancreatic condition. Morphological changes in the pancreas typically do not manifest within the initial day of the disease, making early CT diagnostics potentially misleading regarding the true state and severity of acute pancreatitis.

A study on demographic and clinicopathological characteristics of severe acute pancreatitis in a tertiary-level intensive care unit in Nepal

BACKGROUND AND AIMS Severe acute pancreatitis can have serious consequences and a high mortality rate and may necessarily require intensive care unit admission. This study is to describe the demographic and clinicopathological characteristics of severe acute pancreatitis (SAP) in a tertiary-level intensive care unit (ICU). METHODS The study was designed retrospectively with a diagnosis of severe acute pancreatitis (SAP) admitted to the tertiary-level adult ICU “between” January 2019 to December 2022. RESULTS A total of 52 patients were enrolled in this study. The maximum numbers of patients were between 41 to 52 years of age, with a median age of 47.6 years. Gallstone (biliary) was identified as the most important etiological factor associated with severe acute pancreatitis. Among the known etiological factors, 52% of the cases were related to gallstone disease, 28.8% were due to alcohol, 7 (13.4%) to other causes (such as idiopathic, post-viral, post-ERCP, and drug-induced), and 5.7% were due to triglycerides. In our study, the most common symptoms were abdominal pain and vomiting. And the majority of patients recovered with conservative treatment. The majority 48 (92.3%) of patients improved, while 4 (7.6%) died. Eighteen (34.6%) patients required Mechanical ventilation (MV), while 10 (19%) with vasopressor supports. Eleven patients (21%) had evidence of an acute kidney injury on admission. Three patients (5.7%) underwent surgery, including necrosectomy and open cholecystectomy. The median length of ICU stay was 6.3 days. CONCLUSIONS The most common cause of severe acute pancreatitis was gallstone, followed by alcohol-related. SAP was seen more commonly in the male gender in the age group of 41-52 years. The most common presenting symptoms were abdominal pain and vomiting. Most SAP cases could be managed conservatively.

Diagnostic Accuracy of Admission C Reactive Proteins in Predicting Severity of Acute Pancreatitis Keeping CT Scan as Gold Standard

Introduction: Acute pancreatitis is common, with an alarming rise in the global incidence. The clinical course of AP is highly variable, ranging from mild, self-limiting symptoms to multiple organ dysfunction and/or death. Objective: To evaluate the diagnostic accuracy of admission C reactive proteins in predicting the severe acute pancreatitis keeping computed tomography as gold standard. Material and methods: This Cross-sectional study was conducted at Department of Gastroenterology, Aga khan hospital, Karachi from 19-06-2019 till 19-06-2020. Data was prospectively collected from patients after taking a verbal consent. 181 patients who met the diagnostic criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy was calculated. Results: A total of 181 patients who met the inclusion and exclusion criteria were included in this study. Mean age, duration of symptoms, BMI, height, weight and CRP in our study was 49.48±10.36 years, 14.88±4.87 hours, 29.8±4.74 kg/m2, 146.5±10.41 cm, 78.9±8.58 kg and 110.9±28.54 mg/L. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CRP for diagnosis of severe acute pancreatitis by taking CT scan as gold standard was found to be 88.8%, 81.5%, 94.7%, 65.9% and 87.2%. Conclusion: CRP it is an inexpensive alternative to the conventional severity assessment methods for the prediction of severity and outcome of patients with acute pancreatitis and can serve as an early indicator of the progression of acute pancreatitis into a serious state. Keywords: Severe acute pancreatitis, C reactive protein and CT scan.

The Effectiveness of BISAP Score for the Diagnosis of Severe Acute Pancreatitis

Background: The clinical profile of severity of acute pancreatitis ranges from modest pancreatic inflammation to an unusually fatal acute necrotizing pancreatitis rightly known as severe acute pancreatitis (SAP). For the evaluation of clinical spectrum of pancreatitis, a more accurate models that is also cost-effective is required. Here, we sought to evaluate the contribution BISAP scoring systems to the diagnosis of severe of acute pancreatitis by comparing it with CT severity index. Settings and duration: This observational study was carried out at medicine department, Jinnah hospital, Lahore from 16th July 2022 to 15th January 2023. Sampling: Patients diagnosed with acute pancreatitis were registered. Acute pancreatitis was labelled based triad of classic epigastric pain, blood markers and imaging tool. BISAP score ≥3 was meant SAP and CT severity index for SAP included findings like necrosis and collection. Diagnostic accuracy was determined. Results: The patient's age ranged from 20 to 60 years with mean age of 36.41 + 9.362 years. The ratio of male to female participants was 2.3 to 1. For the diagnosis of SAP, the BISAP score's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were each 95.8%, 55.2%, 85.2%, 83.3%, and 84.8%, respectively. Conclusion: Simple clinical tools like BISAP score could be helpful in diagnosing severe acute pancreatitis, precluding the need for expensive and technically complex imaging modalities. Keywords: Severe acute pancreatitis (SAP), BISAP Score, Diagnostic accuracy

The Diagnostic Value of Procalcitonin in Patients with Severe Acute Pancreatitis: A Meta-Analysis.

The role of procalcitonin in diagnosing severe acute pancreatitis has not been clearly assessed. This meta-analysis aims to evaluate the overall diagnostic accuracy of procalcitonin as a biomarker for severe acute pancreatitis. Medline (via PubMed), Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and China WanFang Data were searched systematically for prospective studies reporting procalcitonin as a diagnostic marker of severe acute pancreatitis before August 31, 2021. Sensitivity, specificity, and other measures of the accuracy of procalcitonin in the diagnosis of severe acute pancreatitis were pooled by Stata 15.0 software. Heterogeneity was evaluated by I2 test, and the quality of included studies was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies-2 system. Further, the sources of heterogeneity were verified using meta-regression and subgroup analysis, and the publication bias was evaluated by the Deeks’ funnel plot. A total of 18 studies meeting the inclusion criteria were included, containing 1764 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the receiver operating characteristic curve of procalcitonin for diagnosing severe acute pancreatitis were as follows: 0.80 (95% CI: 0.73-0.86), 0.84 (95% CI: 0.78-0.88), 4.95 (95% CI: 3.46-7.09), 0.23 (95% CI: 0.16-0.34), 21.26 (95% CI: 11.09-40.74), 0.89 (95% CI: 0.86-0.92). Also, P > .05 suggested no significant publication bias. Current evidence indicates that procalcitonin has good sensitivity and diagnostic accuracy for severe acute pancreatitis. However, the findings should be carefully used as routine evidence in diagnosing patients with severe acute pancreatitis alone because of the limited number of included studies and high heterogeneity.

Quantitative metabolic analysis of plasma extracellular vesicles for the diagnosis of severe acute pancreatitis

BackgroundSevere acute pancreatitis (SAP) is the most common gastrointestinal disease and is associated with unpredictable seizures and high mortality rates. Despite improvements in the treatment of acute pancreatitis, the timely and accurate diagnosis of SAP remains highly challenging. Previous research has shown that extracellular vesicles (EVs) in the plasma have significant potential for the diagnosis of SAP since the pancreas can release EVs that carry pathological information into the peripheral blood in the very early stages of the disease. However, we know very little about the metabolites of EVs that might play a role in the diagnosis of SAP.MethodsHere, we performed quantitative metabolomic analyses to investigate the metabolite profiles of EVs isolated from SAP plasma. We also determined the metabolic differences of EVs when compared between healthy controls, patients with SAP, and those with mild acute pancreatitis (MAP).ResultsA total of 313 metabolites were detected, mainly including organic acids, amino acids, fatty acids, and bile acids. The results showed that the metabolic composition of EVs derived from SAP and MAP was significantly different from those derived from healthy controls and identified specific differences between EVs derived from patients with SAP and MAP. On this basis, we identified four biomarkers from plasma EVs for SAP detection, including eicosatrienoic acid (C20:3), thiamine triphosphate, 2-Acetylfuran, and cis-Citral. The area under the curve (AUC) was greater than 0.95 for both discovery (n = 30) and validation (n = 70) sets.ConclusionsOur data indicate that metabolic profiling analysis of plasma EVs and the screening of potential biomarkers are of significant potential for improving the early diagnosis and severity differentiation of acute pancreatitis.Graphical abstract

The Step up Approach in the Management of Infected Pancreatic Necrosis: A Case Report

Approximately 15% of patients with acute pancreatitis develop the severe form. Treatment of infected necrotizing pancreatitis has changed over the past 20 years and continues to evolve with increasing experience, new techniques, and research. The “Step Up Approach” consists of the successive placement of drains of progressively greater caliber, it has demonstrated, since the publication of the PANTER study, its superiority over the classical surgical approach in terms of morbidity. In up to 35% of cases, the episode will be resolved only in this way, in the rest of patients, the pancreatic cell will be debrided. We present the case of a patient with a diagnosis of severe acute pancreatitis and infected pancreatic necrosis who was managed with the now popular “step up” approach 28-year-old male with dyslipidemic origin, with necrosis pancreatic, peripancreatic collections, and gas in retroperitoneum, treated with TPN, pancreatin (CREON) and antibiotic therapy (Imipenem). He developed infected necrosis that required drainage with two 12 Fr and 14 Fr pigtails (25th day-hospitalization), with ultrasound-guided access in the right flank and left flank. Catheter replacement and progressive increase in diameter were performed, followed by RPVA necrosectomy following the path of the left pigtail (th day-hospitalization). The evolution was favorable, with progressive withdrawal of drains, and discharge without drains on day 65 of hospitalization. The "Step Up Approach" is the current standard in the treatment of infected pancreatic necrosis, it is effective and safe, avoiding the serious complications of open necrosectomy, with a good recovery of the patient.

Accurate prediction of acute pancreatitis severity with integrative blood molecular measurements.

Background: Early diagnosis of severe acute pancreatitis (SAP) is essential to minimize its mortality and improve prognosis. We aimed to develop an accurate and applicable machine learning predictive model based on routine clinical testing results for stratifying acute pancreatitis (AP) severity.Results: We identified 11 markers predictive of AP severity and trained an AP stratification model called APSAVE, which classified AP cases within 24 hours at an average area under the curve (AUC) of 0.74 +/- 0.04. It was further validated in 568 validation cases, achieving an AUC of 0.73, which is similar to that of Ranson’s criteria (AUC = 0.74) and higher than APACHE II and BISAP (AUC = 0.69 and 0.66, respectively).Conclusions: We developed and validated a venous blood marker-based AP severity stratification model with higher accuracy and broader applicability, which holds promises for reducing SAP mortality and improving its clinical outcomes.Materials and Methods: Nine hundred and forty-five AP patients were enrolled into this study. Clinical venous blood tests covering 65 biomarkers were performed on AP patients within 24 hours of admission. An SAP prediction model was built with statistical learning to select biomarkers that are most predictive for AP severity.

The step up approach in the management of infected pancreatic necrosis. A case report

Presenter: Maria Liz Sanchez MD | Hospital de Clínicas de Asunción Background: Approximately 15% of patients with acute pancreatitis (AP) develop the severe form. Treatment of infected necrotizing pancreatitis has changed over the past 20 years and continues to evolve with increasing experience, new techniques, and research. Treatment of Infected necrosis by laparotomy is associated with high morbidity and mortality. The “Step Up Approach” consists of the successive placement of drains of progressively greater caliber, it has demonstrated, since the publication of the PANTER study, its superiority over the classical surgical approach in terms of morbidity. In up to 35% of cases, the episode will be resolved only in this way, in the rest of patients, the pancreatic cell will be debrided. Methods: We present the case of a patient with a diagnosis of severe acute pancreatitis and infected pancreatic necrosis who was managed with the now popular “step up” approach Results: Clinical case: 28-year-old male with dyslipidemic origin (AP), with necrosis pancreatic, peripancreatic collections, and gas in retroperitoneum, treated with TPN, pancreatin (CREON) and antibiotic therapy (Imipenem 20 days and then according to antibiogram). He developed infected necrosis that required drainage with two 12 Fr and 14 Fr pigtails (25th day-hospitalization), with ultrasound-guided access in the right flank and left flank. Catheter replacement and progressive increase in diameter were performed, followed by RPVA necrosectomy following the path of the left pigtail (th day-hospitalization). The evolution was favorable, with progressive withdrawal of drains, and discharge without drains on day 65 of hospitalization. Conclusion: The “Step Up Approach” is the current standard in the treatment of infected pancreatic necrosis, it is effective and safe, avoiding the serious complications of open necrosectomy, with a good recovery of the patient.

Triglyceride and glucose (TyG) index is an effective biomarker to identify severe acute pancreatitis

BackgroundEarly diagnosis of severe acute pancreatitis (AP) is important to reduce morbidity and mortality. We investigated the association between the triglyceride and glucose index (TyG index) and the prognosis of severe AP (SAP). MethodsThe TyG index was calculated as: ln [fasting triglycerides (mg/dL) x fasting plasma glucose (mg/dL)]/2. Multivariable logistic regression analyses were used to investigate the independent association between the TyG index and the severity of AP. ResultsIn this study, 373 patients with AP were recruited from three hospitals. The TyG index was higher in the SAP group than in the non-SAP group. Further, the TyG index was higher than in patients admitted to an intensive care unit and those who died of AP. The TyG index was an independent predictive factor for SAP (odds ratio 7.14, 95% confidence interval 2.80–18.19). The area under the curve increased significantly, from 0.738 to 0.830, after adding the TyG index to a predictive SAP model. ConclusionsOur findings suggest that the TyG index is an independent prognostic factor in patients with AP and could be used as a simple prognostic indicator for SAP.

EFFICIENCY OF PROTEASE INHIBITOR ULINASTATIN IN PATIENTS WITH ACUTE PANCREATITIS

Introduction. Acute pancreatitis is one of the most common acute gastroenterological diseases in the world. A key element of its pathogenesis is “pancreatic self-digestion” by pancreatic enzymes. In recent years, the use of protease inhibitors has attracted considerable interest as a pathogenetic therapy of acute pancreatitis.Objective: To study the effect of ulinastatin on the severity of acute pancreatitis.Materials and methods. A total of 50 patients with acute pancreatitis were examined. Group 1 (n = 25) received standard therapy, group 2 (n = 25) additionally received intravenous ulinastatin infusion in a dose of 100,000 IU 1 time per day for 3 days. Indicators of pancreatic inflammation and mortality were studied.Results and discussion. On admission, patients had enzymatic ascites, an acute increase in blood levels of α-amylase and diastase in the urine, neutrophilic leukocytosis with a left shift and relative lymphocytopenia. Compared to standard therapy, ulinastatin reduced the frequency of abdominal drainage from 68.0% to 40.0%. Blood α-amylase and urine diastase levels in the ulinastatin group decreased 2-6 times as compared with the control group and normalized on day 5, whereas in the control group they did not reach the norm. The number of leukocytes in the ulinastatin group on day 5 decreased by 38.1% from the baseline, and in the control group – only by 26.0%. On the 5th day the left shift, LII and lymphocytopenia decreased in the ulinastatin group, but not in the control group. In the first 3 days of the disease, the diagnosis of severe acute pancreatitis was confirmed in 80.0% of patients in the control group and 48.0% in the ulinastatin group. Mortality in the control group was 20.0%, and there were no fatal cases in ulinastatin group. Ulinastatin decreased duration of treatment in ICU from 3.6 ± 1.0 to 2.3 ± 0.9 days and did not affect total hospital stay.Conclusions. Ulinastatin has a significant anti-inflammatory effect in patients with acute pancreatitis. This is manifested by a rapid and reliable reduction of signs of inflammation in the pancreas, which prevents the development of pancreatic necrosis, reduces pancreatitis severity, accelerates SIRS resolving and reduces mortality.

1304 The Great Mimicker: Leptospirosis

INTRODUCTION: Leptospirosis is the most prevalent zoonotic disease with higher incidence in the tropical regions. Humans are infected after direct contact with urine of an infected animal or environmental exposure. Most infections are asymptomatic and self-limited while a severe life-threatening infection, known as Weil's disease, occurs in about 10% of patients. Among those with severe disease, hepatitis, acute kidney injury, myocarditis, and rarely, acute pancreatitis can develop. We herein report a case of an acute pancreatitis as an uncommon presentation of severe leptospirosis. CASE DESCRIPTION/METHODS: 71-year-old male patient with past medical history of hypertension, diabetes mellitus, presented with complaints of abdominal pain, myalgia, nausea as well as vomiting for seven days prior to admission. Patient has not been able to tolerate food due to nausea and severe diffuse abdominal pain. Initial physical examination was remarkable for dry oral mucosa and jaundice. Laboratory evaluation demonstrated microcytic anemia with Hgb 9.4 g/dL, WBCs in 9.7 × 10-3/ul with neutrophil predominance, and acute thrombocytopenia. A complete metabolic panel showed a severe direct hyperbilirubinemia with normal liver enzymes and an increased creatine, 1.5 times baseline. Lipase levels were three times upper limit that along with presenting symptoms suggested an acute pancreatitis. Further examination with an abdominal sonogram revealed a diseased acalculus gallbladder with a positive Murphy sign and no obstruction of the biliary tree. Initial clinical diagnosis of severe acute pancreatitis was made, however, findings of non-obstructive jaundice along acute renal failure raised the suspicion of Weil's disease. Acute medical care included intravenous ceftriaxone with adequate clinical response. During admission Leptospira IgG titers were positive with specificity of 100%. Following treatment with ceftriaxone the patient was uneventfully discharged home to complete oral doxycycline therapy for a total of seven days. DISCUSSION: Leptospirosis in Puerto Rico accounts for approximately 50% of all the cases reported in the United States. It is of foremost importance to be aware of the diverse clinical manifestations of Weil's disease, often, confused with a viral illness. Unusual etiologies can lead to common complaints in this case an acute pancreatitis; therefore, early identification and acute care management of infectious diseases can positively influence patient's outcome.

Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent.
 Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis.
 Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed.
 Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment.
 Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity.
 CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

Severe pancreatitis with colonic perforation successfully managed using video-assisted retroperitoneal debridement: a case report

Background: Colorectal complications including penetration and perforation in acute pancreatitis often become severe and fatal. Effective drainage is pivotal for successful treatment. We present a case of large retroperitoneal abscess with colonic necrotizing perforation due to severe acute pancreatitis treated with video-assisted retroperitoneal debridement (VARD) using a step-up approach. Case presentation: A 31-year-old man was admitted to a general hospital with a diagnosis of severe acute pancreatitis due to fallen gallstones. At 10 days after onset, he was referred to our hospital for more intensive treatment. On day 16, he experienced melena and shock. Therefore, embolization of the three straight arteries of the descending colon was performed. On day 30, because computed tomography showed retroperitoneal abscess, percutaneous drainage using the retroperitoneal route was performed. On day 36, ileostomy was performed because the appearance of drained pus from the retroperitoneal abscess became feces-like. On day 58, VARD was performed to treat the refractory retroperitoneal abscess causing highly inflammatory state due to insufficient drainage. On day 85, fluoroscopic imaging showed disappearance of the abscess cavity. He was transferred to the previous hospital on day 89. Conclusions: VARD enabled less invasive treatment for patients with colonic necrotizing perforation due to severe pancreatitis.

Випадок успішного консервативного лікування шлункової нориці як одного з багатьох ускладнень виразкової хвороби дванадцятипалої кишки

У публікації наведено клінічне спостереження одного пацієнта М. протягом останніх шести років. У 2010 р. пацієнт М., 46 років був направлений в центр гострого панкреатиту з підозрою на гострий тяжкий панкреатит, а через 12 год після госпіталізації прооперований з приводу перфоративної виразки дванадцатипалої кишки з поширеним перитонітом на тлі ви­разкового стенозу дванадцатипалої кишки. Виконано ушивання виразки з накладанням попереду-ободового гастроентероанастомозу. Систематичного лікування не отримував. У лютому 2016 р. госпіталізований в хірургічне відділення з флегмоною передньої черевної стінки, причиною якої була пенетрація виразки гастроентероанастомозу в передню черевну стінку. Після розкриття флегмони відкрилася шлункова нориця, яка закрилася на тлі інтенсивної протизапальної терапії і приймання мак­симальних доз пантапразолу.У квітні 2016 р. виконано резекцію шлунка і гастроентероанастомоз за Ру. В подальшому було три епізоди кровотеч, які усували консервативно.У кінці 2016 р. з'явилися труднощі при ковтанні їжі, діагностовано стеноз нижньої третини стравоходу, пройшов курс лікування в торакальному відділенні за допомогою бужування, прохідність відновлена. Повторно оглянутий в квітні 2017 р., стан задовільний, ковтання вільне. На ФГДС у ділянці гастроентероанастомозу рецидивна виразка.Хворому запропоновано стаціонарне лікування у відділенні гастроентерології та обстеження з підозрою на синдром Золлінгера–Еллісона.

Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis

Early diagnosis of severe acute pancreatitis (SAP) is important for the successful management of patients. Most scoring systems are complex or involve multiple parameters, which makes it difficult to ascertain the severity of acute pancreatitis at an early stage. Our study aims to evaluate the bedside index for severity in acute pancreatitis (BISAP) in predicting the severity of pancreatitis and mortality in a rural population, where financial constraints pose a major problem during treatment. We studied 55 patients of acute pancreatitis who presented to our institution between October 2014 and August 2016. The BISAP score was calculated within 24 h of admission. During the hospital stay, the CT severity index (CTSI) was calculated, and patients closely monitored to detect presence of organ failure or mortality. The accuracy of the BISAP and CTSI scores in predicting severity and mortality was determined by plotting receiver operating characteristic (ROC) curves, and calculating the area under curve (AUC). Sixteen (29%) patients developed persistent organ failure and were classified as severe acute pancreatitis (SAP), and four (7%) died. No patient with a BISAP score of 0 or 1 developed severe pancreatitis. The area under curve (AUC) for BISAP score in predicting severity and mortality was 0.902 and 0.958, respectively, better than that of CTSI. BISAP scores of 0 or 1 have a very high negative predictive value, and hence accurate for predicting mild disease. These patients can safely avoid a CT scan and the costs associated with it.

重症急性膵炎を契機に発見された十二指腸乳頭部癌の1例

A 81-year-old woman complaining of epigastric pain was admitted to our hospital with diagnosis of severe acute pancreatitis. Esophagogastroduodenoscopy was performed for the further examination because of recurrence of pancreatitis, and it revealed a lobular protruding lesion in the duodenal papilla. Histopathological examination performed by biopsy revealed adenocarcinoma. As a result of consultation with surgeons, we decided to perform the curative surgery after inflammation improved. We placed the stent in the main pancreatic duct for the purpose of preventing the recurrence of the pancreatitis. Subtotal Stomach-Preserving Pancreaticoduodenectomy (SSPPD) was performed in 6.5 months after the onset of pancreatitis. Papillary lesions are relatively rare as a cause of pancreatitis, but it seems to be necessary to keep in mind, especially when repeating pancreatitis. The pancreatic duct stent is considered to be an effective device for preventing recurrence of pancreatitis during the waiting period until curative surgery.

Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition

The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical exami- nation, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Ac), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se--98.10%), for estimation of organ failure--MODS 2 (Sp--100%, PPV--100%) and APACHE II (Sp--100%, PPV--100%), for detection of pancreatonecrosis sings--CTSI (Sp--100%, NPV--100%), for estimation of need for intensive care--MODS 2 (Sp--100%, PPV--100%, NPV--96.29%) and APACHE II (Sp--100%, PPV--100%, NPV--97.21%), for prediction of lethality--MODS 2 (Se-- 100%, Sp--98.14%, NPV--100%) and APACHE II (Se--95.00%, NPV-.99.86%). Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow and BISAP Scoring systems MODS 2, APACHE I high specificity and positive predictive value allow using it at clinical practice.