Manifestations Of Chronic Pancreatitis Research Articles

TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMPLICATED BY PANCREATORAGIA.

The aim: To present and share our experience in the treatment of pancreatoragia which could help to prevent pancreatoragia in patients with chronic pan¬creatitis in the pre- and postoperative period. Materials and methods: Surgical treatment of complicated chronic pancreatitis (CP) was performed on 249 patients in the surgical clinic of the medical faculty №2 of National Pirogov Memorial Medical University of Vinnytsia during 2000 - 2021. Pancreatorrhagia occurred in 6 (2.4%) patients, group A - 3 (1.2%) - as disease manifestation, group B - 3 (1.2%) - as complication after surgery. In group A the source of bleeding was the lower pancreato-duodenal artery: 2 (0.8%) had lower pancreaticoduodenal artery aneurysms with bleeding into the cyst, 1 (0.4%) - a year after previously performed pancreato-duodenal resection. In group B pancreatorrhagia developed in 3 (1.2%) patients after the Frey-Izbitsky local resection of the pancreas: 2 (0.8%) - from pancreato-jejuno anastomosis, 1(0.4%) - from pancreatopleural fistula. Conclusions: Pancreatoragia, as a manifestation of chronic pancreatitis, occurred in 6 (2.4%) patients. Bleeding occurred as a manifestation of the disease in 3 (1.2%) patients and in 3 (1.2%) patients - in the postoperative period. It is possible to use fibrin or cyanoacrylate glue to filling the defect of the pancreatic duct or to suture vessels in the parenchyma of the pancreas by PDS for the prevention of pancreatoragia in the postoperative period.

Minimally invasive percutaneous cystogastrostomy in the surgical treatment of postnecrotic pancreatic cyst

The incidence of pancreatitis in the last ten years has been steadily growing — the age of patients with the first diagnosis of acute / chronic pancreatitis has decreased from 50 to 39 years, the percentage of patients with disability has increased to 15 %. One of the most common manifestations of chronic pancreatitis is the development of postnecrotic pancreatic cysts of various localization with a corresponding clinical picture. Currently, the main types of surgical treatment for postnecrotic pancreatic cysts are: drainage and resection methods of treatment. Topographic and anatomical features and the presence of concomitant pathology in the anamnesis necessitate the development of new minimally invasive, safe and effective methods of surgical treatment of postnecrotic pancreatic cysts.

Optimal time for surgical treatment of chronic pancreatitis or optimal surgery?

Background. The majority of studies on the surgical treatment of chronic pancreatitis (CP) compare treatment outcomes by the type of the procedure. However, some studies, especially systematic reviews and meta-analyses, indicate the equality of different surgeries by their long-term results. During last 5–9 years, several studies showed advantages of early surgery in chronic pancreatitis, within three years after symptoms onset. Objective: to analyze the short- and long-term results of surgical treatment for chronic pancreatitis regarding timing and, accordingly, the neglect of the disease. Materials and methods. Retrospective analysis of data of 147 patients from 2001 to 2020, the main intervention was surgery aimed at the main manifestations of CP, such as pancreatic ductal and/or parenchymal hypertension. Patients who suffered from CP symptoms 3 years or more were included in the control group (late surgery), and those who noted symptoms of CP for less than 3 years were included in the study group (early surgery). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the study authors, via telephone or mail, or during the visit. Results. According to all scales of the SF-36 questionnaire, except for Physical functioning, the group of early surgery prevails over the group of late surgery. The early surgery group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the late surgery group, except for the Cognitive functioning. Of the symptomatic scales, the early surgery group had the best averages on Pain and Diarrhea. The average Health/Quality of life scale was significantly better in the early surgery group. Conclusions. The quality of life, pain control, pancreatic function in patients operated within 3 years from the onset of CP symptoms were better compared to those with longer disease duration, with the same short-term results. The duration of the disease is a major factor for the success of surgical treatment of chronic pancreatitis in terms of long-term results. The early surgery is effective approach to obtain better long-term outcomes in chronic pancreatitis.

Modern aspects of diagnosis and treatment of chronic pancreatitis in children: experience of the center Center for the treatment of developmental anomalies and diseases of the hepatopancreatobiliary system in children

Chronic pancreatitis is one of the most pressing problems of pediatric gastroenterology and surgery of hepatopancreatobiliary organs. Diagnosis and treatment of this category of patients requires a comprehensive examination using modern highly sensitive research methods and the collegial participation of a surgeon, gastroenterologist and endocrinologist. Due to the fact that the algorithm for managing these patients is not regulated, patients often receive enzyme replacement therapy for a long time, with indications for surgical treatment. In addition, the non-specificity of complaints and clinical manifestations of chronic pancreatitis, the asymptomatic course and the initial detection of exo- and endocrine insufficiency lead to a later choice of the optimal treatment method and increase the risk of complications. The key to effective care for children with chronic pancreatitis is the staging and continuity in research and treatment. At the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Filatov Hospital, highly effective interventions are carried out for chronic pancreatitis in children, the purpose of which is to ensure an adequate outflow of pancreatic juice using longitudinal pancreaticojejunostomy, which, in addition to draining the pancreas, allows to achieve clinical remission and stop the progression pathological process, including diabetes mellitus. The article reflects the experience of diagnosis and treatment of chronic pancreatitis in children.

A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management.

An inflammatory process involving the pancreas, known as pancreatitis, can be categorized as either acute or chronic and may present in one of many ways. The clinical manifestations of acute pancreatitis are generally limited to epigastric or right upper quadrant pain, while manifestations of chronic pancreatitis are broader and may include abdominal pain in tandem with signs and symptoms of pancreatic endocrine and exocrine insufficiency. An understanding of the initial insult, proper classification, and prognosis are all factors that are of paramount importance as it pertains to managing patients who are afflicted with this disease. Our review delves into the depths of pancreatitis by exploring the embryology and anatomy of the pancreas, the pathophysiology and etiology of acute and chronic pancreatitis, and the medical and surgical management of acute and chronic pancreatitis.

Clinical course and approaches to the therapy of chronic pancreatitis in patients with comorbid pathology

The features of pathogenesis, clinical course and diagnostics of chronic pancreatitis combined with diseases of the cardiovascular system are discussed in the article. Results of the author’s own research on the effectiveness of influence of enzyme replacement therapy on the course of pancreatitis and comorbid pathology are presented. Significant positive dynamics of both manifestations of chronic pancreatitis and cardiovascular diseases, laboratory and instrumental examinations, improvement of patients’ quality of life upon the prescription of pancreatin are noted.

Hereditary Pancreatitis: Dilemmas in Differential Diagnosis and Therapeutic Approach

Hereditary pancreatitis (HP) is a rare, heterogeneous familial disease and should be suspected in any patient who has suffered at least two attacks of acute pancreatitis for which there is no underlying cause and unexplained chronic pancreatitis with a family history in a first- or second-degree relative. Genetic factors have been implied in cases of familial chronic pancreatitis. The most common PRSS1 mutations worldwide are the R122H and N29I variants. HP usually appears with an acute, a recurrent acute, and a chronic phase, referring to the inflammation of the pancreas and the symptoms' onset and duration. The clinical features of acute pancreatitis begin in childhood and last less than 6 months. HP carries a 50-70-fold increased risk of pancreatic cancer within 7-30 years of disease onset. HP diagnosis is defined by the presence of a detected cationic trypsinogen gene mutation (with or without clinical or radiological manifestations of chronic pancreatitis) or when the patient's family satisfies the requirements of the EUROPAC. With regard to the therapeutic approach, pancreatic enzyme replacement therapy and analgesics are offered to control pain. In addition, endoscopic and surgical intersections are reserved for all relevant complications. Unfortunately, surgical removal of affected pancreatic tissue does not necessarily guarantee the patient's long-term survival. Furthermore, the prognostic factors and the efficacy of extended resection remain controversial.

Clinical manifestation of chronic pancreatitis associated with SPINK1 mutations in children

s / Pancreatology 12 (2012) 502–597 565 We present the case of a 54 year old female patient, who underwent surgery for a neuroendocrine tumor, with a large pancreatic tail mass, diagnosed by computer tomography. Laparoscopic distal resection of the pancreas was conducted. The perioperative period was complicated by an infection of the wound and suppuration. The patient was discharged on the 7th day after the operation. Postoperative histopathological examination revealed the intrapancreatic accessory spleen. Accessory spleen mimicking a pancreatic tumor is difficult to diagnose. Some papers compare examination methods, but usually they are complicated, expensive and unavailable to patients. Moreover, in most of cases, EUS-FNA is impossible due to splenic vessels. In such cases, minimal invasive procedures appear to offer a good alternative to classic operations.

An Unusual Case of an Isolated Midbody Pancreatic Calculus Causing Recurrent Acute Pancreatitis

Pancreatic calculi are manifestations of chronic pancreatitis. Occasionally, a solitary calcification causes recurrent acute pancreatitis and is a target for therapy. A 50 year-old woman teetotaler was admitted for acute pancreatitis. Serum lipase and amylase were 8545 U/L and 345 U/L. Abdominal CT revealed an 8mm calcification in the mid-portion of the main pancreatic duct with dilatation upstream. ERCP confirmed the presence of an obstructing intraductal calcification in the mid-body of the pancreas, 15 cm from the papilla. Attempts at removal with a basket and ESWL were unsuccessful. She suffered recurrent pancreatitis and underwent surgery. A distal pancreatectomy removed an 8 mm calcium carbonate calculus. Tissue upstream from the obstruction revealed acute and chronic inflammation with normal tissue downstream. These findings implicate the stone as the primary etiology of her recurrent acute pancreatitis. Ductal hypersecretion of calcium or lithostathine deficiency may have caused the stone. Since pancreatectomy 35 months ago, she developed diabetes mellitus, but has been pain free. Interventional endoscopy coupled with ESWL has emerged as an excellent alternative to surgery for symptomatic pancreatic stones. Its success is greater with a single stone < 12 mm in size and located in the head or pre-papillary segment. ESWL alone can be successful as well but requires more repetitive treatments. Stones located in the body or tail, proximal to a stricture, or difficult to reach by retrograde cannulation are candidates for combined interventional endoscopy and ESWL. An immediate reduction in pain is achieved in 75–95% of patients. The best results are seen in patients who have the duct completely cleared of stones and fragments. Surgery can be applied when less invasive therapy is unsuccessful. [figure 1][figure 2]Figure 1Figure 2

Endoscopic management of pancreatic stones

Pancreatic calculi are a cardinal manifestation of chronic pancreatitis. The precipitation of calcium carbonate and stone growth lead to duct obstruction, fibrosis, and impaired secretory function. Endotherapy using the traditional endoscopic tools, such as sphincterotomy and balloon or basket extraction, have limitations when applied to a tortuous or strictured pancreatic duct. For this reason, adjunctive use of extracorporeal shockwave lithotripsy is a keystone to successful endoscopic extraction. Clearance of stones from a dilated duct often relieves pain related to outflow obstruction, and success is usually associated with a decreased pancreatic duct diameter. Because of the complexity of pancreatic stone management, patients are best treated at referral centers with the necessary expertise and resources.

Standards and Limitations of Conservative Treatment in Chronic Pancreatitis

Pain and malabsorption are the main and most frequent manifestations of chronic pancreatitis (CP) requiring treatment. Abstinence from alcohol and administration of analgesics are primary measures for

Abdominal radiotherapy is a cause for chronic pancreatitis

We report a series of five patients with nonalcoholic chronic pancreatitis who underwent abdominal radiotherapy for Hodgkin's disease (n = 4) or seminoma (n = 1) at doses ranging from 3600 to 4050 rads, 6 to 20 years (median, 7 years) before the onset of pancreatitis. Patients were in complete remission for their malignant disease. Other causes of chronic pancreatitis were excluded. The manifestations of chronic pancreatitis (median follow-up after the diagnosis of pancreatitis, 5 years) were pancreatic pain (n = 5), acute pancreatitis (n = 3), pseudocysts (n = 3), common bile duct stenosis (n = 2), duodenal stenosis (n = 1), splenic vein obstruction (n = 1), diabetes mellitus (n = 4), steatorrhea (n = 4), and pancreatic calcifications (n = 1). Other abdominal radiation injuries were severe chronic ulcer of the genu superius (n = 1), stenosis at the junction of the right and left hepatic ducts (n = 1), and splenic and left renal atrophy (n = 1). In one patient, pathological examination of the pancreas showed signs of chronic pancreatitis, severe fibrous endarteritis, and lack of inflammation. Abdominal radiotherapy should be added to the list of causes of chronic pancreatitis. We suggest that the physiopathology of postradiotherapy chronic pancreatitis is a vascular process.

Chronic pancreatitis in China: Etiology and management

The incidence of chronic pancreatitis in China is unknown. Endoscopic retrograde cholangiopancreatography (ERCP), surgery, and autopsy demonstrated that chronic pancreatitis in China is mainly secondary to cholelithiasis and other diseases of the bile ducts. Stones in the common bile duct, both intra- and extrahepatic, are extremely frequent in China. Such patients may have scores, even hundreds, of stones filling the common bile duct and its radicles. Biliary tract disease constitutes the etiology of chronic pancreatitis in 40-50% of our patients. The prolongation of necrosis, abscess, or pseudocyst after acute pancreatitis may also lead to chronic inflammation of the pancreas, as may a diverticulum at the second part of the duodenum. The pancreatitis observed in China is apt to be of the chronic relapsing type. Pancreatic ductal stones and ascaris lumbricoides may sometimes be associated with chronic inflammation of the pancreas; however, the cause of chronic pancreatitis is obscure in a large segment of the patients. Beside the ordinary clinical manifestation of chronic pancreatitis, such as abdominal pain, fever, jaundice, and steatorrhea, regional (splenic) portal hypertension may be observed. ERCP has been useful in diagnosis, and the major changes found in the pancreatic duct are discussed. Since the symptoms and signs of chronic pancreatitis in China are usually mild or moderate, the patient with intractable pain is uncommon, most being treated with medication. Most surgical procedures utilized to treat chronic pancreatitis are related to the biliary system, such as cholecystectomy with internal or external drainage of the choledochus. Internal drainage of a pancreatic pseudocyst, partial pancreatectomy, and pancreaticojejunostomy are also performed, as indicated, but are less frequent.