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At least 19 recordsLinked to original sources
PubMed1997

Nonoperative therapy for acute necrotizing pancreatitis.

Acute necrotizing pancreatitis is a highly morbid and lethal condition. We performed a retrospective study of all patients admitted to Louisiana State University Medical Center between 1980 and 1995 with a diagnosis of pancreatitis (N = 617) and specifically examined those (N = 26) who developed acute necrotizing pancreatitis. During the period 1980 to 1989, there were 7 patients who progressed to acute necrotizing pancreatitis. Six of these seven patients died (mortality, 86%). These patients were managed with multiple operations for debridement and necrosectomy. The age ranged from 31 to 86 years in this group, with a mean of 58.5. The patients' total hospital days ranged from 2 to 125 days with a mean of 63.5 days. In 1989, we adopted an initial nonoperative approach to necrotizing pancreatitis and began using CT-guided catheter drainage for this condition. During this time period, 19 patients have progressed to necrotizing pancreatitis. The range of hospital days was from 13 to 90 days, with a mean of 43.8 days. There were 2 deaths in this last group, resulting in a mortality rate of 10.5 per cent. All of these patients were treated nonoperatively in the acute phase of their illness. Two patients (15.8%) subsequently underwent laparotomy and drainage when the collections were not amenable to CT-guided drainage. Morbidity in this population approached 70 per cent; however, the mortality was only 10 per cent compared to 86 per cent in the previous group. Although nonoperative therapy has its associated morbidity, and although we understand the controversy surrounding the management of this condition, it appears at least in this population to have much less mortality than those who were treated operatively in the acute phase.

Adolescent↗
PubMed1981

Biochemical and coagulation changes in a canine model of acute necrotizing pancreatitis.

Acute necrotizing (hemorrhagic) pancreatitis was induced in 12 dogs by infusing oleic acid into their pancreatic ducts. There were decreases in blood pH, complement, antithrombin III, blood platelets, 24- and 48-hour plasminogen, and 24-hour haptoglobin and modest decreases in serum albumin. There were increases in fibrinogen, 48- to 120-hour haptoglobin, and 96-hour and 120-hour plasminogen and prolongations of prothrombin and activated partial thromboplastin times. The latter 2 changes together with decreases in antithrombin III, platelet numbers, and complement were indicative of consumption coagulopathy. A clinically innocuous but statistically significant decrease in serum total and ionized calcium despite significant acidosis was noted. This indicates that serum total and ionized calcium is helpful in making the diagnosis of acute necrotizing pancreatitis. Methemalbuminemia of 6 mg/dl at 24 hours and 7 mg/dl at 48 hours indicates that methemalbuminemia is a valuable diagnostic and prognostic finding in association with acute necrotizing pancreatitis.

Acute Disease↗
PubMed1985

[Morphologic and functional changes in the pancreas following acute necrotizing pancreatitis].

Acute necrotizing pancreatitis according to the presented results leads to definite endo- and/or exocrine functional loss in 57% of the patients (n = 21, pancreatic necrosis ascertained by laparotomy) evaluated by orale glucose tolerance test, secretin-ceruletide-test and fluorescein-dilaurate-test. Morphological alterations developed in 76% of patients, predominantly cicatricial ductal lesions shown by ERCP. The finding of a normal pancreatic function after extended necrosis in 43% of the patients can be explained by the enormous functional reserve of the pancreatic gland.

Acute Disease↗
PubMed1994

Genetic determinants of mortality in acute necrotizing pancreatitis.

Acute necrotizing pancreatitis (ANP), which often progresses to infection, sepsis, and multisystem organ failure, runs a course remarkably similar to that seen frequently after severe burns, massive physical trauma, or major surgery. There is extensive evidence that the development of the sepsis response is mediated by immunocytes, particularly activated polymorphonuclear leukocytes (PMNLs) and their secretions (reactive oxygen species, lysosomal hydrolases, cytokines, and so on). Some years ago it was suggested that the high mortality of ANP may be related to an overaggressive immunological defense system of the host rather than to autodigestion of the gland. Recent investigations of the immunoregulatory responses following surgery or other trauma have not only furnished additional support for this concept, but also revealed some genetic factors that may critically influence the outcome of posttraumatic illness including ANP. The prognostic significance of abnormal, early polymorphonuclear leukocyte (PMNL) activation in the development of sepsis, high neutrophil expression of certain receptor molecules, low monocyte and lymphocyte expression of major histocompatibility antigen MHC-class II, and the influence of the genetically encoded TNF and IL-1 secretion on the course of the illness are discussed and related to ANP. Evidence is presented for the potential usefulness of some of these parameters in the prognosis and future treatment of ANP.

Acute Disease↗
PubMed2001

[Acute necrotizing pancreatitis].

Acute pancreatitis ranges from mild to severe necrotizing form complicated by multiorgan failure with high mortality rate. It has different causes, not entirely clear pathogenesis and unpredictable and variable course. Therapeutic measures are limited. The mainstay of therapy is supportive intensive care, prevention of sepsis and multiple organ failure and identification and treatment of infected pancreatic necrosis. Surgical approach is justified in verified infected necrosis. In case of sterile pancreatic necrosis complicated by organ failures is the role of surgical intervention debatable.

Aged↗
PubMed2002

Altered intestinal morphology and immunity in patients with acute necrotizing pancreatitis.

PURPOSE/BACKGROUND: Impairment of gut barrier function has been demonstrated in patients with severe acute pancreatitis and may contribute to the development of local and systemic septic complications. The underlying mechanisms, however, remain unclear. Against this background, our aims were to investigate the small intestinal epithelial morphology and mucosal immunity in patients with severe acute pancreatitis. METHODS: Segments of terminal ileum from three patients with severe necrotizing acute pancreatitis who underwent pancreatic debridement and ileocolic resection for doubtful or evident segmental colonic viability were available for the study. Control specimens were available from seven patients who underwent gastric bypass and distal ileal resection for morbid obesity. Sections were cut and stained with hematoxylin and eosin for the measurement of villous height and crypt depth, and with toluidine blue for the determination of mucosal mast cell counts. Only adequately oriented specimens were deemed suitable for computer-aided image analysis. Results were expressed as the villous height/crypt depth ratio (VH/CD) and mucosal mast cell index (ratio of mast cell count/length of muscularis mucosa). RESULTS: Microscopy of the small intestine from controls was normal. The villous height and VH/CD were significantly reduced in patients with acute pancreatitis compared with controls (median, 0.47 mm vs 0.68 mm, and 1.9 vs 2.8, respectively; P < 0.00001). The mast cell index was significantly reduced in patients with acute pancreatitis compared with controls (median, 5.88 cells/mm vs 8.58 cells/mm; P= 0.001). A positive correlation was observed between the mast cell index and the height of the villi ( r= 0.23; P= 0.027). CONCLUSIONS: Patients with necrotizing acute pancreatitis have an altered intestinal morphology and depleted mucosal mast cells. These factors may contribute to the impairment of gut barrier function in patients with severe acute pancreatitis.

Aged↗
PubMed2006

Ligustrazine alleviates acute lung injury in a rat model of acute necrotizing pancreatitis.

BACKGROUND: Acute necrotizing pancreatitis leads to a systemic inflammatory response characterized by widespread leukocyte activation and, as a consequence, distant lung injury. The aim of this study was to evaluate the effect of ligustrazine, extracted from Ligusticum wallichii a traditional Chinese medicine, on lung injury in a rat model of acute necrotizing pancreatitis (ANP). METHODS: A total of 192 rats were randomly divided into three groups: control (C group); ANP without treatment (P group); and ANP treated with ligustrazine (T group). Each group was further divided into 0.5, 2, 6 and 12 hours subgroups. All rats were anesthetized with an intraperitoneal injection of sodium pentobarbital. Sodium taurocholate was infused through the pancreatic membrane to induce ANP. For the T group, sodium taurocholate was infused as above, then 0.6% ligustrazine was administered via the femoral vein. The effects of ligustrazine on the severity of lung injury were assessed by lung wet/dry weight ratio, myeloperoxidase (MPO) activity and histopathological changes. Pulmonary blood flow was determined by the radioactive microsphere technique (RMT). RESULTS: The blood flow in the P group was significantly lower than that of the C group, while the blood flow in the T group was significantly higher than that of the P group but showed no significant difference from the C group. Compared with C group, the lung wet/dry ratios in both the P and T groups were significantly increased, but there was no significant difference between them. The MPO activity in the P group was greatly increased over that of the C group. In the T group, although the MPO activity was also higher than in the C group, it much less increased than in the P group. Moreover, the difference between P and T groups was significant after 0.5 to 12 hours. After induction of the ANP model, the pancreas showed mild edema and congestion; the longer the time, the more severe this became. The pulmonary pathological changes were aggravated significantly in the P group. Histopathological scores were higher in the P group than in the C group throughout the experimental course. Histopathological scores in the T group were lower than those in the P group at 6 and 12 hours. CONCLUSIONS: Microcirculatory disorder is an important factor of lung injury in ANP. Ligustrazine can ameliorate microcirculatory disorder and alleviate the damage to the lung.

Animals↗
PubMed1990

Pancreatogastrostomy in experimental acute necrotizing pancreatitis.

Experimental acute necrotizing pancreatitis was induced retrogradely in dogs with sunflower oil injected intraductally. Then, a zipper was sutured into the abdominal wound. From the first postoperative day, three different treatments were started: first group: only conservative therapy was used; second group: removal of necrotized tissue and single peritoneal lavage were applied; and third group: the necrotic part of the pancreas was marsupialized into the stomach. Through the systematic opening of the zipper, the abdominal cavity could easily be explored and the temporal course of disease could be observed in all animals. During this regular procedure, the amylase concentration and the amount of peritoneal exudate were determined. The blood amylase and glucose levels were also measured. On the first postoperative day, the amylase level and the amount of peritoneal exudate were high in all groups. The dogs of the pancreatogastrostomized group showed a dramatic decrease of the exudate and the most advantageous temporal course of the blood amylase level. The survival rate similarly was advantageous in the pancreatogastrostomized group.

Acute Disease↗
PubMed1985

[Perioperative interdisciplinary management of acute necrotizing pancreatitis].

Severely acute necrotizing pancreatitis (degrees II and III) requires good teamwork between surgery and intensive care from the very beginning. Treatment was successful in 10 of 12 of our cases (83.4%); laparotomy and subsequent endoscopic necrosectomy were performed using a mediastinoscope, supplemented by optimal perioperative intensive therapy (long-term respiration with PEEP, infusion therapy, calcitonin, antibiotics, etc.). Before 1981, lethality amounted to 70%. No relaparotomies were necessary and organ failures (kidney and lung) were avoided.

Acute Disease↗
PubMed1997

[Comparison of the usefulness of ultrasonography and computed tomography in diagnosis of acute necrotizing pancreatitis].

The aim of this paper is to evaluate the sensitivity and specificity of ultrasound and computed tomography imaging in necrotizing acute pancreatitis. Since 01'95 till 12'96 we treated 36 patients with acute pancreatitis. They were diagnosed by US and contrast enhanced CT. 15 patients were intraoperatively classified as necrotizing pancreatitis. US done several times before operations positively predicted only 8 cases as having necrosis (sensitivity 53.3%) and in 7 patients the extension of its spread (specificity 87.5%). Preoperative CT positively predicted 13 cases of necrosis (sensitivity 86.6%) and the extension of its spread was properly stated in 7 patients (sensitivity 46.6%). 4 times preoperative CT was done twice. Contrast enhanced CT is better than US in predicting of the existence of pancreatic necrosis but it is not in evaluation of the extension of necrosis spread.

Contrast Media↗
PubMed1986

Pancreatic debridement in acute necrotizing pancreatitis: an obsolete procedure?

Thirty-eight patients treated by pancreatic debridement for acute necrotizing pancreatitis were studied. Group 1 consisted of 12 critically ill patients who underwent early surgery. Group 2 was formed from 15 patients operated upon secondarily for supervening complications and group 3 contained 11 patients operated upon electively for gallstone pancreatitis. The operative mortality was 100, 27 and 0 per cent for groups 1, 2 and 3 respectively. Pancreatic debridement was associated with a high morbidity whether performed for complications (66 per cent) or elective biliary surgery (36 per cent). These data suggest that there is probably only limited indication for pancreatic debridement in patients with acute necrotizing pancreatitis.

Acute Disease↗
PubMed2006

No debridement is necessary for symptomatic or infected acute necrotizing pancreatitis: delayed, mini-retroperitoneal drainage for acute necrotizing pancreatitis without debridement and irrigation.

We sought to determine if necrosectomy can be omitted for complicated acute necrotizing pancreatitis (ANP). Since 1996, we prospectively performed retroperitoneal drainage by introducing a sump drain to the pancreatic head area via a small left flank incision without debridement and irrigation on 19 consecutive complicated ANP patients. We purposely delayed surgery until liquefaction of retroperitoneal tissue reached the left flank. Our patients had a mean Ranson's and APACHE II score of 5.9 (range, 4-8) and 20.1(range, 4-45), respectively. Sixteen available CT showed retroperitoneal liquefaction after 21.3 days (range, 14-26). Operations were delayed for 4.7 weeks (range, 1.3-9.0). No patient succumbed during this period. The indications were infected necrosis in 16 and severe abdominal pain/food intolerance in 3 patients. Average skin incision was 4.0 cm (range, 3-9). Fungi or bacteria were cultured in 15 patients (80.0%). The recovery courses were surprisingly uneventful. Oral intake began within 2.4 days (range, 1-5) and mean hospital stay (16 survivals) was 23.2 days (range, 4-120) after operation. Drains were completely removed 120.6 days (range, 60-250) later from these outpatients. One gastric perforation and one minor duodenal leak were the only procedure-related complications (10.5%). Three patients died (15.8%), although one had a healed ANP. In conclusion, this delay-until-liquefaction strategy without necrosectomy is an easy and effective treatment method.

Aged, 80 and over↗
PubMed1986

Complications after pancreatic resection for acute necrotizing pancreatitis.

The risks of pancreatic resection for acute necrotizing pancreatitis were evaluated in 37 patients, all with greater than or equal to 3 positive Ranson signs, most with extensive peripancreatic fat necrosis and almost half with extensive parenchymal necrosis. The mortality (43%), though comparable with most other reports, was higher than in the authors' earlier experience. The reason was not clear. Postoperative bleeding from the surgical field was the most common problem, being responsible for half of the deaths. Septicaemia due to abscess or fistulation occurred in eight patients and was fatal in five. Pulmonary and renal complications were common, but caused only three deaths. Time from onset of symptoms to operation did not influence complications or age-matched mortality. With increasing extent of resection, lung complications diminished, but not other complications or mortality. All patients older than 60 died. Resection thus should be avoided for the elderly, and its role in younger cases remains far from clear. The postoperative complications and insignificantly lower death rate than after other treatments have diminished the former enthusiasm for resection in acute necrotizing pancreatitis.

Acute Disease↗
PubMed2000

[CT guided percutaneous fine needle aspiration for early diagnosis of pancreatic infection after acute necrotizing pancreatitis].

OBJECTIVE: To assess CT-guided percutaneous fine needle aspiration (FNA) for early diagnosis of pancreatic infection after acute necrotizing pancreatitis. METHODS: CT-guided percutaneous FNA was employed to diagnose pancreatic infection after acute necrotizing pancreatitis in 14 patients. The aspirates were smeared, cultured and subjected polymerase to chain reaction (PCR) for detecting bacteria. RESULTS: Ten patients were diagnosed as having pancreatic infection and 4 non-pancreatic infection. FNA was totally performed for 15 times: left retroperitoneal route for 12 times, left and right retroperitoneal route for one time, and transperitoneal route for two times. The sensitivity of smear, PCR, culture to diagnose pancreatic infection was 7/10, 9/10, 10/10, respectively. Their specificity was 4/4, and the time for obtaining the results was 30 minutes, 4 hours, 3 days respectively. CONCLUSIONS: Retroperitoneal approach can be used for most patients with acute necrotizing pancreatitis when performing CT guided-percutaneous FNA. PCR of aspirates is a rapid and accurate method to diagnose pancreatic infection.

Adult↗
PubMedDate not supplied

Treatment of patients with severe acute necrotizing pancreatitis based on prospective evaluation.

BACKGROUND/AIMS: To examine the impact of a prospectively applied diagnostic and treatment protocol in patients with severe acute necrotizing pancreatitis. METHODOLOGY: During a 4-year period (1993-1996), 26 patients were treated for necrotizing pancreatitis, as documented by contrast-enhanced computed tomography (CE-CT). All patients were prospectively treated by medical means. Patients with persistent systemic inflammatory response syndrome underwent fine-needle aspiration for bacterial cultures. In case of positive results operative intervention was followed, while in negative results the conservative management was continued. Fine-needle aspiration was repeated every 5-7 days if systemic inflammatory response syndrome persisted or worsened. Sixty-five patients hospitalized during the preceding 11 years (1982-1992), when such a treatment was not constantly applied, served as controls. RESULTS: Infected pancreatic necrosis was demonstrated in 7 of the 26 patients (27%) and was treated by open drainage and/or post-operative lavage with a mortality rate of 14.2%. Thirteen patients in whom fine-needle aspiration was not necessary and 6 with negative cultures after fine-needle aspiration (73%) followed conservative treatment and the mortality rate was 5.2%. The total mortality rate of 7.7% was significantly lower than the mortality rate of 26.2% observed in the control group (p = 0.05). CONCLUSIONS: Recent evolution made in the management of severe necrotizing acute pancreatitis can lead to better results in the context of a strictly applied treatment protocol. Such protocols may improve mortality and serve as controls in future study.

Adult↗
PubMed1986

Effects of antifibrotic substances on pancreatic fibrosis following acute necrotizing pancreatitis.

This study was designed to search for a way to inhibit pancreatic fibrosis following acute pancreatitis. Experimental necrotizing pancreatitis was induced by a freezing procedure in the pancreas of male Wistar rats. After the freezing procedure, the rats were divided into 3 groups: nothing addition was done to the control group, while the other 2 groups received daily intraperitoneal administration of antifibrotic substances (colchicine or L-azetidine-2-carboxylic acid (AZC)) for 6 weeks. Pancreatic enzymes in the serum were not markedly influenced by administration of antifibrotic substances, and there were no differences in the ratios of dry to wet weights of the pancreas between groups with and without these drugs. After freezing, the hydroxyproline levels in the pancreas of the control group increased from 1 to 4 weeks and then decreased during the 5th and 6th weeks. All groups receiving colchicine or AZC exhibited a significant decrease in the hydroxyproline levels at 2 to 4 weeks compared with the control group (P less than 0.01). Histological examination also showed the inhibition of pancreatic fibrosis, agreeing with changes in the hydroxyproline levels in groups receiving colchicine or AZC. These results suggest that administration of antifibrotic substances, colchicine and AZC, have the possibility of inhibiting pancreatic fibrosis following acute pancreatitis.

Animals↗
PubMed1977

Survival of patients with duodenal fistulas from necrotizing pancreatitis.

Acute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X-ray findings of an intra-abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X-rays to locate new intra-abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.

Acute Disease↗
PubMed2001

Laparoscopic necrosectomy for acute necrotizing pancreatitis.

Severe acute pancreatitis (SAP), a disease state that is often complicated by an intricate pathologic process, has remained difficult to manage and is associated with high morbidity and mortality rates. Approximately 80% of patients have a mild form of the disease, while the other 20% develop a severe life-threatening form of the disease. These patients are at great risk for infection, multisystem organ failure, and, possibly, death. Necrotizing or infected pancreatitis requires a multimodal approach and often offers an indication for surgical intervention. The retroperitoneum of the patient with necrotizing pancreatitis should be treated as an abscess cavity, and drainage and debridement of all necrotic tissue should be performed. Over the past several decades, great achievements have been made in the treatment of the patient that presents with acute pancreatitis. However, the morbidity and mortality have remained high, according to recent literature. The laparoscopic era brings new alternatives in the surgical management of pancreatic diseases. Advances in laparoscopic technology and instrumentation allow the utilization of minimally invasive techniques, and lessen the stress of surgery in the already compromised pancreatitic patient.

Female↗