1/27. Acute pancreatitis as a complication of polyarteritis nodosa.CONCLUSIONS: polyarteritis nodosa (PAN) must be considered as one of the rare causes of "idiopathic" acute necrotizing pancreatitis. BACKGROUND: PAN is characterized by panmural inflammation of arterioles causing arteriolar ectasia, aneurysm formation, and thrombosis, resulting in organ ischemia. methods: We report a case of necrotizing pancreatitis associated with segmental necrosis of the liver and spleen due to polyarteritis nodosa. RESULTS: Five previously reported cases of documented acute pancreatitis secondary to PAN have been identified from the English literature. The mechanism through which pancreatic ischemia results in acute pancreatitis is unknown. Although limited pancreatic infarction is common in PAN, necrotizing pancreatitis is rare, and the poor overall prognosis of PAN is owing largely to other organ complications.- - - - - - - - - - ranking = 1keywords = necrosis (Clic here for more details about this article) |
2/27. stenotrophomonas (xanthomonas) maltophilia infection in necrotizing pancreatitis.CONCLUSION: Although the therapy of infected pancreatic collections or organized pancreatic necrosis remains surgical, we have demonstrated that infected organized pancreatic necrosis can be treated endoscopically. BACKGROUND: stenotrophomonas (xanthomonas) maltophilia has been increasingly recognized as a nosocomial pathogen associated with meningitis, pneumonia, conjunctivitis, soft tissue infections, endocarditis, and urinary tract infections. This organism is consistently resistant to imipenem, a drug commonly employed in patients with necrotizing pancreatitis to prevent local and systemic infections. methods AND RESULTS: We report the first case of infected pancreatic necrosis by S. (X.) maltophilia. Our patient was treated successfully with endoscopic drainage of the pancreatic fluid collection and appropriate antibiogram-based antibiotic therapy. Endoscopic drainage has emerged as one of the treatment modalities for pancreatic fluid collections.- - - - - - - - - - ranking = 3keywords = necrosis (Clic here for more details about this article) |
3/27. Experience with duodenal necrosis. A rare complication of acute necrotizing pancreatitis.Duodenal necrosis is a rare, but very serious complication of acute necrotizing pancreatitis that most likely is the result of vascular compromise and ischemia of the peri-Vaterian aspect of the duodenal wall. In this article, we present three patients with duodenal necrosis complicating acute necrotizing pancreatitis. The diagnosis was made at the time of necrosectomy. Management options of this challenging complication of necrotizing pancreatitis are discussed.- - - - - - - - - - ranking = 6keywords = necrosis (Clic here for more details about this article) |
4/27. Case report: inappropriate use of percutaneous drainage in the management of pancreatic necrosis.We describe three cases of severe necrotizing pancreatitis, with apache II scores of 11, 17 and 22, respectively. There was no significant pancreatic parenchymal perfusion in any of the three patients on contrast-enhanced computed tomography. All three patients were primarily treated with percutaneous drains and all three subsequently required open laparotomies. We do not recommend percutaneous drainage as a definitive therapy for severe necrotizing pancreatitis.- - - - - - - - - - ranking = 4keywords = necrosis (Clic here for more details about this article) |
5/27. Laparoscopic pancreatic necrosectomy.We describe a patient with infected pancreatic necrosis who was treated successfully with minimally invasive surgery. Five weeks after an episode of acute uncomplicated pancreatitis, he was found to have infected pancreatic necrosis and splenic vein thrombosis. The patient underwent a laparoscopic pancreatic necrosectomy, splenectomy, and cholecystectomy. Seven days after surgery, the patient was discharged and continued to be asymptomatic for the 6 months of follow-up.- - - - - - - - - - ranking = 2keywords = necrosis (Clic here for more details about this article) |
6/27. Peripancreatic fat necrosis mimicking pancreatic cancer.A case of peripancreatic fat necrosis, after an episode of acute pancreatitis, which mimicked pancreatic cancer with lymph node metastases, is presented. We describe the imaging findings with helical CT scanning and with unenhanced and mangafodipir-enhanced MR imaging, with special emphasis on the differential diagnoses.- - - - - - - - - - ranking = 5keywords = necrosis (Clic here for more details about this article) |
7/27. Acute pancreatitis complicated by spontaneous unilateral adrenal hemorrhage.A 52-year-old lady with a history of hypertension, dilated cardiomyopathy and diabetes mellitus type 2, presented with severe upper abdominal pain and vomiting of 4 hours duration. Acute pancreatitis was diagnosed based on high serum amylase and an abdominal computerized tomography scan. On the 3rd day she developed fever, increasing abdominal pain and shortness of breath. A repeated computerized tomography scan showed severe pancreatic necrosis and right adrenal hemorrhage.- - - - - - - - - - ranking = 1keywords = necrosis (Clic here for more details about this article) |
8/27. Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis.BACKGROUND: Secondary infection of pancreatic necrosis is an indication for surgical debridement, and has traditionally been treated by laparotomy, and more recently by laparoscopic transmesocolic or transgastrocolic and retroperitoneoscopic approaches. This report describes and evaluates the safety and feasibility of a laparoscopic transgastric approach to extensive necrosectomy for infected pancreatic necrosis. METHOD: A 66-year-old man developed severe acute pancreatitis with more than 50% necrosis of the body and some necrosis of the tail of the gland. Clinical deterioration with respiratory and renal impairment at 2 weeks prompted a computed tomogram (CT) guided fine-needle aspiration of the necrosis, which proved to be infected with Gram-negative bacilli. A favorable response to supportive therapy and systemic antibiotics enabled a cautious deferment of surgery to week 6 of the illness while the necrosis and its inflammatory wall matured. A laparoscopic transgastric pancreatic necrosectomy with drainage of an associated abscess was performed. RESULT: Intraoperative blood loss was minimal, and operative time was 270 min. The debrided pancreas (30 g) was infected with anaerobes. The patient made an uneventful recovery and was discharged on postoperative day 14. At this writing, he remains well after 2 months of follow-up evaluation. CONCLUSION: Laparoscopic transgastric pancreatic necrosectomy appears to be a safe and effective minimally invasive approach for the debridement and internal drainage of infected pancreatic necrosis in the selected patient. Further experience with this technique is needed to define the selection criteria and its limitations, advantages, and disadvantages.- - - - - - - - - - ranking = 11keywords = necrosis (Clic here for more details about this article) |
9/27. Conservative management of infected necrosis complicating severe acute pancreatitis.OBJECTIVES: patients with severe necrotizing pancreatitis are at risk for infection, a major cause of morbidity and mortality. Most patients with infected pancreatic tissue require surgical intervention (necrosectomy), which is associated with high morbidity and mortality. A subset of these patients can be managed successfully with conservative management combined with prolonged courses of antibiotics. methods: Three cases of severe acute pancreatitis seen at our institution are described, in which the patients developed aspirate-proven pancreatic infections. The patients were nonetheless stable from a clinical standpoint and were treated with long courses of antibiotics known to penetrate the pancreas; emergent surgery was deferred. RESULTS: In two patients, surgery was completely avoided, with good clinical outcome. In the third patient, elective surgery was undertaken 12 wk after the episode of acute pancreatitis, to perform necrosectomy on organized pancreatic necrosis and to evaluate the patient's biliary tree. There were no postoperative complications. CONCLUSIONS: A subset of patients with severe acute pancreatitis complicated by infection can be successfully managed with long term antibiotics and other supportive measures. High risk necrosectomy can, in some instances, be delayed or avoided entirely.- - - - - - - - - - ranking = 5keywords = necrosis (Clic here for more details about this article) |
10/27. Pancreatic necrosis associated with preeclampsia-eclampsia.CONTEXT: Acute pancreatitis during pregnancy is rare and commonly occurs in association with biliary disease. Preeclampsia is associated with microvascular abnormalities that may involve cerebral, placental, hepatic, renal and splanchnic circulation and rarely can cause acute pancreatitis. CASE REPORT: A case of acute pancreatitis in a patient with preeclampsia-eclampsia where the diagnosis was missed initially that resulted in a protracted course and development of organized pancreatic necrosis. The pancreatic necrosis resolved with conservative management over 8 weeks. CONCLUSIONS: The development of severe hypoalbuminemia, out of proportion to proteinuria, hypocalcemia and findings of capillary leak should alert the physician to search for other inflammatory causes, including acute pancreatitis so that early and effective management be given to avoid complications.- - - - - - - - - - ranking = 6keywords = necrosis (Clic here for more details about this article) |
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