Filter by keywords:



Filtering documents. Please wait...

1/15. Postoperative acute pulmonary thromboembolism in patients with acute necrotizing pancreatitis with special reference to apheresis therapy.

    Eight patients with pancreatic abscesses secondary to acute necrotizing pancreatitis underwent drainage of their abscesses under laparotomy. Two of them died of acute pulmonary thromboembolism (PTE) within 1 week. autopsy revealed a large thrombus at the main trunk of the pulmonary artery and in the left common iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery, increased trypsin/kinin/kallikrein, increased endotoxin, and decreased antithrombin-III (AT-III) were present following drainage of the pancreatic abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial oxygen gradients obtained by blood gas analysis and mean pulmonary artery pressure estimated by pulsed Doppler echocardiography are very useful. In terms of the treatment, attention should be paid to the following to prevent deep venous thrombosis: prophylactic administration of low molecular weight heparin and administration of AT-III (AT-III > or = 80%), use of the subclavian vein whenever possible as blood access for apheresis therapy, as short a compression time as possible after removing the blood access catheter (< or =6 h), and application of intermittent pneumatic compression devices or elastic compression stockings on the lower extremities.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

2/15. Massive intraperitoneal hemorrhage from a pancreatic pseudocyst.

    Massive bleeding from a pancreatic pseudocyst is a rare condition that poses a diagnostic and therapeutic challenge. A 36-yr-old woman presented with acute pancreatitis due to gallstones. Twenty-two days later, she developed severe abdominal pain and hypotension. CT scan revealed hemorrhage into a pancreatic pseudocyst and a large amount of free blood in the peritoneal cavity. At laparotomy, 8 L of blood was evacuated from the peritoneal cavity and 14 units of blood were transfused. The gastroduodenal artery was found to be the cause of the bleeding and was undersewn. A pancreatic necrosectomy was performed and the cavity was packed. The packs were removed the following day. Postoperatively, pancreatic collections were aspirated under ultrasound guidance on three occasions. She was discharged 50 days after admission and had an open cholecystectomy 1 month later. She remains well 1 yr after surgery.
- - - - - - - - - -
ranking = 0.25
keywords = operative
(Clic here for more details about this article)

3/15. Ischaemic necrotizing pancreatitis after cardiac surgery. A case report and review of the literature.

    Ischaemia is a rare but often lethal aetiology of pancreatitis. A 67-year-old man underwent aortocoronary by-pass. Postoperatively, he developed atrial fibrillation and possibly acute myocardial infarction. Later, he had acute pancreatitis and underwent laparotomy for purulent peritonitis due to a ruptured pancreatic abscess. Cholesterolosis was found but no gallstones. The postoperative period was heavily complicated and the patient eventually died due to multiorgan failure. The occurrence of ischaemic pancreatitis should be more readily suspected in patients with abdominal symptoms following surgery that induces ischaemia of the pancreas. It is possible that delay in diagnosis accounts for the high death rate of such postoperative complication.
- - - - - - - - - -
ranking = 0.75
keywords = operative
(Clic here for more details about this article)

4/15. The first histological demonstration of pancreatic oxidative stress in human acute pancreatitis.

    Necrotizing acute pancreatitis is associated with an inflammatory explosion involving numerous pro-inflammatory mediator cascades and oxidative stress. Acinar oxygen free radical production aggravates pancreatic tissue damage, and promotes cellular adhesion molecule upregulation resulting in leukocyte adherence and activation. The cerium capture oxygen free radical histochemistry combined with reflectance confocal laser scanning microscopy allows the "in situ" histological demonstration of oxygen free radical formation in live tissues. Here we present a case report, where oxidative stress is demonstrated on a histological level for the first time in human acute pancreatitis. A 44-year-old male patient suffering from acute exacerbation of his chronic pancreatitis developed a pancreato-pleural fistula with amylase-rich left pleural exudate causing respiratory compromise. Subsequent to an urgent thoracic decompression a distal pancreatectomy and splenectomy was performed with the closure of abdomino-thoracic fistula. The postoperative course was uneventful, except for a transient pancreatico-cutaneous fistula, which healed after conservative treatment. To carry out cerium capture oxygen free radical histochemistry the resected pancreas specimen was readily perfused with cerium-chloride solution through the arteries on the resection surface. frozen sections were cut, E-, p-selectin, ICAM and VCAM were labeled by immunofluorescence. The tumor-free margin of an identically treated pancreas carcinoma specimen served as a control. Intrapancreatic oxidative stress and cellular adhesion molecule expression were detected by confocal laser scanning microscopy. Numerous pancreatic acini and neighboring capillaries showed oxygen free radical-derived cerium-perhy-droxide depositions corresponding to strong local oxidative stress. Acinar cytoplasmic reflectance signals suggested xanthine-oxidase as a source of oxygen free radicals. These areas presented considerably increased endothelial p-selectin expression with adherent, oxygen free radical-producing polymorphonuclear leukocytes displaying pericellular cerium-reflectance. Modest ICAM upregulation was noted, e-selectin and VCAM expression was negligible. The control pancreas specimen showed minimal oxidative stress with weak, focal p-selectin expression. The development of deleterious pancreatic oxidative stress was based on indirect evidence in human acute pancreatitis. To the best of our knowledge this is the first report demonstrating persistent intrapancreatic oxidative stress histologically in human acute pancreatitis. We have noted p-selectin overexpression with a preponderance in the areas of acinar oxidative stress.
- - - - - - - - - -
ranking = 0.25
keywords = operative
(Clic here for more details about this article)

5/15. Necrotizing pancreatitis during pregnancy: a rare cause and review of the literature.

    Acute pancreatitis is an uncommon cause of abdominal pain during pregnancy, and rarely progresses to the necrotizing from of the disease in this clinical setting. Hyperlipidemia is an infrequent cause of acute pancreatitis. Whereas only 100 cases of hyperlipidemia-induced necrotizing pancreatitis have been reported in the literature to date, all of the cases were mild in severity and responsive to conservative medical management. Herein we present a case of life-threatening necrotizing pancreatitis, which developed in a hyperlipidemic pregnant woman and required multiple peripartum pancreatic necrosectomies. Additionally, we review the evaluation of pregnant patients with abdominal pain, the pathophysiology of hyperlipidemia-induced necrotizing pancreatitis, and the operative care of this challenging group of patients, revisiting an innovative technique for management of the retroperitoneum.
- - - - - - - - - -
ranking = 0.25
keywords = operative
(Clic here for more details about this article)

6/15. 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 = 0.5
keywords = operative
(Clic here for more details about this article)

7/15. Necrosectomy followed by closed cavity lavage for necrotising pancreatitis--report of three cases.

    Necrotizing pancreatitis is a life threatening condition involving pancreas, peripancreatic and retroperitoneal tissues. It's serious regional and systemic involvement causes multiple organ or system failure. Planned and carefully performed necresectomy followed by closed cavity lavage can significantly reduce the mortality and morbidity of this catastrophic condition. Meticulous preoperative resuscitation, preparation and operative necrosectomy followed by continuos irrigation in the postoperative period were done in three consecutive patients. The operative procedure including postoperative management and follow up is reported and analyzed.
- - - - - - - - - -
ranking = 1.25
keywords = operative
(Clic here for more details about this article)

8/15. 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 = 0.25
keywords = operative
(Clic here for more details about this article)

9/15. Necrotizing pancreatitis after radiofrequency destruction of pancreatic tumours.

    BACKGROUND: Intraoperative radiofrequency (RF) can be used to treat multiple small pancreatic tumours. patients AND methods: Two patients with multiple pancreatic metastases from renal cancer were treated with RF destruction of the pancreatic tumours. The first was treated with a monopolar device and the second with a bipolar device. A high temperature (>90 degrees C) was used, and one patient underwent cooling of the intrapancreatic common bile duct. RESULTS: The destruction of tumours was effective. However, the two patients presented post-operatively a severe necrotizing pancreatitis, with life-threatening hemorrhagic complications. CONCLUSION: RF destruction of pancreatic tumours is dangerous with current devices.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

10/15. Percutaneous video-assisted necrosectomy for infected pancreatic necrosis.

    AIMS OF THE STUDY: Percutaneous drainage of infected pancreatic necrosis is not always efficient and morbidity is high with open necrosectomy techniques. Minimally-invasive procedures have been developed to reduce this morbidity. We report our early experience with percutaneous video-assisted necrosectomy. methods: Among 61 patients with acute pancreatitis treated between January 2001 and February 2003, seven developed infected pancreatic necrosis. Six of these seven patients underwent percutaneous video-assisted necrosectomy after failure of radio-guided percutaneous drainage. RESULTS: One to four sessions of percutaneous video-assisted necrosectomy were required. There was no death. sepsis control was achieved in all patients. One patient developed postoperative peritonitis due to intraoperative contamination of the peritoneal cavity. Eighteen months after the last necrosectomy, one patient developed a pseudocyst which was successfully cured by percutaneous drainage. One patient developed diabetes mellitus. CONCLUSION: Early experience in six patients has shown that percutaneous video-assisted necrosectomy is feasible, safe and efficient, in accordance with reports in the literature. Further evaluation is necessary.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Pancreatitis, Acute Necrotizing'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.