scholarly journals Acute necrotising pancreatitis – early management in the district general hospital and tertiary hepato-pancreatico-biliary unit

2018 ◽  
Vol 20 (3) ◽  
pp. 263-267
Author(s):  
Rajiv P Lahiri ◽  
Nariman D Karanjia
Keyword(s):  
Acute Pancreatitis ◽  
Nutritional Support ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Early Management ◽  
Surgical Emergency ◽  
High Dependency ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Acute pancreatitis is a common general surgical emergency presentation. Up to 20% of cases are severe and can involve necrosis with high associated morbidity and mortality. It is most commonly due to gallstones and excess alcohol consumption. All patients with acute pancreatitis need to be scored for severity and patients with severe acute pancreatitis should be managed on the high dependency unit. The mainstay of early treatment is supportive, with care to ensure strict fluid balance and optimisation of end organ perfusion. There is no role for early antibiotic use in acute necrotising pancreatitis and antibiotics should only be used in the presence of positive cultures. Nutritional support is vitally important in improving outcomes in necrotising pancreatitis. This should ideally be provided enterally using an naso-jejunal tube if the patient cannot tolerate oral intake. Patients with significant early necrosis, persisting organ dysfunction, infected walled off necrosis requiring intervention or haemorrhagic pancreatitis should be referred to a regional hepato-pancreatico-biliary unit for advice or transfer. Percutaneous and endoscopic necrosectomy has replaced open surgery due to improved outcomes. Acute necrotising pancreatitis remains a complex surgical emergency with high morbidity and mortality that requires a multidisciplinary approach to attain optimum outcomes. The mainstay of treatment is supportive care and nutritional support. Patients with significant pancreatic necrosis or infected collections requiring drainage require input from a tertiary HPB unit to guide management.

scholarly journals A rare case of acute necrotising pancreatitis in a paediatric patient

2020 ◽  
Vol 3 (1) ◽  
pp. 061-063
Author(s):  
Jansen Lizeri ◽  
Colleran Gabrielle ◽  
Okafor Ikechukwu ◽  
Quinn Nuala
Keyword(s):  
Acute Pancreatitis ◽  
Paediatric Patient ◽  
Rare Event ◽  
Paediatric Hospital ◽  
Abdominal Symptoms ◽  
Distended Abdomen ◽  
Important Differential Diagnosis ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED). We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital. This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent. Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.

scholarly journals Emblica Officinalis: A Novel Therapy for Acute Pancreatitis — An Experimental Study

HPB Surgery ◽  
1995 ◽  
Vol 9 (1) ◽  
pp. 25-30 ◽  
Author(s):  
S. P. Thorat ◽  
N. N. Rege ◽  
A. S. Naik ◽  
U. M. Thatte ◽  
A. Joshi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Cell Damage ◽  
Smooth Endoplasmic Reticulum ◽  
Emblica Officinalis ◽  
Novel Therapy ◽  
Traditional System ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Acute necrotising pancreatitis is associated with an unacceptably high mortality for which no satisfactory remedy exists. Emblica officinalis (E.o.) is a plant prescribed in Ayurveda, the Indian traditional system of medicine, for pancreas-related disorders. This study was carried out to evaluate the protective effect of E.o. against acute necrotising pancreatitis in dogs. Pancreatitis was induced by injecting a mixture of trypsin, bile and blood into the duodenal opening of the pancreatic duct. Twenty eight dogs were divided into 4 groups (n = 6-8 each): GpI–control, GpII–acute pancreatitis, GpIII–sham-operated, GpIV–pretreatment with 28 mg E.o./kg/day for 15 days before inducing pancreatitis. Serum amylase increased from 541.99 ± 129.13 IU/ml to 1592.63 ± 327.83 IU (p<0.02) 2 hrs after the induction of pancreatitis in GpII. The rise in serum amylase in both GpIII and GpIV was not significant. On light microscopic examination, acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group as compared to GpII. Electron microscopy confirmed this and showed an increased amount of smooth, endoplasmic reticulum and small, condensed granules embedded in a vacuole. More studies are needed to explore the clinical potential of E.o. and its mechanism of action.

scholarly journals Acute Complicated Necrotising Pancreatitis Treated with Video-Assisted Retroperitoneal Debridement

2021 ◽  
Vol 75 (2) ◽  
pp. 136-141
Author(s):  
Sergejs Šapovalovs ◽  
Viktors Ļiņovs ◽  
Andris Gardovskis ◽  
Sintija Lapsa ◽  
Māris Pavārs ◽  
...  
Keyword(s):  
Complex Disease ◽  
Mortality Rates ◽  
High Morbidity ◽  
Ultrasound Guided ◽  
Infected Necrosis ◽  
Video Assisted ◽  
Surgical Methods ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Abstract Acute necrotising pancreatitis is a complex disease with high morbidity and mortality rates. In cases of infected necrosis, treatment consists of a step-up approach involving endoscopic or mini-invasive surgical methods. In some cases, there are extremely rare complications. In addition, the underlying comorbidities worsen the course of the disease. We report a case of a 32-year-old male with acute necrotising pancreatitis complicated with recurrent retroperitoneal abscesses, sepsis, iatrogenic pylephlebitis, exacerbation of underlying Crohn’s disease, and the outcome of the treatment was successful. During the period of hospitalisation, one ultrasound-guided percutaneous drainage, two computed tomography-guided punctures of the retroperito-neal space (percutaneous and transhepatic) and five video-assisted retroperitoneal debridement procedures were carried out. The patient was discharged after 185 days of hospitalisation.

scholarly journals The presence of acute cholangitis defined by 2013 Tokyo Guidelines (TG13) in acute necrotising pancreatitis is associated with poor outcomes

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S815
Author(s):  
E. Pando Rau ◽  
P. Alberti Delgado ◽  
L. Blanco Cuso ◽  
M. Caralt Barba ◽  
C. Dopazo Taboada ◽  
...  
Keyword(s):  
Acute Cholangitis ◽  
Tokyo Guidelines ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Poor Outcomes ◽  
Acute Necrotising

scholarly journals Spontaneous fistulisation of infected walled-off necrosis (WON) into the duodenum in a patient following acute necrotising pancreatitis

2014 ◽  
Vol 2014 (jan10 1) ◽  
pp. bcr2013202863-bcr2013202863 ◽  
Author(s):  
V. Boopathy ◽  
P. Balasubramanian ◽  
T. Alexander ◽  
R. Koshy
Keyword(s):  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Walled Off Necrosis ◽  
Acute Necrotising
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