Aim: to present a rare clinical case of multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia, chronic pancreatitis in a 27-year-old woman, clinically manifested like a palpable mass in the right iliac region.Main results. In the first part of the article, a detailed analysis of the medical history is given, the results of archival imaging studies and the data of laboratory and instrumental examination at the time of treatment are presented. The literature review presents modern definitions of splenosis, as well as brief information about the anatomy and physiology of the spleen.Conclusion. The diagnostic process requires a detailed analysis of the history of the disease, the performance of laboratory studies in combination with modern imaging studies, as well as a thorough study of the literature data.
The lack of efficiency in the diagnosis and treatment of chronic pancreatitis (CP) is associated with a number of objective and subjective reasons, one of which is insufficient knowledge about the pathogenesis of the disease, especially when it is combined with other internal diseases, in particular, with chronic obstructive pulmonary disease (COPD). The frequent combination of COPD and CP is associated not only with the frequency of these diseases, but also with the common links of pathogenesis, and a significant place in the pathogenesis of both diseases is occupied by the syndrome of excessive bacterial growth in the small intestine (SIBO). Aim: to increase the effectiveness of the treatment of CP in combination with COPD based on the inclusion of rifaximin and probiotic Subalin in the complex therapy of concomitant diseases. Materials and methods. We examined 128 patients with CP in the stage of exacerbation in combination with COPD in the stage of mild exacerbation, which were divided into two groups: the main group and the comparison group. The basic treatment of CP was carried out according to the clinical recommendations of the Russian Gastroenterological Association. Patients of the main group, in addition to basic therapy, received rifaximin (Alfa Normix) for 10 days, and then Subalin-forte for 2 weeks. Patients in the comparison group received only basic therapy. Results. Due to the treatment with the inclusion of rifaximin and Subalin, there is a significant suppression of the phenomenon of “evasion” of the pancreatic-specific enzyme into the blood, an improvement in the exocrine function of the pancreas according to the results of the fecal elastase test and the response of the pancreas to food intake according to the dynamics of uroamylase flow rates and endogenous pancreozymin induction coefficients. Under the influence of the main treatment option, there is an increase in the frequency of normalization of the echogenicity of the pancreas and less often than with traditional therapy, an increase in the pancreas or part of it, blurring and unevenness of the contours persist. In addition, the indicators of ultrasonic histography of the pancreas are significantly improved, and a more pronounced positive dynamics of the clinical manifestations of COPD is observed. Thus, the eradication of SIBO provides a significant increase in the effectiveness of the treatment of patients with a combination of CP and COPD.
This review analyzes the terminology of pancreatic steatosis, the data about the prevalence of non-alcoholic fatty pancreas disease (NAFPD) were given.
The etiological factors of NAFPD are usually subdivided into hereditary, metabolic, and toxic ones. The main etiopathogenetic factor of pancreatic fatty infiltration is obesity: it causes pancreatic infiltration by adipocytes, leading to the development of NAFPD. The pathogenesis of the disease is associated with adipocytic tissue dysfunction, which induces local and systemic inflammatory response with corresponding clinical consequences. Insulin resistance and oxidative stress play major role in the pathogenesis of NAFPD. From a histological point of view, NAFPD is a heterogeneous process, characterized by excessive intracellular accumulation of lipids and fatty infiltration followed by fatty replacement of the pancreas.
NAFPD clinical picture is asymptomatic and nonspecific. Diagnosis of NAFPD is based primarily on the results of imaging methods (ultrasound, CT, MRI). A consequence of NAFPD is exocrine pancreatic insufficiency requiring enzyme replacement therapy. One of the NAFPD complications is the development of pancreatic adenocarcinoma.
Currently, standards for the diagnosis, treatment and management of patients with NAFPD have not been developed yet, but on used the guidelines for the treatment of non-alcoholic fatty liver disease (rational diet, exercises, weight loss). The “gold standard” of enzyme replacement therapy, such as Creon®, is used for correction of exocrine pancreatic insufficiency. The detailed analysis of the clinical case of total pancreatic steatosis with severe exocrine pancreatic insufficiency was done in this article.
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