Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.
Upgrading of the emergency medical care service is required.
Abstract. Inflammatory bowel diseases (IBD) are chronic intestinal disorders caused by a number of factors, including external influences, intestinal microbiota and genetics. The two major clinically defined types of IBD are Crohn's disease and ulcerative colitis, each of which is characterized by relapses in the clinical course, thus patients must be under constant observation via regular endoscopies. As endoscopy, which has been used for direct evaluation and diagnosis of IBD, requires uncomfortable and expensive bowel preparation, a non-invasive test was required to reduce the number of patients undergoing unnecessary endoscopy. Calprotectin is a protein occurring in the cytosol of inflammatory cells and is released by the activation of leukocytes. As it is elevated and stable in the faeces of patients with IBD and can be reliably detected in faecal samples of <5 g, it may serve as an inexpensive, non-invasive diagnostic method for IBD. This is explored in the following review.
TBI is a major element of trauma. Knowledge of the epidemiologic characteristics of the disease is imperative for adequate planning and future quality assessment.
Background: Pancreatic fistula following pancreaticoduodenectomy is a serious complication associated with high morbidity rates.We present a modification for duct-tomucosa, end-to-side pancreaticojejunostomy with a seromuscular jejunal flap,in order to increase the safety of the anastomosis. Methods: The technique we describe is an end-to side, duct-to-mucosa,two layer pancreaticojejunostomy with a seromuscular jejunal flap and insertion of a silicon stent. We performed this modified anastomosis in sixty-three patients who underwent a pancreaticoduodenectomy procedure from July 2009 to November 2016. The procedure was classic pancreaticoduodenectomy except six cases with pyloric preservation. Results: There were 63 patients with periampullary tumor that underwent pancreaticoduodenectomy with the modified pancreaticojejunostomy technique. Thirty-six (57%) of them were males and 27 (43%) females, with a mean age of 67.4 years (range 32-82). The mean operative time was 308.2+37 min and the mean time needed to perform the anastomosis was 24.6 min (range 21-26 min). Five patients (8%) developed pancreatic fistula; four grade A and one grade C who needed reoperation due to bleeding. The overall morbidity was 22%. There was no anastomosisrelated mortality. Conclusion: This modified pancreaticojejunostomy appears to be a safe and reliable technique without adversely affecting operative time. The seromuscular jejunal flap intends to promote healing process especially in cases of soft pancreas and narrow pancreatic duct.
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