Chronic pancreatitis with pancreatic hypertension is extremely rare in childhood. Chronic pancreatitis in this age is usually always associated with a сongenital defect of the pancreatic duct system. The article describes the case of long-term clinical observation and minimally invasive treatment of chronic calculous pancreatitis, first diagnosed in a girl at the age of 16 years. Despite the fact that clinical manifestations were observed from the age of 3 years, the correct diagnosis could be made only at the age of 16, by joint application of ultrasound, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP). The cause of chronic pancreatitis were concrements and strictures of the main and additional pancreatic ducts that caused pancreatic hypertension. Attempt of endoscopic retrograde lithoextraction from the pancreatic ducts was impossible because of the presence of severe stricture. Therefore, it was decided to apply a combined approach using percutaneous access under ultrasound navigation. The patient underwent series of minimally invasive combined procedures including the lithoextraction, balloon dilatation and transcutaneous drainage of the pancreatic ducts with the endoscopic and percutaneous access with ultrasound and radiologic control. For the prevention of restenosis, the antegrade stenting of the main pancreatic duct with self-expanding coated nitinol stent was used with further removal of the stent. Due to the treatment, there was no pancreatitis within 5 years after stent removal.
Bleeding from the uppergastrointestinal tract is one of the most dangerous complications in patients with acute CVA (ischemic and/or hemorrhagic type). The combination of these conditions requires special attention in the diagnosis and choice of treatment methods. Central Nervous System pathology makes diagnosis, choosing methods oftreatment and the use of drug more complicated to surgeons in the postoperative period. With onset of hemorrhage, antithrombotic treatment should be canceled, that can negatively affect the results of treatment of patients with ischemic type of cerebral vascular accident. The use of anti-ulcer drugs, namely proton pump inhibitors, may increase the risk of hospital-acquired pneumonia,Clostridium difficileinfections, and cardiovascular diseases. These factors force us to consider issues related to diagnosis and treatment plans in this group of patients. The most promising direction in the treatment of patients with ischemic or hemorrhagic stroke in combination with gastroduodenal bleeding is the identification of risk factors for upper gastrointestinal bleeding, early endoscopic diagnosis and treatment, performing preventive treatment. The article presents a brief review of domestic and foreign literature, some issues of etiology and pathogenesis of gastroduodenal bleeding in patients with cancer, the results of our own research, capabilities of modern endoscopy in the diagnosis and treatment of gastrointestinal bleeding in this group of patients. The algorithm of management of patients with a combination of bleeding from the upper gastrointestinal tract and CNS pathologies.
The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.
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