Endotherapy for Complications of Pancreatitis: Ready for Prime Time

Baron, Todd H.

doi:10.3121/cmr.2.2.83

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…One possible mechanism is following an acute episode of focal pancreatitis as seen in this patient. Another mechanism is pancreatic duct blowout due to main pancreatic duct obstruction [3,5,14]. Our patient had pancreatic calcifications involving head, neck, and body regions.…”

Section: Discussionmentioning

confidence: 84%

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Kanchana¹,

Dharmapala²,

Dassanayake³

et al. 2021

Case Reports in Surgery

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Introduction. Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day. Conclusion. The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.

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Section: Discussionmentioning

confidence: 84%

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Kanchana¹,

Dharmapala²,

Dassanayake³

et al. 2021

Case Reports in Surgery

View full text Add to dashboard Cite

show abstract

“…A recent large, singlecentre series reported an impressively low mortality of 4% after laparotomy for infected necrotizing pancreatitis [33] . Although it has been stated that randomized studies are difficult to perform in this category of patients [32] , they are clearly warranted. To that extent, in 2007, the Dutch Pancreatitis Study Group started a (pilot) multicenter randomized controlled trial comparing endoscopic transgastric necrosectomy with surgical necrosectomy [the Penguin Trial (Pancreatitis, endoscopic transgastric versus primary necrosectomy in patients with infected necrosis), trial registration ISRCTN07091918].…”

Section: Discussionmentioning

confidence: 99%

“…Since the incidence of infected necrosis in acute pancreatitis is rather low, it has been recommended that patients should be referred and treated in pancreatitis-referral centres [21,27,32] . These centres should have round-the-clock access to a dedicated multidisciplinary team, including experienced gastrointestinal surgeons, interventional radiologists and interventional endoscopists.…”

Section: Discussionmentioning

confidence: 99%