Role of correction of the syndrome of intestinal failure and abdominal hypertension in the prevention of infection of pancreatic necrosis

Abstract

The number of patients with acute pancreatitis and pancreatic necrosis has been steadily increasing. mortality in infected pancreatic necrosis remains high. Aims. To develop measures to prevent infection of pancreatic necrosis by timely correction of intra-abdominal hypertension and the syndrome of intestinal failure. Material and methods. Developed a package of measures, consisting of early intestinal lavage and enterosorption, intravenous highdoses of octreotide, epidural blockade, adequate detox and the start of effective antimicrobial therapy. Comparative evaluation of clinical, laboratory and instrumental data in the primary (n=50) and control (n=50) groups. Results. In the main group pancreatogenic sepsis occurred in 10%, control 18%. mortality, respectively, was 8 and 16%.

Microbial Community of Small Intestine in Acute Severe Pancreatitis Patients: a Pilot Study

“…In turn, systemic complications develop both as a result of mesenteric hypoperfusion and dysregulation of intestinal motility, and the destruction of the intestinal barrier, with the translocation of bacterial bodies and their substrates. It should be noted that all of the above processes increase the risk of developing multiple organ failure, leading to an increase in the number of deaths [1]. With the advent of methods for high-throughput sequencing of microbiome samplesfor example, in the 16S rRNA format -the possibilities for studying the structure of microbial communities have significantly expanded.…”

“…Diagnosis and treatment of intestinal failure syndrome (AIC) is difficult task, since intestinal dysfunction and gastrointestinal tract insufficiency develop in the most severe patients with a long stay in the intensive care unit (ICU) [13]. Instrumental methods for detecting manifestations of SCI remain complex, and laboratory markers do not always reflect the real picture of critical events in the small intestine [1,[14][15][16]. With the advent of methods for high-throughput sequencing of microbiome samples -for example, in the 16S rRNA format -the possibilities for studying the structure of microbial communities have significantly expanded.…”

Role of endosurgical procedures in the correction of intraabdominal hypertension in patients with severe acute pancreatitis

“…Несмотря на успехи комплексной многокомпонентной терапии и хирургических методов лечения острого панкреатита (ОП), летальность при тяжелых формах этого заболевания составляет 55-69% [1]. Главными факторами риска развития летального исхода в ранней фазе тяжелого ОП являются: объем и характер некроза поджелудочной железы, распространенность поражения забрюшинной клетчатки (ЗБК), тяжесть ферментативного перитонита и эндотоксикоза, степень внутрибрюшной гипертензии (ВБГ) и выраженность пареза кишечника, обусловливающего массивное поступление из его просвета бактерий и токсинов в брюшную полость, портальную венозную систему и лимфатическое русло [2]. К основным причинам развития синдрома ВБГ у больных тяжелым ОП относятся стойкий парез кишечника, компрессия двенадцатиперстной кишки, гастростаз, отек париетальной и висцеральной брюшины, наличие острых жидкостных скоплений в брюшной полости и забрюшинном пространстве, массивный ретроперитонеонекроз (парапанкреатит), а также ригидность мышц передней брюшной стенки вследствие неадекватной аналгезии [2][3][4].…”