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Features of the course of acute pancreatitis in patients with obesity

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Kebkalo A., Tkachuk O., Reyti A.
Polish Journal of Surgery
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2019
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vol. 91(6)
28-34
EN
Purpose: The purpose of the study is to investigate the course of acute pancreatitis in obese patients, the development of local and systemic complications and mortality rates. Materials and methods: We took and analyzed 482 histories of acute pancreatitis treated at Kyiv Regional Clinical Hospital from January 1, 2011 to February 2, 2019. The data were statistically processed in the Excel 2010 program using a descriptive method applying relative, absolute numbers, mean square deviations and their errors. A correlation between variables was studied using the Pearson’s test (R2). The significance of the difference between the two independent groups was tested with Student’s t-test. Results: We included 482 patients in our study, i.e. 260 patients (54%) with obesity (the study group), and for comparison, 222 (46%) patients with normal body mass, constituting a control group. Obese patients had a higher mean age (55.4 ± 9.4 years, P = 0.01); also, they showed a statistically higher incidence of severe course of acute pancreatitis [85 (32.7%) vs. 16 (7.2%); P = 0.01*]. We noted an increase in the rate of acute pancreatitis with severe course in obese patients with mass gain (from 10.20% to 53.93%, P = 0.03*). Hospitalization time of obese patients was longer than in case of patients with normal body mass. In addition, we observed a two-fold longer hospitalization of obese patients at intensive care units (5.8 ± 0.8 vs. 2.7 ± 0.5 days, P = 0.01*). When investigating the mortality rate, we found out that the main cause of death was the progression of organ failure – 30 cases (6.3%), pulmonary embolism (TB) – 15 (3.1%) and DIC – 18 (3.7%). C onclusions: The presence of obesity in patients involves a high risk of severe acute pancreatitis. This risk increases with body mass increase. In addition, in obese patients the hospitalization and in-patient care takes longer, which increases the total cost of treatment and requires a cost-effective algorithm in the future. A high mortality rate in obese patients requires an improved treatment algorithm.
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Morphological changes of the pancreas in course of acute pancreatitis during treatment with Ulinastatin

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Wallner G., Solecki M., Ziemiakowicz R., Ćwik G., Dyndor P., Maciejewski R.
Polish Journal of Surgery
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2013
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vol. 85
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issue 3
114-122
EN
Acute pancreatitis is a severe clinical conditio that causes significant mortality in patients. Since we do not have at the moment effective causal treatment research on the use of pro tease inhibitors can produce tangible benefits. In view of the growing number of cases and high mortality in severe AP with one hand, and the lack of a usal treatment research efforts undertaken to search for effective drugs for this disease seem to have deep reasons. Aim of the study was to determine the histopathological changes in the pancreas in the treatment of acute pancreatitis with Ulinastatin. Material and methods. The study was conducted in male Wistar rats weighing 250-300 grams. 150 individuals were used for the experiment, 60 of them were treated with Ulinastatin. Experimental acute pancreatitis was induced by the model proposed by Aho and Henckel using sodium taurocholate. Ulinastatin dose numer depended on the duration of the experiment. For histopathological examination pancreatic fragments weighing approximately 1 g each were taken. Assessment and documentation of histopathological preparations were made by light microscopy. Results. Evaluation of the histological preparations of various time groups showed significantly improved results after application of Ulinastatin, depending on the duration of the inflammation and the number of doses of the drug. Conclusions. Application for the treatment of UTI leads to inhibition of the inflammatory process at the stage of pancreatic edema and in cases of severe necrotizing course limits the progression of the disease which gives grounds for its clinical use in humans.
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Assessment of Pharmacological Prophylaxis for Acute Pancreatitis Following ERCP in Patients with Choledoholithiasis

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Łubowska-Pająk E., Kołomecki K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
620-625
EN
Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.
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Assessment of pharmacological prophylaxis for acute pancreatitis following ERCP in patients with choledoholithi

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Łubowska-Pająk E., Kołomecki K.
Polish Journal of Surgery
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2015
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vol. 87(12)
620-625
EN
Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients
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Enteral Nutrition Without the Use of An Endoscope in Patients with Severe Acute Pancreatitis

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Czerepko M., Hać S., Sawicka W., Śledziński Z.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
630-633
EN
One of the main elements of acute pancreatitis therapy is nutritional treatment, which should ensure the implementation of the patients' energetic needs, limit the exocrine activity of the pancreas, and maintain the gastrointestinal passage. The most important argument in favor of the above-mentioned is the fact that enteral nutrition in case of severe acute pancreatitis prevents infectious complications. The most effective method is enteral nutrition. The unavailability of bedside endoscopy, and thus the need to transport the patient in order to obtain access, considerably complicates the procedure. Literature data described various bedside techniques consisting in the blind introduction of the feeding tube, which are rarely used, despite the fact that they are cheaper and as effective as endoscopy.
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Bile Infection and Bile Acids Concentration in Bile in Acute Biliary Pancreatitis

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Zasada J., Panek J., Dolecki M., Biesiada Z., Dembiński M.
Polish Journal of Surgery
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2009
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vol. 81
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issue 12
655-669
EN
Biliary stones are the most common etiology of acute pancretitis (AP). Pathomechanism of this etiology is based on common channel theory of Opie.Material and methods. 113 patients with ABP were included in the study - 91 with mild and 22 with severe form of ABP. 17 patients with cholelithiasis and choledocholithiasis without ABP served as controls. All the patients were submitted to the same model of treatment. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sfincterotomy (ES) were performed in the day of admission and laparoscopic cholecystectomy within the next 24 hours. Bile specimens were taken from main bile duct (MBD) during ERCP and from gall-bladder (GB) during laparoscopic cholecystectomy. Bacteriological cultures, bile acids (BA) concentration and total and secretory form of IgA concentration were assessed in particular groups of patients.Results. No significant statistical differences of bile infection in MBD and GB were found between the analyzed groups of patients. Furthermore, the bile among the patients with severe ABP was more frequently infected, particularly when obtained from gall-bladder. Most common pathogens found in cultures were Gram negative bacteria. Interestingly, Gram positive cultures and fungi were also significant. The number of species of pathogens was of no significance for infection concerning both: source of bile and groups of patients. Mean concentrations of total BA were different between study groups of patients in MBD and in GB. It is worth mentioning, that the fraction of hydrophobic, secondary BA which are potentially more toxic, was increased in total concentration of BA in MBD particularly in patients with severe form of AP. Among patients with mild AP and controls these values were lower and similar.Conclusions. It seems that BA play as an aggressive factor during AP while in physiologic condition have a protective, antibacterial meaning.
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Serum Leptin and Ghrelin Levels in Patients in the Early Stages of Acute Biliary Pancreatitis and Different Degrees of Severity

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Panek J., Bonior J., Pieton J., Jaworek J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
211-217
EN
Acute pancreatitis (AP) is a potentially fatal disease. In animal experiments leptin and ghrelin were shown to modulate the course of AP. The aim of the study was to estimate the relationship between the severity of acute biliary pancreatitis (ABP) and serum levels of leptin and ghrelin in nonobese patients in the first seven days of the hospitalization. Material and methods. The study included nine patients with mild ABP (MABP), eleven patients with severe ABP (SABP) and twenty healthy controls, appropriately matched age, sex and weight. Serum concentrations of leptin and ghrelin were measured in patients on the first, third, fifth, and seventh days of hospitalization using leptin and ghrelin RadioImmunoAssay (RIA) kits. Results. At admission and throughout the study the mean serum leptin concentration in SABP patients was higher than in the controls but without statistical significance. Serum ghrelin concentrations on admission were significantly lower in patients with ABP than in the controls. We observed steadily increasing serum ghrelin levels in both groups of the patients during the course of ABP. Conclusions. The results of our study do not support the role of leptin as a marker of the severity of ABP. On the other hand, rising serum ghrelin levels during the course of ABP may be a marker of recovery and an indicator of the healing process
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Introduction of new technique of single-port transgastric access for repeated debridement of infected pancreatic necrosis

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Kobiela J., Hać S., Śledziński Z.
Polish Journal of Surgery
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2013
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vol. 85
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issue 4
228-233
EN
In this article we introduce a novel technique of repeated single-port transgastric debritment of walledoff pancreatic necrosis using TriPort ™ Access System. The presented technique seems an appealing and innovative approach to the treatment of walled-off pancreatic necrosis in acute pancreatitis patients. Studies proving feasibility, safety and efficiency are necessary to elucidate real value of the technique
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Roux-en-y biliary by-pass – a new approach in the treatment of hypertriglyceridemia induced recurrent acute pancreatitis. Clinical case study

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Szwedziak K., Muras K., Strzelczyk J.
Polish Journal of Surgery
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2013
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vol. 85
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issue 3
137-140
EN
Acute pancreatitis is a disease with significant mortality. Hypertriglyceridemia (HTG) is the third most common etiological factor of this disorder after alcohol and gall-stones. The authors presented a case of 42-years old caucasian female who was hospitalized due to recurrence of acute pancreatitis. She had been diagnosed with HTG. She had earlier seven episodes of acute pancreatitis. Endoscopic papillotomy and conservatory treatment didn’t change her complaints and she was consented for surgery. Exclusion of distal part of bile duct was performed. The common bile duct was anastomosed side-to-side to the 70 cm long Roux loop of the jejunum with the ligation of the distal part of the common bile duct. Following the surgery authors observed normalization of amylase, lipase, leukocytosis and CRP levels. During six months after procedure patient didn’t have any new episode of pancreatitis. Exclusion of distal part of bile duct may be a useful tool in surgical treatment of recurrent acute hypertriglyceridemia-induced pancreatitis.
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Risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography – a retrospective cohort study

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Głuszek S., Matykiewicz J., Kozieł D., Klimer D., Wawrzycka I., Ogonowska A.
Polish Journal of Surgery
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2015
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vol. 87(10)
499-505
EN
Endoscopic retrograde cholangiopancreatography (ERCP) is the most important non-surgical procedure in serious pancreatic and biliary diseases, still burdened with the risk of severe complications. The objective of the study was to distinguish factors which could increase the risk of occurrence of ERCP complication in the form of pancreatitis. Material and methods. The study included 452 patients who had undergone ERCP. Patients’ records were retrospectively analyzed from the aspect of demographic data, indications for the procedure, type and course of the procedure, type and severity of complications, width of the common bile duct (CBD), concomitant diseases and administered medicines which might increase the risk of complications. Results. In 35 patients (7.7%) a complication occurred in the form of pancreatitis (AP). A severe course was confirmed in 11 patients (31%). Cholelithiasis constituted approximately 2/3 of indications for ERCP. AP after ERCP was significantly more often observed in the group of patients aged under 40 (22.9% vs 8.6%; p<0.05). Narrow biliary ducts (3-8 mm) were the factor increasing the frequency of development of AP (25.9% vs 45%; p<0.05). Death occurred in 5 patients (1.1%), including 4 patients (0.96%) in the group without complications, and in 1 patient (2.85%) with complicated AP. Conclusions. ERCP is a very valuable procedure in clinical treatment; however, it is burdened with the risk of complications, such as AP, bleeding, or duodenal perforation. A group especially exposed to the risk of complications in the form of AP are young patients aged under 40 with a narrow CBD.
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Models of Certain Types of Surgical Shock Based on the Assessment of Selected Critical Parameters

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Budzyński P., Brongel L., Nazimek R., Kuliś M., Hładki W., Lorkowski J., Trybus M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
346-352
EN
The aim of the study was to devise models that describe three types of surgical shock based on a set of simple biochemical and clinical parameters and establish a method of assigning new patients to each surgical shock scenario.Material and methods. Prospective analysis included patients hospitalized in IInd Chair of Surgery from 2001 to 2005 who belonging to the following groups: multiple injuries (at least 7 points according to LSO), upper GI bleeding (in patients requiring blood transfusions during first day) and severe acute pancreatitis (at least 3rd degree according to Trapnell's scale). A set of nineteen parameters was evaluated on the first, fourth and seventh day in every patient. Discrimination analysis was used for statistical analysis with calculation of Mahalanobis squared distances between groups that reflect their reciprocal differences. Discrimination functions were calculated allowing the assignment of a new observation to one of the models. Eventually, reliability of categorizing patients to the studied groups was evaluated.Results. Differences among the groups - reflected by Mahalanobis squared distances - proved statistically significant in every studied day. Overall, the ratio of proper classifications according to discrimination functions equaled about 87%. The most common mistake in categorizing was observed in groups of multiple injuries and acute pancreatitis - due to similar pathophysiological processes leading through SIRS to MOF.Conclusions. The abovementioned results indicate that the presented models can be successfully used in diagnostic processes, especially in emergency cases. The set of clinical and biochemical parameters used is simple and easy to obtain even in non-specialized centers.
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Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage of walled-off pancreatic necrosis (WOPN)

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Jagielski M., Smoczyński M., Adrych K., Sztuczka E., Jackowski M.
Polish Journal of Surgery
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2020
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vol. 92(1)
12-17
EN
Introduction: The endoscopic treatment of walled-off pancreatic necrosis (WOPN) as well as other minimally invasive methods have been evolving since last years. Aim: The aim of this study is evaluation of efficiency and safety of endoscopic necrosectomy under fluoroscopy done during the transmural drainage in patients with symptomatic WOPN. Material and methods: The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. Material and methods: The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. Results: Endoscopic necrosectomy was performed under fluoroscopic guidance during transmural drainage in 24/114 (21.05%) patients. The mean amount of endoscopic procedures in each patient was 8.88 (3–27). The active drainage was continued averagely for 40.1 (11–96) days. The avarage number of necrosectomy procedures during continued drainage was 6.54 (1–24) per patient. Additional percutaneous drainage was applied in just two patients. The complications of endotherapy were present in 9/24 (37.5%) patients. The therapeutic success was reached in 23/24 (95.83%) patients. The mean time of observation was 35 [18–78] months. The recurrence of pancreatic fluid collection was stated in 4 patients during the observation time. The mean time between the end of endotherapy and recurrence of fluid collection was 19 [16–22] months. In three patients recurrent fluid collections were treated endoscopically and in one patient were treated surgically. Long-term success of endoscopic treatment of WOPN was reached in 22/24 (91.67%) patients. Conclusions: Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage is successful and safe method of minimally invasive treatment in selected patients with walled-off pancreatic necrosis.
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Epidemiological Characteristic of Acute Pancreatitis in Trzebnica District

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Bogdan J., Elsaftawy A., Kaczmarzyk J., Jabłecki J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 2
70-75
EN
Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas.
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Giant Post-Inflammatory Pancreatic Cyst Associated with Giant Abdominal Hernia - a Case Report

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Murawa D., Nowaczyk P., Adamczyk B.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
389-394
EN
The case of a patient who developed a giant post-inflammatory pancreatic cyst, which resulted in the development of a giant abdominal hernia, is presented. The cyst developed as a consequence of earlier shortcomings in the diagnostic and therapeutic process; cyst development was also due to the patient's irresponsible approach to the problem. The patient did not present any typical symptoms of pancreatic pseudocyst. He reported to the Surgical Outpatient Clinic in the Wielkopolska Cancer Centre because of a reduced quality of life caused by a giant abdominal hernia. Basic laboratory tests and an abdominal CT were conducted, and a decision was reached regarding laparotomy. The pseudocyst was anastomosed with the intestinal wall on Roux-en-Y loop. A prolene net was applied simultaneously, due to the extensive defects in the abdominal integuments. In this case, treatment should have been implemented at a much earlier stage, without exposing the patient to the consequences of basic disease and the presence of a foreign body (net) in the abdominal integuments.
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Complex Interventional Treatment of Extensive Consequences of Necrotizing Pancreatitis - Case Report

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Jagielski M., Smoczyński M., Studniarek M., Śledziński Z., Adrych K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 1
39-42
EN
The paper presents description of the effective treatment of patients with extensive consequences of necrotizing pancreatitis. The strategy of treatment was to extend access to necrotic areas („step-up approach”). Applied endoscopic transmural access (transgastric), percutaneous access (transperitoneal) and surgical access. The cooperation endoscopist, surgeon and interventional radiologist gave very beneficial clinical effects in patients with extensive complications of acute pancreatitis.
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Description of minimally invasive methods of treatment of walled-off pancreatic necrosis (WOPN)- the use of „step up approach” in patient with pancreatic n

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Jagielski M., Smoczyński M., Studniarek M., Adrych K.
Polish Journal of Surgery
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2015
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vol. 87(8)
409-412
EN
The study presents description of treatment of patients with walled-off pancreatic necrosis (WOPN). The strategy of treatment was to extend access to necrotic areas (“step-up approach”). Applied endoscopic transmural access (transgastric) and percutaneous access (transperitoneal). The endoscopic necrosectomy under fluoroscopic guidance was repeated four times during active transluminal drainage. Endoscopic treatment with percutaneous drainage gave very beneficial clinical effects.
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ZACHOWANIA ZDROWOTNE A STARZENIE SIĘ NA PRZYKŁADZIE PACJENTÓW Z ZAPALENIEM TRZUSTKI

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Lubecka H., Haor B.
Long-Term Care Nursing
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2019
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vol. 3
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issue 3
EN
Introduction Most people with acute pancreatitis are between 41 and 60 years old. Among the factors contributing to the onset of the disease are the anti-health behaviors. Aim The aim of the study was to present the health behavior of patients with acute pancreatitis according to sociodemographic variables that may influence the course of the aging process. Material and methods The study was conducted among 50 people with diagnosed acute pancreatitis. The study used the estimation method, the estimation technique using the Health Behavior Inventory. Results Patients affected with acute pancreatitis exhibited an average level of health behavior that was differentiated according to selected sociodemographic variables. Conclusions Age-related effects have been shown to have a higher level of health behavior in patients with acute pancreatitis.
PL
Streszczenie Wstęp Najwięcej zachorowań na ostre zapalenie trzustki dotyczy osób między 41 a 60 rokiem życia. Wśród czynników sprzyjających wystąpieniu choroby wymienia się zachowania antyzdrowotne. Cel Celem opracowania było zaprezentowanie zachowań zdrowotnych pacjentów z ostrym zapaleniem trzustki w zależności od zmiennych socjodemograficznych, które mogą wpływać na przebieg procesu starzenia się jednostki. Materiał i metody Badania zostały przeprowadzone wśród 50 osób z rozpoznanym ostrym zapaleniem trzustki. W badaniach zastosowano metodę szacowania, technikę skali szacunkowej z wykorzystaniem Inwentarza Zachowań Zdrowotnych. Wyniki Pacjenci, których dotyczyło ostre zapalenie trzustki wykazywali średni poziom zachowań zdrowotnych, który podlegał zróżnicowaniu w zależności od wybranych zmiennych socjodemograficznych. Wnioski Zaawansowanie wieku wpływało na prezentowanie wyższego poziomu zachowań zdrowotnych przez pacjentów z ostrym zapaleniem trzustki.
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