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Chronic pancreatitis with Numerous Exacerbations - Surprising Final

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Łaski D., Hać S., Smoczyński M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
362-366
EN
The authors presented a case of 62-year old caucasian race male patient that was repeatedly admitted to hospitals, in 3 last years, with exacerbations of the chronic pancreatitis. During two last hospitalisations, according to the ERCP examination and high level of CEA and Ca 19.9 in pancreatic juice, a hypothesis of IPMN was put. Patient underwent a distal pancreatectomy with splenectomy. Postoperative specimen examination revealed dilated Wirsung duct in distal part of the pancreas. Small cysts and multiple papillas in the lumen of MPD were found. Microscopy reveal Intraductal Papillary Mucinous Neoplasm with medium grade dysplasia without cancer.When we confronted the reported case with available literature, we found that IPMN is not a frequent cause of recurrent pancreatitis, but those patiets require separate treatment strategy to other chronic pancreatitis patients.
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Usage of pregabalin in the treatment of pain associated with chronic pancreatitis – a clinically oriented narrative review

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Gałązka J. K., Skrzydło-Radomańska B., Kasztelan-Szczerbińska B., Cichoż-Lach H.
European Journal of Translational and Clinical Medicine
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2023
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vol. 6
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issue 2
91-94
EN
Abdominal pain is one of the main symptoms of pancreatic diseases, including chronic pancreatitis (CP). Once the disease is in remission, pain management is a key element of treatment. Co-analgesics may also be used at any stage of analgesia, among which antiepileptic drugs such as pregabalin. The first data on the beneficial effect of pregabalin on pain in the course of CP was published in a clinical trial in 2011, and it has been known since 2015 that the analgesic effect of pregabalin on CP has a different mechanism of action than conventional analgesics. Currently, research is focused on combining pregabalin with antioxidants and on methods to predict the patient's response to pregabalin administration. Based on current research, pregabalin appears to be a very useful agent for the pharmacologic treatment of pain in the setting of CP.
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Comparison of single-layer continues or two-layer interrupted pancreatojejunal suture in Frey procedure for treatment of chronic pancreatitis: a prospective randomized study

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Šileikis A., Jurevičius S., Butvila M., Strupas K.
Polish Journal of Surgery
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2019
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vol. 91(6)
11-14
EN
Background: Many patients with chronic pancreatitis are elected for surgery when endoscopic interventions are ineffective. Duodenum preserving pancreatic head resection introduced by Charles F. Frey is the most common procedure used for surgical treatment of chronic pancreatitis. However, technical aspects of this procedure have not been studied extensively. Goal Our prospective randomized study is aimed to compare usage of single-layer continuous (I group) and two-layer interrupted sutures (II group) in constructing pancreatojejunostomy after Frey procedure. Methods and materials: In a period between 2009 and 2016, a total of 103 patients, diagnosed with chronic pancreatitis and determined medical indications for surgical treatment were included into the study and randomized into group I (52 patients) and group II (51 patients). Preoperative, intraoperative patient characteristics and postoperative results were compared between both groups. Results: Mean duration of surgery was statistically shorter in group I – 210 min, while in group II – 240 min (p = 0.004). Pancreatojejunoanastomosis construction time was shorter in group I – 19 (±6) min versus 51 (±18) min in group II, p <0,001. No statistically relevant differences were observed in postoperative morbidity: group I – 51.9% and group II – 45,1% (p = 0.177) and mortality: group I – 3.8% and group II – 2% (p = 0.636). Conclusions: Frey procedure using single-layer continuous pancreatojejunostomy is safe, fast and less complex method in surgical treatment of chronic pancreatitis.
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Evidence of use: A selective COX-2 inhibitor in the treatment of experimental chronic pancreatitis induced by Dibutyltin dichloride

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Sukhodolya S., Falalyeyeva T., Kuryk O., Petrushenko V., Beregova T.
Current Issues in Pharmacy and Medical Sciences
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2015
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vol. 28
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issue 2
131-135
EN
The search for new prophylactic and therapeutic drugs for the treatment of chronic pancreatitis (CP) is an urgent problem in current pancreatology. A promising direction in CP therapy may be the use of nonsteroidal anti-inflammatory drugs. Hence, the aim of the present study was to investigate the selective inhibition properties of COX-2 rofecoxib on the development of pancreas fibrosis in rats with experimental chronic pancreatitis induced by Dibutyltin dichloride (DBTC). The 60 male albino Wistar rats of our study were placed into three groups of 20 animals in each: I - the intact control; II - that which received an intraperitoneal injection (i.p.) of DBTC (6 mg/g); III - those which, 28 days after administration of DBTC (6 mg/g, i.p.), received a two-week course of treatment of rofecoxib (5 mg/kg, i.p). One day after rofecoxib treatment was completed, analysis was undertaken regarding the level of amylase, as well as the pancreatic amylase and lipase in the blood serum and the prostaglandin E2 in the pancreatic tissue. In addition, the morphological condition of the pancreas was ascertained. The obtained data suggest that administration of Rofecoxib reduces the development of fibrosis and improves the morpho-functional state of the pancreas in rats with chronic pancreatitis induced by DBTC. Thus, treatment with a selective COX-2 inhibitor could be a possible strategy for improving the clinical outcome of patients with CP.
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En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation

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Generette G. S., Bachul P. J., Golab K., Basto L., Pyda J. S., Borek P., Tibudan M., Anteby R., Perea L., Charlton M., Perez-Gutierrez A., Jayant K., Lucander A., Matthews J. B., Millis J. M., Fung J., Witkowski P.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 2
11-17
EN
We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.
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Pancreas transplantation in a patient after total pancreatectomy due to chronic pancreatitis – the first case in Poland

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Durlik M., Baumgart K.
Polish Journal of Surgery
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2016
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vol. 88(2)
106-108
EN
Chronic pancreatitis is an inflammatory disease that may require surgical intervention. In some patients a total pancreatectomy is necessary. Such patients develop diabetes, which in some cases may be difficult to control. When standard insulin treatment is unsuccessful and the patient has frequent blood glucose swings with life-threatening hiper- and hypoglycemic episodes, a pancreas transplant should be considered.
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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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Concentration of Gelatinases and Their Tissue Inhibitors in Pancreatic Inflammatory and Neoplastic Tumors and Their Influence on the Early Postoperative Course

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Lekstan A., Olakowski M., Jabłońska B., Łabuzek K., Olakowska E., Filip I., Lampe P.
Polish Journal of Surgery
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2013
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vol. 85
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issue 2
65-72
EN
Pancreatic cancer (PC) is the fourth leading cause of death in the world, due to neoplastic disease. Chronic pancreatitis (CP) is a progressive disease leading towards pancreatic fibrosis. The aim of the study was to assess the impact of matrix metalloproteinases 2 and 9 (MMP2 and 9) and their tissue inhibitor (TIMP 1 and 2) concentrations in case of PC and CP tissue homogenates on early treatment results of patients subject to pancreatic resections. Material and methods. The study group comprised 63 patients, including 25 (39.68%) female and 38 (60.32%) male patients. Group 1 (CP) consisted of 31 patients with CP (F: M = 10/21). Group 2 (PC) consisted of 32 patients with PC (F: M = 15:17). The pancreatic tumor samples were collected from the resected pancreas, being subject to electrophoresis and immunoenzymatic studies. After confirming their activity, MMP2, MMP9, TIMP1, TIMP2 concentrations were determined. Correlation analysis of MMPs and TIMPs concentrations was performed in relation to the following: tumor diameter, age, BMI, hospitalization, duration of symptoms and surgery, blood loss, incidence of perioperative complications. Results. Group differences were presented in terms of: age, BMI, ASA, duration of symptoms, jaundice, tumor diameter, time of operation. There were no differences considering weight loss, blood loss, extent of resection, and hospitalization. Significant MMPs and TIMPs concentration differences between groups were demonstrated. Conclusions. Comparison of PC to CP tissue samples showed significantly higher levels of metalloproteinases and TIMPs in the former. Positive correlations of MMP1, TIMP1 and 2 with tumor diameter (CP) were observed, and MMP2 with the duration of surgery and blood loss (PC). There was no MMPs and TIMPs concentration levels influence on the incidence of postoperative complications.
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