Tag Archives: Pancreas

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis

Posted on by
Reply

“Acute pancreatitis is the most common pancreatic disease worldwide. Necrotizing pancreatitis develops in approximately 20 to 30% of patients with acute pancreatitis. Pancreatic and peripancreatic necrosis that becomes infected nearly always leads
to invasive intervention. The current standard approach for infected necrotizing pancreatitis is a minimally invasive step-up approach with catheter drainage as the first step. International guidelines advise postponement of catheter drainage and administration of antibiotics until the infected pancreatic and peripancreatic necrosis has become encapsulated; such walled-off necrosis usually takes 4 weeks to develop.”

Continue reading →

Pancreatic necrosis

Posted on by
Reply

“Pancreatic necrosis is the most devastating complication of acute pancreatitis. Management of this complex disease has improved dramatically over the past decade, and mortality rates are regularly reported in the range of 20% instead of the 50% to 70% range reported in the 1970s. Despite this improvement, 80% of deaths from acute pancreatitis evolve from infectious complications of pancreatic and peripancreatic necrosis.”

Continue reading →

Management of pancreatic injuries

Posted on by
Reply

Ho VP, Patel NJ, Bokhari F, et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Jan;82(1):185-199. Free-full text.

In summary, we propose the following recommendations:

  1. For adult patients with grade I or II injury to the pancreas identified on CT scan, we conditionally recommend nonoperative management.
  2. For adult patients with grade III or IV injury to the pancreas identified on CT scan, we conditionally recommend operative intervention.
  3. For adult patients with grade I or II injuries to the pancreas who are undergoing an operation, we conditionally recommend non-resectional management.
  4. For adult patients with grade III or IV injuries to the pancreas who are undergoing an operation, we conditionally recommend resectional management.
  5. For adult patients with grade V injuries to the pancreas who are undergoing an operation, we give no recommendation regarding whether a pancreaticoduodenectomy or a surgical procedure other than pancreaticoduodenectomy should be performed.
  6. For adult patients who have undergone an operation for pancreatic trauma, we conditionally recommend against the routine use of octreotide prophylaxis.
  7. For adult patients undergoing a distal pancreatectomy for pancreatic trauma, we give no recommendation regarding whether routine splenectomy or splenic preservation should be performed.

Pancreas-preserving duodenectomy

Posted on by
Reply

Di Saverio S, et al. Pancreas-sparing, ampulla-preserving duodenectomy for major duodenal (D1-D2) perforations. Br J Surg. 2018 Oct;105(11):1487-1492.

Results: Ten patients were treated with this technique; seven had perforated or bleeding peptic ulcers, two had iatrogenic perforations and one blunt abdominal trauma. Their mean age was 78 (range 65-84) years. Four patients were haemodynamically unstable. The location of the duodenal injury was always D1 and/or D2, above or in close proximity to the ampulla of Vater. The surgical approach was open in nine patients and laparoscopic in one. The mean duration of surgery was 264 (range 170-377) min. All patients were transferred to the ICU after surgery (mean ICU stay 4·4 (range 1-11) days), and the overall mean hospital stay was 17·8 (range 10-32) days. Six patients developed major postoperative complications: cardiorespiratory failure in five and gastrointestinal complications in four. Surgical reoperation was needed in one patient for postoperative necrotizing and bleeding pancreatitis. Two patients died from their complications.

Continue reading →

The anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades

Posted on by
Reply

Kumar KH, et al. Anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades in the human pancreas: a cadaveric study. Surg Radiol Anat. 2021 Mar;43(3):367-375.

Full-text for Emory users.

Results: The gastroduodenal (GDA), anterior superior pancreaticoduodenal (ASPD), and anterior inferior pancreaticoduodenal (AIPD) artery was found in all the cases, whereas the posterior superior pancreaticoduodenal (PSPD) and posterior inferior pancreaticoduodenal (PIPD) artery was present in 93.34% cases. The ASPD artery originated from GDA in all the cases. Two types of variations were observed in the origin of PSPD artery and four types each in the origin of AIPD and PIPD artery. Anatomical and numerical variations were observed in both anterior and posterior arches, posterior arch being absent in 20% cases.

Continue reading →