Roux-en-Y loop jejunal necrosis: another pancreatitis associated enteropathy.

Severe acute pancreatitis is frequently associated with systemic and local complications. Local sequelae include disorders of the stomach, duodenum, small and large bowel, collectively termed pancreatic enteropathies. We describe a patient with post-gastrectomy acute haemorrhagic pancreatitis which was complicated by necrosis and perforation of an intra-thoracic Roux-en-Y jejunal loop. This does not appear to have been previously reported.     

Acute pancreatitis after double-balloon enteroscopy: an old pathogenetic theory revisited as a result of using a new endoscopic tool

Double-balloon enteroscopy is a novel technique for visualizing the entire small bowel. Complications have been reported relatively rarely in the small series published up until now. In this report we describe two patients who developed acute pancreatitis immediately after double-balloon enteroscopy, diagnosed on clinical, biochemical, and radiological grounds. In both patients the pancreatitis resolved with supportive care. Based on early studies on the pathogenesis of acute pancreatitis, we discuss the possible pathogenetic mechanism for pancreatitis arising as a complication of this novel endoscopic technique.     

Pancreatitis associated with simvastatin plus fenofibrate

OBJECTIVE: To report a case of acute necrotizing pancreatitis associated with simvastatin and fenofibrate use. CASE SUMMARY: A 70-year-old white man presenting with rapid onset of abdominal pain, nausea, and vomiting was diagnosed with acute pancreatitis. On bowel rest, his condition deteriorated secondary to systemic inflammatory response syndrome, and he was transferred to a tertiary hospital's intensive care unit (ICU). He had been taking fenofibrate for 1 year; 6 months prior to this admission, he had been taking simvastatin 3 days of the week and fenofibrate the other 4 days of the week. The pancreatic tissue became necrotic, requiring surgical debridement. After a hospital stay of 121 days, including multiple ICU admissions, the patient died secondary to a bowel perforation. DISCUSSION: Although idiopathic pancreatitis cannot be ruled out in this patient, no causes of pancreatitis were identified other than drug induced. Five cases of acute pancreatitis caused by simvastatin have been reported; no case reports were found for fenofibrate. The onset of pancreatitis relative to the duration of therapy with simvastatin supports this medication as a possible cause of the pancreatitis. CONCLUSIONS: Drug-induced pancreatitis is well established as an adverse effect of some medications, although most are substantiated only with case reports. Given the absence of other apparent causes, simvastatin and fenofibrate should be considered as possible causes of pancreatitis in this patient.     

重症急性胰腺炎病人肠内营养护理进展

介绍了重症胰腺炎病人早期进行肠内营养的必要性、安全性、时机、方法及护理要点。认为重症胰腺炎病人早期进行肠内营养可改善肠黏膜的屏障功能，缩短病人的住院时间，降低病死率。     

重症急性胰腺炎病人肠内营养护理进展

介绍了重症胰腺炎病人早期进行肠内营养的必要性、安全性、时机、方法及护理要点。认为重症胰腺炎病人早期进行肠内营养可改善肠黏膜的屏障功能,缩短病人的住院时间,降低病死率。     

The digestive system and pancreas in 1982

The present review is concerned with the main pathophysiological, clinical and therapeutic progresses in the following fields: gastro-esophageal reflux, gastric antisecretory drugs, chronic inflammatory bowel diseases, cancer of colon and esophagus, pancreatic diseases (chronic pancreatitis, pancreatic carcinoma), acute bacterial diseases of the digestive tract, acquired immunodeficiency syndrome of the adult, diffuse nodular lymphoid hyperplasia of the adult small bowel.     

急性胰腺炎累及小肠系膜腹膜下间隙的多层螺旋CT表现及其与CT严重指数的相关性

目的:探讨急性胰腺炎累及小肠系膜腹膜下间隙的多层螺旋CT表现及其与CT严重指数(CTSI)的相关性。方法:回顾分析58例行全腹CT增强扫描且符合Balthazar CT分级C级及其以上的经临床实验室检查和(或)手术病理所证实的急性胰腺炎患者的资料,着重观察并记录胰腺的大小、形态、密度及胰周改变,并计算出CTSI评分,以及小肠系膜腹膜下间隙受累情况及其多层螺旋CT表现。结果:(1)58例患者中,CTSI评分在4～5分者20例,6～7分者23例,8～10分者15例;小肠系膜腹膜下间隙受累者50例,小肠系膜腹膜下间隙积液者13例;(2)小肠系膜腹膜下间隙受累表现为肠系膜水肿增厚、密度增高,系膜血管边缘模糊不清,伴或不伴液体积聚;(3)急性胰腺炎小肠系膜腹膜下间隙积液发生率与其CTSI评分有相关性(P<0.05)。结论:多层螺旋CT可充分显示急性胰腺炎累及小肠系膜腹膜下间隙的情况;其表现可在一定程度上反映急性胰腺炎的严重程度。     

PS液对急性胰腺炎肠道功能恢复的观察及护理

目的：探讨复方磷酸钠液（PS液）用于急性胰腺炎（acute pancreatits,AP）肠道功能恢复的疗效及其护理。方法：四川大学华西医院消化科收治的68例AP患者,随机分为实验组35例和对照组33例,两组均采用内科常规治疗,实验组加用PS液,对照组加用33％硫酸镁,观察两组用药后24h内的排便时间、症状减轻时间、排便次数及肠鸣音恢复时间。结果：采用PS液比采用33％硫酸镁对患者的腹胀、腹痛、呕吐等症状减轻所需平均时间少1．12h（P〈0．05）;肠鸣音恢复所需平均时间少0．92h（P〈0．05）;首次排便所需平均时间均少1．05h（P〈0．05）;24小时内平均排便次数多2．2次（P〈0．05）。结论：PS液用于AP患者肠道功能恢复方面优于33％硫酸镁,护理操作简便、易掌握,在AP肠道功能恢复方面值得推广。     

A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis

BACKGROUND:

In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites.

METHODS:

A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography (CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fluid administration, and electrolyte replacement. However, on the 14^th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fluid. Percutaneous transgastric drainage was performed and a 14 French gauge (Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space.

RESULTS:

After drainage, the patient recovered well and the last catheter was removed on day 123 of admission.

CONCLUSIONS:

Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.KEY WORDS: Percutaneous drainage, Acute necrotizing pancreatitis, Minimally invasive technique     

系统性红斑狼疮伴发急腹症的手术治疗

目的：总结系统性红斑狼疮（SLE）并发急腹症的临床特点及诊断和治疗体会。方法：对8例有急腹症的SLE患者手术治疗的临床资料进行回顾分析。结果：术后诊断急性阑尾炎2例,其中1例合并急性胰腺炎;肠梗阻1例,合并有多脏器结核;消化道穿孔4例,其中1例合并肠结核,1例有心梗、脑梗史,1例十二指肠球部后壁穿孔术前误诊为急性阑尾炎;血管炎1例,合并肾功能不全,术前误诊为急性阑尾炎。确诊消化道穿孔3例术后均应严重感染性休克死亡。结论：SLE合并急腹症临床表现形式多样,病情危重。长期服用激素及免疫抑制剂可对患者的症状,体征及血白细胞计数造成一定的影响,如无明显穿孔,梗阻征象临床诊断困难,易误诊和延误恰当的治疗,病死率高。     

大黄联合床边血浆置换治疗重症高脂血症性急性胰腺炎疗效观察

目的：评估重症高脂血症性急性胰腺炎应用大黄联合床边血浆置换治疗的临床疗效。方法：47例确诊为重症高脂血症性急性胰腺炎患者分为大黄联合床边血浆置换治疗组（24例）和对照组（23例）,观察血浆置换的安全性,两组患者的甘油三酯（TG）、炎症因子、呼吸功能、肠道功能、BalthazarCT评分、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、住院时间、住院费用和病死率等。结果：24例床边血浆置换有4例发生轻微并发症,无严重并发症;治疗组治疗第2天和第8天TG和炎症因子与对照组比较明显降低（均P〈0.05）;治疗组机械通气人数和时间少于对照组,治疗组治疗第2天和第8天氧合指数和胸腔积液与对照组比较差异有统计学意义（均P〈0.05）;治疗组治疗第2天和第8天腹内压均低于对照组,肛门首次排便时间和肠内营养开始时间均早于对照组（均P〈0.05）;治疗组治疗第2天APACHEⅡ评分、第8天APACHEⅡ评分和BalthazarCT评分与对照组比较差异有统计学意义（均P〈0.05）;治疗组住院时间、住院费用和病死率均低于对照组（均P〈0.05）。结论：床边血浆置换有良好的安全性;大黄联合床边血浆置换对重症高脂血症性急性胰腺炎有良好的临床疗效。     

A simple quantitative index of the P3 amylase isoenzyme in the diagnosis of acute pancreatitis

Following a report (Legaz, M.E. and Kenny, M.A. (1976) Clin. Chem. 22, 57--62) that the amylase isoenzyme, P3, is elevated in acute pancreatitis but not in other conditions a new "P3 Index" is proposed. This reflects the ratio of the P3 isoenzyme to the major salivary isoenzyme, S1. The P3 Index eliminates the problems of peak overlap which prevent accurate detection or direct quantitation of P3. In acute pancreatitis a large increase in 3 produces a serum P3 Index of below 80%. Normal serum exhibits a P3 Index of above 80%. Most causes of hyperamylasaemia observed without acute pancreatitis also exhibited a P3 Index of above 80%. The P3 Index seems to be a useful aid to the diagnosis or exclusion of acute pancreatitis in patients exhibiting equivocal hyperamylasaemia.     

Role of free radicals in the development of severe acute pancreatitis

Acute pancreatitis is an inflammatory disease which leads to acinar cell damage, interstitial edema, and hemorrhage. Some patients develop severe acute pancreatitis and result in multiple organ dysfunction syndrome. Acute pancreatitis is initiated by the activation of pancreatic enzyme in acinar cells. Following activation of trypsinogen into trypsin, local inflammation is initiated and activated inflammatory mediators are produced. Polymorphonuclear neutrophils, macrophages, and lymphocytes release lysosomal enzymes, oxygen free radicals, vasoactive substances, and proinflammatory mediators. In the course of the development of acute pancreatitis oxygen-free radicals and their derivatives play an important role as the molecular trigger in constituting lesions in the pancreas. Damaged acinar cells as well as activated neutrophils and macrophages produce large amount of oxygen radicals in acute pancreatitis. The hydrogen peroxide, superoxide, the hydroxyl radical, and singlet oxygen are key elements capable of cellular injury in acute pancreatitis. These highly reactive species cause various reactions, such as destruction of lipid membranes by peroxidation of fatty acids and destruction of lysosomal membranes. The oxygen radicals generated in the circulation might injure the capillary endothelium, and play an important role in accelerating the progression of acute pancreatitis. The imbalance of oxygen radical generating and oxygen radical scavenging processes is considered to lead to the cell injury in acute pancreatitis. These oxygen radicals are not only restricted in the pancreatic tissue, but involved in the systemic manifestation of the disease, particularly in the lungs, liver, and blood.     

胃管注入大黄汤解除急性胰腺炎病人腹胀的临床研究

[目的]探讨从胃管注入大黄汤减轻急性胰腺炎病人腹胀的效果。[方法]选择49例急性胰腺炎病人,随机分为实验组(31例)和对照组(18例),在对照组常规治疗的基础上,实验组加用胃管注入大黄汤法,观察两组病人肠鸣音恢复时间、留置胃管时间、禁食时间等。[结果]实验组留置胃管时间、肠鸣音恢复时间、住院天数比对照组明显缩短(P<0.05)。[结论]从胃管注入大黄汤法,能减轻急性胰腺炎病人的腹胀,减轻病人痛苦。     

螺旋CT双期扫描对急性胰腺炎的诊断价值

目的 评价螺旋CT双期扫描对急性胰腺炎的诊断价值。方法 回顾性分析64例经临床证实的急性胰腺炎CT平扫和增强扫描资料。结果 64例中，急性水肿型胰腺炎40例，CT表现为胰腺肿大，胰周脂肪层模糊或消失，肾前筋膜增厚，部分见少量胸水。急性出血坏死型胰腺炎24例，其中坏死型21例，化脓型2例，出血型1例，CT表现为胰腺内点状、片状或大范围无增强效应的低密度坏死灶，胰周间隙渗出及积液，蜂窝织炎，胰内或外出现气体或高密度出血灶。结论 螺旋CT双期扫描对急性胰腺炎的分型，临床治疗方案的选择，以及判断预后有重要诊断价值。     

Congenital diaphragmatic hernia: Presentations and problems in the adult

Three cases of congenital diaphragmatic hernia in the adult are reported. Strangulation of the large bowel was the presenting feature in 1 case and pancreatitis in another. The abnormality was discovered as a coincidental finding in a third case. The incidence, presentations, and diagnosis of this uncommon condition are discussed.     

松节油点压神厥穴及腹部按摩对急性胰腺炎患者肠动力恢复的临床研究

目的:探讨松节油点压神厥穴及腹部按摩对急性胰腺炎患者肠动力恢复的效果。方法:应用随机对照研究方法,将82例急性胰腺炎患者随机分为试验组(42例)和对照组(40例)。对照组采取常规治疗,试验组在常规治疗的基础上加用松节油点压神厥穴及腹部按摩的方法。对两组患者肠鸣音恢复时间、腹胀缓解时间、住院天数及腹胀程度积分进行比较。结果:试验组的各项指标恢复时间均较对照组明显缩短,有统计学意义(P0.05),且治疗后试验组腹胀程度积分低于对照组(P0.05)。结论:松节油点压神厥穴及腹部按摩可促进急性胰腺炎患者肠动力恢复,有效降低患者腹内压,缓解病情,缩短住院时间,减少医疗费用,操作简便,值得推广。     

Prevention of infection following severe acute pancreatitis

PURPOSE OF REVIEW: This review highlights recently reported strategies aimed at quantifying severity of illness earlier in the course of acute pancreatitis and at preventing secondary infection in pancreatic necrosis. RECENT FINDINGS: New and improved scoring models appear to suggest that the optimal interventional window is between 24 and 72 h of the onset of severe acute pancreatitis. Prospective randomized clinical trials in which patients with severe acute pancreatitis were treated with broad-spectrum antimicrobial regimens as prophylaxis, however, have demonstrated no benefit in terms of preventing late infection in pancreatic necrosis. In contrast, early enteral nutrition with various formulas and supplements, including probiotics, may confer a clinical advantage in terms of morbidity and mortality. SUMMARY: Continuing to advocate antimicrobial prophylaxis in severe acute pancreatitis is not reasonable, in view of the evidence now available from two large clinical trials. Current guidelines should be revised because of the potential harm to gastrointestinal ecology associated with long-term antibiotic treatment. A suitable alternative way to prevent bacterial overgrowth and secondary infection is lacking, however.     

尿胰蛋白酶原—2测定在急性胰腺炎诊断中的意义

目的：探讨尿胰蛋白酶原－2的测定在急性胰腺炎诊断中的临床意义。方法：收集69例急腹症病人血清和尿液标本，按最终诊断分为急性胰腺炎组（34例）和非急性胰腺炎组（35例），分别测定尿胰蛋白酶原－2，血清脂肪酶和血、尿淀粉酶，并将其结果进行比较。结果：尿胰蛋白酶原－2试纸条检测对急性胰腺炎诊断的敏感性，特异性，准确度分别为85％，83％，84％；血清脂肪酶为82％，60％，71％；血淀粉酶为88％，54％，71％；尿淀粉酶为79％，54％，67％。结论：尿胰蛋白酶原－2检测是诊断急性胰腺炎的一个非常有用的筛选指标，尤其是特异性较高。阴性结果可以在很大程度上排除急性胰腺炎。     

Protective effects of exogenous secretin on ceruletide-induced acute pancreatitis in the rat.

Unconscious rats given intravenous ceruletide (diethylamine salt of the decapeptide caerulein) in large pharmacologic doses consistently developed moderate acute pancreatitis by 3 h and florid pancreatitis by 6 h. Biochemical serum markers of acute pancreatitis tended to parallel the severity of the pancreatic damage. In 50% of the rats, mesenteric fat necrosis was present, free peritoneal fluid containing massive elevations of trypsinogen and amylase were noted in most animals. Intravenous secretion at a low dose given simultaneously with ceruletide exerted a variable protective effect on the pathological process. A high dose of secretin produced a striking macroscopic, microscopic, and biochemical protective effect on ceruletide-induced pancreatitis. High resolution light microscopy and electron microscopy showed a marked cellular disorganization in the acini of animals treated with ceruletide alone. By contrast, there was a striking apical redirection of zymogen granules in acini of the animals treated with secretin. The results of this study suggest that high dose intravenous secretin may exert a beneficial effect on acute pancreatitis.