Duodenal necrosis and intramural haematoma complicating acute pancreatitis

Although segmental bowel necrosis is a recognized complication of pancreatitis, the duodenum is rarely involved. We report a unique case of acute duodenal obstruction characterized by transmural necrosis and intramural duodenal haematoma in a young man with acute alcohol-induced pancreatitis. The patient recovered following pancreaticoduodenectomy.     

Pyelonephritis complicating relapsing acute pancreatitis

A case of right pyelonephritis with hydronephrosis complicating relapsing acute pancreatitis and right pararenal phlegmon formation is presented. Hydronephrosis is a reportedly rare complication of extrapancreatic inflammation; the only 6 previous cases involving the right side are reviewed. The present case report, to our knowledge, is the first to describe clinical and laboratory evidence of pyelonephritis secondary to partial obstruction of the right upper renal tract by an extrapancreatic phlegmon. The clinician caring for patients with acute pancreatitis should be aware of this important complication, since the presentation of pyelonephritis-flank pain and fever--could erroneously be attributable solely to the pancreatitis.     

Pancreatic necrosis and acute pancreatitis

The surgeon should take pains to section and study himself the operative specimen after excision for acute pancreatitis, in order to understand the true nature of the lesions, which the most attentive and competent pathological examination cannot describe as vividly as direct examination by the operator. Often he will be surprised to find that the lesions, predominant in the capsule, are less profound and less severe than he had thought at first sight. The necrosis, which is sometimes limited to the peripheral and interstitial tissue, sparing the gland itself (its prognosis is less serious and has led many surgeons to perform surgical excision). However the problems encountered postoperatively have given rise to doubts a posteriori as to whether this is legitimate. Reference is made to the decapsulation of the pancreas described by Romanian authors, and a method for future operative diagnosis of glandular necrosis is proposed.     

Isolated papillary muscle rupture complicating acute pancreatitis

Papillary muscle rupture in the absence of coronary stenoses is a rare event. An isolated infarction of the papillary muscle is involved in most cases, but the pathogenesis is still debated. We describe an anterolateral papillary muscle rupture complicating acute pancreatitis in a patient without significant coronary stenoses and with evidence of coronary spasm. This suggests that an increased susceptibility to coronary spasm and thrombosis, triggered by an acute systemic inflammatory response, may represent a mechanism of selective papillary muscle infarction.     

急性坏死性胰腺炎的临床表现和治疗

目的总结急性坏死性胰腺炎(ANP)的临床表现,探讨对ANP的诊断和治疗方法。方法共46例,经腹腔穿刺抽出血性腹水后,立即行急诊剖腹手术,从发病到手术平均时间约（29.36±3.42）小时,手术后采用抑制胰腺分泌及抗感染等综合治疗。结果39例存活,7例死亡。死亡患者的特点：有明显的诱因、既往身体健康、入院时体征不明显,但病情迅速恶化;胰腺坏死严重,无恢复希望、手术前后多器官功能衰竭迅速发生、手术后腹腔内组织继续大量坏死。结论详细采集病史、CT检查,有助于本病的诊断,积极使用扩血管药物,改善胰腺血液循环,及时行坏死胰腺全切除可能较为合适。     

Enterolith ileus complicating afferent loop syndrome simulating acute pancreatitis

Afferent loop syndrome after Billroth II gastrectomy is usually caused by those events that impair the evacuation of the afferent duodenal loop. The formation of an enterolith in an afferent loop is a rare but dangerous event. We present a unique report of a patient in whom a huge enterolith developed in the afferent loop of a Billroth II anastomosis, which led to intestinal occlusion. This migration occurred after a laparoscopic procedure, so we hypothesized that this procedure could be the cause of enterolith migration.     

Mediastinal necrosis in acute pancreatitis - case report

Ascites, pseudocyst, necrosis of the retroperitoneal fat tissue and pancreatopleural fistula with left sided pleural effusion may complicate pancreatitis. However, steatonecrosis of the mediastinum and right side pleural effusion are rather rare complications of pancreatitis. We present a case of a patient with alcohol induced pancreatitis. Chest x-ray showed right sided pleural effusion. Although high levels of amylase in pleural fluid made the diagnosis of pancreatopleural fistula most likely, necrosis of the mediastinal fat tissue with right side pleural effusion was found postmortem.     

Inferior vena caval thrombosis complicating acute pancreatitis. Case report

This case report describes a patient with acute pancreatitis who was found to have inferior vena caval thrombosis. This was diagnosed by CT scan and confirmed by digital subtraction venography. Of the many recognised vascular complications of acute pancreatitis, isolated inferior vena caval thrombosis has not been previously reported.     

高脂血症促使大鼠急性胰腺炎胰腺腺泡由凋亡趋向坏死

目的 通过建立高脂血症性急性胰腺炎大鼠模型,探讨高脂血症可能加重急性胰腺炎病程的机制.方法 D-果糖饮食诱导SD大鼠的产生高脂血症,在此基础上通过腹腔注射蛙皮素诱导急性胰腺炎,并且设立正常组、高脂血症组和急性胰腺炎组作为对照.8周后,取大鼠血浆检测血糖、血脂和游离脂肪酸等指标;收集大鼠胰腺以及胰周组织,检测组织匀浆中ADP与ATP比值,通过Western blot法检测组织中caspase-3和caspase-8等蛋白以及其底物的表达情况,对组织切片进行HE染色并通过TUNEL法分析组织凋亡和坏死的情况.结果 高脂血症性急性胰腺炎大鼠的血浆中血脂、游离脂肪酸等指标偏高;caspase-3和caspase-8活性片断表达下调,而其底物蛋白降解较少;TUNEL分析阳性率偏低,以上提示胰腺组织凋亡蛋白活性受到一定的抑制;另外,ADP与ATP比值相对较高,提示胰腺组织更易产生坏死反应.结论 笔者推测高脂血症可能通过促进大鼠胰腺组织由凋亡趋向坏死,从而加重急性胰腺炎病变程度.     

系统性红斑狼疮合并急性胰腺炎患者的护理

对6例系统性红斑狼疮合并急性胰腺炎患者采取有效的治疗措施,并严密观察病情,密切观察药物反应,熟悉药物性能,规范用药,进行积极有效的心理疏导,指导正确的饮食结构。6例患者均好转出院,出院后半年复查胰腺CT未出现假性囊肿。提出早发现、早诊断、早治疗,配合积极科学的护理措施,能有效控制系统性红斑狼疮合并急性胰腺炎患者病情,提高治疗效果。     

Direct retroperitoneal approach to necrosis in severe acute pancreatitis

From 1981 to 1987, 40 patients with severe acute pancreatitis were operated on using a direct retroperitoneal approach, 22 primarily and 18 after a first operation performed through another incision. The severity of the disease was assessed by Ranson's bioclinical and computed tomography scan scoring systems. The retroperitoneal approach consisted of a left lateral incision, just anterior to the 12th rib, allowing direct access to the pancreas and a complete manual exploration of the gland and peripancreatic spaces. All patients but one were operated on for infected necrosis. The overall mortality rate was 33 per cent but was lower in the patients operated on primarily through a direct retroperitoneal approach (18.2 per cent). Twenty patients (50 per cent) developed a local complication (haemorrhage, colon fistula and/or necrosis). The direct retroperitoneal approach permits the removal of necrosis and several reoperations without the risk of large wound dehiscence and does not preclude the extension of the incision to a subcostal incision when necessary.