Contemporary diagnosis and treatment of severe pancreatic necrosis complications

Abstract

Introduction: The last years are characterized by a considerable increase of frequency of acute pancreatitis which ranks third (6-9 %) out of the number of patients with acute surgical pathology of abdominal cavity, yielding to appendicitis and acute cholecystitis. Destructive forms of acute pancreatitis are considered one of the most difficult problems of gastroenterological surgery because of its high mortality rates, ranging between 25 – 50 % and more. The appraisal of complex diagnostic principles of severe pancreonecrosis. The appraisal of optimal methods of surgical treatment; and analysis of severe pancreonecrosis treatment results; and its complications in the early postoperative period. Materials and methods: We present the clinical material which includes the analysis of 22 patients diagnosed with severe pancreonecrosis treated at The Emergency Medicine Institute, in Septicpurulent Surgery during 2012-2015. Discussion results: The clinical state of these patients was dominated by pain syndrome, presented at 22 patients (100%), being the first clinical symptom. Afterwards, the dyspeptic syndrome appeared at 18 patients (81 %). The patients’ state at the moment of internment was assessed as being extremely critical at 6 (27%) patients, critical at 10 (45) patients, medium severity at 6 (27 %) patients. The diagnosis of pancreonecrosis was made on the basis of objective and subjective data, laboratory data, and methods of invasive and non-invasive investigation. Pancreonecrosis diagnosis was assessed based on ultrasound imaging at 12 patients (54,4%), based on computer tomography with intravenous contrast material at 8 patients (36,3%), based on laparoscopy at 2 patients (9%). The strategy of surgical treatment of complications caused by pancreonecrosis of all 22 patients consisted in necro-sequestrectomy, drainage of the lesser sac, bursoomentostomy at 21 patients (95%). Cholecystectomy was conducted in 6 patients (27%). Conclusions: The diagnostic algorithm of patients suffering from pancreonecrosis will compulsorily include clinical and biochemical analysis, ultrasound, computer tomography. Also, patients require special surgery treatment, necro-sequestrectomy and drainage of the lesser sac.