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Abdominal Injuries
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Pancreatic injuries are among the most challenging and complicated to deal with. However, there are some practical issues in the context of forward surgery. First, the diagnosis of the pancreatic injury is very difficult, especially with no CT scanner. It should be suspected when peri-pancreatic haematoma is seen and confirmed after opening of the lesser sac. If the patient is operated a few hours after the injury, the signs of steatonecrosis (white patches) might appear around the pancreas, on omentum, or on the root of mesentery – indicative of pancreatic injury. Most injuries to the pancreas with no main pancreatic duct involvement may be successfully treated by adequate drainage alone and supportive therapy, including somatostatin and total parenteral nutrition. Only when the Virsung duct is transected are more complex and sophisticated surgical intervention is required – but this does not require definitive primary surgery! The best solution to define the extent of the pancreatic injury is not to perform aggressive pancreatic exploration. Minor damage may be easily converted to the big problem! Simply looking at the pancreatic surface and minimal haematoma evacuation may provide the necessary information about the next steps (Figure 10.17). If the pancreatic head is destroyed, drain it! If there is complete transection of the neck of pancreas is diagnosed, close both pancreatic sides using a stapling device, or multiple U-stitches. Neither Whipple’s procedure nor distal pancreatectomy is recommended!
Hepatobiliary Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Key Facts➢ Pancreatitis is an inflammatory process of the pancreas, resulting in release of inflammatory cytokines and pancreatic enzymes (amylase, trypsin, lipase etc), initiated by pancreatic injury.➢ It can vary from a mild attack to developing into full blown SIRS (systemic inflammatory response syndrome)
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Pancreatic and combined pancreaticoduodenal injuries remain a dilemma for most surgeons and, despite advances and complex technical solutions, they still carry a high morbidity and mortality. The increase in penetrating injuries throughout the world, and the increase in wounding energy from gunshots, has made the incidence of pancreatic injury more common. Pancreatic injury must be suspected in all patients with abdominal injuries, even those who initially have few signs. Since the pancreas is retroperitoneal, it usually does not present with peritonitis. It requires a high level of suspicion and significant clinical acumen, as well as aggressive radiographic imaging to identify an injury early.
Increased heat shock protein 70 expression attenuates pancreatic fibrosis induced by dibutyltin dichloride
Published in Scandinavian Journal of Gastroenterology, 2018
Jae Min Lee, Kwang Gyun Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
Chronic pancreatitis is characterized by destruction of the pancreatic parenchyma and fibrosis due to repeated stimulus and damage and presents as a deterioration of pancreatic exocrine function and loss of endocrine function [1]. Chronic pancreatitis is related to recurrent pancreatic injury in acute pancreatitis. Although previous studies have investigated the mechanisms that lead to chronic pancreatitis [2,3], the treatment for chronic pancreatitis has not been clearly elucidated. Moreover, although various methods to treat chronic pancreatitis have been employed, such as digestive enzyme supplementation [4–7], antioxidant therapy [8,9], endoscopy [10,11], and surgery [12,13], their effects have not been established. Therefore, a new idea and approach would be required to treat chronic pancreatitis. Various experimental models of pancreatitis are available [14]; however, animal models of chronic pancreatitis should be validated before treatment evaluation.
Lifetime alcohol intake and pattern of alcohol consumption in patients with alcohol-induced pancreatitis in comparison with patients with alcohol use disorder
Published in Scandinavian Journal of Gastroenterology, 2018
Sigurdur Jon Juliusson, Jon Kristinn Nielsen, Valgerdur Runarsdottir, Ingunn Hansdottir, Ragna Sigurdardottir, Einar S. Björnsson
A high proportion of distilled spirits of total alcohol consumption was suggested to be a risk factor for increased incidence of acute alcoholic pancreatitis, after an observed decline of acute and chronic pancreatitis in Sweden following a decline in sales of distilled spirits between 1971–1987 [34]. A similar decline in acute pancreatitis was observed in Finland between 1987–2007, although alcohol consumption and the incidence of liver cirrhosis in the country increased [18]. The authors suggested that tobacco smoking might play a role, as the percentage of daily smokers decreased among Finnish men from 35% in the early 1980s to 24% in 2006 [18]. An important study using a Swedish cohort of 84.601 individuals found a dose–response association between the amount of spirits consumed on a single occasion and the risk of acute pancreatitis, but not with wine or beer consumption [35]. In line with the results by Sadr Azodi et al. the results of the current study do not suggest that consumption of spirits out of the total alcohol consumption plays a major role in the development of alcoholic pancreatitis. In fact, consumption of spirits was more common in the AUD group and significantly more common in males with AUD. Patients with moderate and severe pancreatitis reported less binge drinking than those with mild pancreatitis. This again supports the idiosyncratic nature of the alcohol induced pancreatic injury.
Acute pancreatitis in COVID-19 patients: true risk?
Published in Scandinavian Journal of Gastroenterology, 2021
Margo C. Bulthuis, Lotte Boxhoorn, Martijn Beudel, Paul W. G. Elbers, Marnix P. M. Kop, Roy L. J. van Wanrooij, Marc G. Besselink, Rogier P. Voermans
We hypothesize that, in the absence of a clear aetiology, severely ill patients with COVID-19 rather develop acute pancreatitis as a result of transient hypoperfusion and pancreatic ischemia, than as a direct effect of SARS-CoV-2. The role of ischemia in the pathogenesis of acute pancreatitis has been well documented after cardiac surgery [11]. All patients included in our study suffered from severe COVID-19 infection; all had (multiple) organ failure and 60% died. Moreover, only one patient was diagnosed with acute pancreatitis at admission, the others were diagnosed during admission when clinically deteriorating. Our hypothesis is supported by previous research demonstrating that pancreatic injury occurs more frequently in patients with severe illness [3].