Evaluation and Prognosis of Surgical Intervention for Severe Acute Pancreatitis in Al-Diwaniyah Teaching Hospital

Adel Shaker Al Tamimi; Muhammed Jaleel Amana

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Adel Shaker Al Tamimi MD FACS CABS FICMS consultant general and laparoscopic surgeon Department of surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
Muhammed Jaleel Amana M B CH B candidate of Iraqi board of medical specialization of general surgery

Vol. 2 No. 7 (2024): International Journal of Integrative and Modern Medicine

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July 20, 2024

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Background Acute pancreatitis can range from a mild, self-limiting process that responds to supportive care to severe disease with multiple organ failure and high mortality. Its incidence is increasing ,and pancreatitis is one of the most common causes of hospital admission for gastrointestinal illness. Objectives: To evaluate surgical intervention and its prognosis in severe acute pancreatitis in AL-Diwaniyah Teaching Hospital. . Patients and methods: A prospective study was conducted in general surgery department, in Al-Diwanyiah Teaching Hospital during the period between January 2018 and march 2021,76 patients with acute pancreatitis were admitted to the surgical ward, among them 31 patients(40.7%) were diagnosed as sever acute pancreatitis in whom 19 patients(25%) underwent surgical intervention. All patients were assessed at admission and 48 there after using the Ranson and, APACHE-II scoring system and classified according to the revised Atlanta scoring system. Results: From those 76 patients, 31 patients diagnosed as severe acute pancretitis(40.7%),from whom 19 patients (25%) underwent surgical intervention, among these biliary was the most common etiology (73.68%) while alcohol was (5.2%). Pseudocyst represented the most frequent indication for surgery (31.57%),followed by infected pancreatic necrosis(15.7%),while colonic perforation and bleeding were the least frequent (5.26%) for each. Conclusion :Multidisciplinary approach in the management of acute pancreatitis is highly recommended.Severe forms of acute pancreatitis should be managed in centers with special and sophisticated facilities if available.Surgery should be avoided in the early phases of severe acute pancreatitis except the special occasions of perforations or bleeding.Pancreatic necrosectomy for infected pancreatic necrosis with or without organ failure is a lifesaving .Intervention in the early phases of pancreatic pseudocyst involution almost doomed with recurrence.

Adel Shaker Al Tamimi, & Muhammed Jaleel Amana. (2024). Evaluation and Prognosis of Surgical Intervention for Severe Acute Pancreatitis in Al-Diwaniyah Teaching Hospital. International Journal of Integrative and Modern Medicine, 2(7), 169–183. Retrieved from https://medicaljournals.eu/index.php/IJIMM/article/view/802

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Schwartz principles of surgery 11th edition p.1429

Baily and Love short practice of surgery 27th edition p.1221

Saluja A, Steer M. Pathophysiology of pancreatitis. Role of cytokines and other mediators of inflammation. Digestion1999;60:27-33.

Shackelford's surgery of the Alimentary tract 8th edition ch.91 p.1076,p.1077

BLUMGART'S Surgery of the Liver, Biliary Tract, and Pancreas 6th edition ch.55 p.883 .

Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102-111. And Working Group IAP/AAP. International Association of Pancreatology/ American Pancreatic Association evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1-e15.

Gravante G, Garcea G, Ong SL, et al. Prediction of mortality in acute pancreatitis: a systematic review of the published evidence.Pancreatology. 2009;9:601-614

Ranson JHC. Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol. 1982;77:633 and from Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. SurgGynecol Obstet.1974;139:6

ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE) II SCORE – THE CLINICAL PREDICTOR IN NEUROSURGICAL INTENSIVE CARE UNIT.

Phuping Akavipat(1), Jadsada Thinkhamrop(2), Bandit Thinkhamrop(3) and Wimonrat Sriraj(4)

Anesthesiology Department, Prasat Neurological Institute, Bangkok, Thailand; 2.Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; 4.Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Clinical practice guideline: management of acute pancreatitis,Joshua A. Greenberg, MD Jonathan Hsu, MD Mohammad Bawazeer, MD John Marshall, MD Jan O. Friedrich, MD Avery Nathens, MD Natalie Coburn, MD Gary R. May, MD Emily Pearsall, MSc Robin S. McLeod, MD.

Johnson CD, Kingsnorth AN, Imrie CW, et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut2001;48:62–9.

Whitcomb DC: Acute pancreatitis, N Engl J Med 354:2142–2150, 2006. Frossard JL, et al: Acute pancreatitis, Lancet 371:143–152, 2008.

Yokoe M, et al: Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2016, J HepatobiliaryPancreat Sci22:405–432, 2015.

Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254-1263. McKay CJ, Imrie CW. The continuing challenge of early mortality in acute pancreatitis. Br J Surg. 2004;91:1243-1244.

Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG. Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology. 2001;1:237-241.

Baily and Love short practice of surgery 27th edition p.1215 .

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-336.

Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT.Radiology. 1985;156(3):767-772.

Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Ann Chir. 1993;47(6):537-541.

Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999;25(3):195-210.

Arvanitakis M, Delhaye M, De Maertelaere V, et al. Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology. 2004;126(3):715-723.

Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. J Am Med Assoc. 1995;274:1870-1873.

Gardner TB, Vege SS, Chari ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology. 2009;9:770-776.

Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. ClinGastroenterolHepatol. 2011;9:705-709.

Working Group IAP/APA. International Association of Pancreatology/ American Pancreatic Association evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1-e15.

Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. ClinGastroenterolHepatol. 2011;9:710-717.e1.

Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2010;(5):CD002941.

Jiang K, Huang W, Yang XN, Xia Q. Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol. 2012;18:279-284.

Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev. 2010;(1):CD002837.

Rahman SH, Ammori BJ, Holmfield J, Larvin M, McMahon MJ. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis. J Gastrointest Surg. 2003;7:26-35 [discussion 35–36].

Fritz S, Hackert T, Hartwig W, et al. Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg. 2010; 200:111-117.

SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT, EIGHTH EDITION page 1079.

Da Costa DW, Bouwense SA, Schepers NJ, et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis(PONCHO): a multi-centre randomised controlled trial. Lancet. 2015;386:1261-1268.

Nealon WH, Bawduniak J, Walser EM. Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections. Ann Surg. 2004;239:741-749.

Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev. 2012;5:CD009779.

Hernandez V, Pascual I, Almela P, et al. Recurrence of acute gallstone pancreatitis and relationship with cholecystectomy or endoscopic sphincterotomy. Am J Gastroenterol.2004;99(12):2417-2423.

Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176-1194.

Sarr MG, Nagorney DM, Mucha P Jr, Farnell MB, Johnson CD. Acute necrotizing pancreatitis: management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains. Br J Surg. 1991;78(5):576-581.

Beger HG. Operative management of necrotizing pancreatitis: necrosectomy and continuous closed postoperative lavage of the lesser sac. Hepatogastroenterology. 1991;38(2):129-133.

Fernandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg.1998;228(5):676-684.

Beger HG, Isenmann R. Surgical management of necrotizing pancreatitis. SurgClin North Am.1999;79(4):783-800, ix.

Davidson ED, Bradley EL 3rd. “Marsupialization” in the treatment of pancreatic abscess. Surgery.1981;89(2):252-256.

Baron TH, Morgan DE, Vickers SM, Lazenby AJ. Organized pancreatic necrosis: endoscopic, radiologic, and pathologic features of a distinct clinical entity. Pancreas. 1999;19(1):105-108.

Navaneethan U, Vege SS, Chari ST, Baron TH. Minimally invasive techniques in pancreatic necrosis. Pancreas.2009;38(8):867-875.

Melman L, Azar R, Beddow K, et al. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystogastrostomy for pancreatic pseudocysts. SurgEndosc. 2009;23(2):267-271.

Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet. 2000;356(9230):653-655.

Loveday BP, Petrov MS, Connor S, et al. A comprehensive classification of invasive procedures for treating the local complications of acute pancreatitis based on visualization, route, and purpose Pancreatology. 2011;11(4):406-413.

Widdison and Karanjia in Br J Surg80:148–154, 1993; Ogawa et al. in Research of the actual situations of acute pancreatitis. Research Group for Specific Retractable Diseases, Specific Disease Measure Research Work Sponsored by Ministry of Health, Labour, and Welfare. Heisei 12 Research Report, pp 17–33, 2001).

Ogawa et al. 2001; Bradely andAllen in Am J Surg 161:19–24, 1991; Rattner et al. in Am. J Surg 163:105–109, 1992).

Pitchumoni CS, Patel NM, Shah P (2005) Factors influencing mortality in acute pancreatitis: can we alter them? J ClinGastroenterol 39: 798–814.

Pezzilli R, Billi P, Morselli-Labate AM (1998) Severity of acute pancreatitis: relationship with etiology, sex and age. Hepatogastroenterology 45: 1859–1864.

Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB (2001) Acute pancreatitis: does gender matter? Dig Dis Sci 46: 2470–2474.

The global, regional, and national burden of pancreatitis in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.GuoqingOuyang, Guangdong Pan , Qiang Liu, Yongrong Wu, Zhen Liu, Wuchang Lu, Shuai Li, Zheng Zhou& Yu Wen.

Acute Pancreatitis Classifications: Basis and Key Goal .Xiao Dong Xu, MD, PhD, Zhe Yuan Wang, MD, PhD, Ling Yi Zhang, MD, Rui Ni, MD, Feng Xian Wei, MD ,Wei Han, MD, PhD, Hui Han Zhang, MD, Ya Wu Zhang, MD, Zhen Gang Wei, MD, Xiao Hu Guo, MD,Liu Qiang Guo MD , Jian Zhong Ma, MD, and You Cheng Zhang, MD, PhD.

Evaluation and management of acute pancreatitis Ahmed T Chatila, Mohammad Bilal, Praveen Guturu. World J Clin Cases 2019 May 6; 7(9): 1006-1020

Acute renal failure in patients with acute pancreatitis: prevalence, risk factors, and outcome. D D Tran , P L Oe, C W de Fijter, J van der Meulen, M A Cuesta PMID: 8272219

Etiology, clinical characteristics, and outcomes of acute pancreatitis in patients at Assiut University Hospital. Enas Ahmed Reda Alkareemy, Lobna Abdel-Wahid Ahmed, Muhammad Abbas El-Masry, Hany Ayad Habib , Mohamed H. Mustafa. Egyptian Journal of internal medicine 2020.

Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM. Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas. 2008 Mar;36(2):105-12

Surgery for Acute Pancreatitis Suresh Navadgi1 & Sanjay Pandanaboyana1,2 & John A. Windsor1,2 Indian J Surg (September–October 2015) 77(5):446–452

Branum G, Galloway J, Hirchowitz Wet al (1998) Pancreatic necrosis: results of necrosectomy, packing, and ultimate closure over drains. Ann Surg 227:870–877

Windsor JA (2007) Minimally invasive pancreatic necrosectomy. Br J Surg 94(2):132–133

Szentkereszty Z, Kerekes L, Hallay J, et al. CT guided percutaneous drainage in the treatment of acute necrotizing pancreatitis. Magyar Sebeszet 2001;54:11–14.

PEG for debridement of organized pancreatic necrosis. Gastrointest Endosc1999;50:574–7.

Gagner M. Laparoscopic treatment of acute necrotizing pancreatitis. SeminLaparoscSurg 1996;3:21–8.

Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology. 2001;1:306–313.

T. Miranda-Aquinoa, , S.E. Pérez-Topetea, J.M. Guajardo-Esparzab, J.A. González-Gonzálezc Colon necrosis secondary to acute pancreatitis: A case report and literature review Revista de Gastroenterología de México. 2016; 81(4) :230---235.

Anthony A. Aghenta,* and Hack J. Kim An Unusual Case of Colon Perforation Complicating Acute Pancreatitis Case Rep Gastroenterol. 2009 May-Aug; 3(2): 207–213.

Klar E, Werner J. New pathophysiological findings in acute pancreatitis. Chirurgia 2000;71:253–64

Mithofer K, Mueller PR, Warshaw AL. Interventional and surgical treatment of pancreatic abscess. World J Surg 1997;21:162–8.

Gloor B, Mu¨ller C, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:9759.

Severe acute pancreatitis: overall and early versus late mortality in intensive care units, Vesna Bumbasirevic et al. Pancreas. 2009 Mar.

Buter A, Imrie C, Carter C, et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89:298–302.

Buchler MW, Gloor B, Mu¨ller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg2000;232:619–26.

Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–73.

Werner J, Uhl W, Bu¨chler M. Surgical treatment of acute pancreatitis. Curr Treat Options Gastroenterol 2003;6:359–68.

Widdison AL, Karanjia ND. Pancreatic infection complicating acute pancreatitis. Br J Surg 1993;80:148–54.

International Journal of Integrative and Modern Medicine

Evaluation and Prognosis of Surgical Intervention for Severe Acute Pancreatitis in Al-Diwaniyah Teaching Hospital

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