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Complete pancreatic transection secondary to severe acute pancreatitis
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Abstracts / Pancreatology 15 (2015) e1ee17
anemia and alterations in bone metabolism, which are also common in the exocrine pancreatic insufficiency (EPI). Objectives: To assess the existence of IPE in patients with CRD stage 4, 5 and dialysis have been transplanted or not. Material and methods: The patients who have been watching prospectively in the Nephrology Department of Hospital General ManchaCentro, and had no previous pancreatic surgery or surgery were included gastroduodenal framework. All of them underwent breath test 13C-MTG, and the coefficient 13CO2 / 12CO2 was determined by spectrometry normally considered if the percentage of 13CO2 recovery was> 29%. Results: 36 patients (24H / 12M), with a mean age of 71 ± 12 years were analyzed. Mean creatinine was 4.13 ± 1.13 mg / dl. 34 patients had arterial hypertension and diabetes mellitus past 16. Only pancreatic function test in 30 patients (22H / 8M), as 6 refused to do so. 19 patients were stage 4 or 5, and received dialysis or transplant 11. IPE was found in 12 patients: 6 CRD stage 4 or 5 (31.5%) and the other 6 in patients on dialysis or kidney transplant (54.5%). Of patients with IPE, 6 were smokers or former smokers, and of these, 4 were also former drinkers. The mean test pancreatic function in CRD stage 4 or 5 was 33%, while in dialysis patients was 23.7%. Conclusions: IPE in CRD has had more prevalence than expected, being more frequent in patients on dialysis or have received it. There seems to be bad relationship between renal function and an increased frequency of IPE. But these data do not indicate chronic pancreatitis.
19. Malnutrition and diabetes in biliopancreatic malignancy: Multimodal support (nutritional-digestive-metabolic) M. Molina-Vega, J.M. Garcia-Almeida, Y. Eslava-Cea, J. Roldan de la Rua, ~ oz, F. Tinahones-Maduen ~o M.A. Suarez-Mun Hospital Universitario Virgen de la Victoria, Malaga, Spain Objective: To evaluate the evolution of a group of patients entered into a medical-surgical protocol for patient care after pancreatectomy. Treatment of malnutrition, hyperglycemia and exocrine pancreatic insufficiency is performed. Material and methods: 25 patients with pancretectomy 2013-2015. We analyzed demographic, clinical-analytic and surgical data. We compared the nutritional status and metabolic control in the preoperative period and in the immediate postoperative period. Results: Our 25 patients: 28% women, 72% men. Mean age 63.56±10 years. Tobacco and alcohol use: 52% no, 8% alcohol, 24% tobacco, 16% alcohol and tobacco. 32% type 2 diabetes mellitus (DM-2). Other comorbidities: 66.7% no, 12.5% 2 comorbidities, 20.8% over 2 comorbidities. Mean Barthel index: 91.6±18.59. Histopathological diagnosis: 52% adenocarcinoma, 16% neuroendocrine tumors, 24% others. Tumor stage: IA 17%, IB 24%, IIA 6%, IIB 47%, IV 6%. Surgical techniques: Cephalic duodenopancreatectomy with preservation of the pylorus (CDPP) and pancreaticojejunal anastomosis 26%, CDPP and pancreatico-gastric anastomosis 17.4%, total duodenopancreatectomy 26%, corporeo-caudal pancreatectomy and splenectomy 30.6%. Nutritional status in the preoperative period and in the immediate postoperative period (table 1): we observed statistically significant differences in BMI, albumin and CPR. Subjective Global Assessment (SGA): preoperative period: 56.4% well nourished, 21.8% risk of malnutrition, 21.8% obvious signs of malnutrition; immediate postoperative period 100% malnourished. From 68% of nondiabetic patients at baseline time, 17.6% require insulin therapy at hospital discharge. Conclusions: Significant deterioration of nutritional status in patients undergoing pancreatectomy requires protocols involvig all professionals to ensure proper approach. In many cases, these patients develop diabetes requiring insulin therapy.
20. Complete pancreatic transection secondary to severe acute pancreatitis ndez 1, R. Villagrasa 2, F. J.M. Gamez del Castillo 1, O. Ferro 1, M.C. Ferna es 1, V. Sanchiz 2, L. Sabater 1, J. Ortega 1 Morera 1, M. Garc 1 Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario de Valencia, Spain 2 Servicio de Gastroenterología, Hospital Clínico Universitario de Valencia, Spain
Introduction: Disconnected pancreatic duct syndrome (DPDS) is characterized by the absence of pancreatic duct continuity such that a viable left side of the pancreas does not drain downstream into the gastrointestinal tract. The most common causes of this syndrome are severe acute pancreatitis and pancreatic trauma, with an estimated incidence of 10-30% in pancreatitis. Nevertheless, the best diagnosis method and management are still controversial. The aim of this presentation is to report an extremely severe grade of DPDS such as the complete transection of the pancreatic parenchyma in acute pancreatitis. Clinical case: A 56 year-old female, was admitted at a community hospital due to acute severe pancreatitis and treated accordingly during 3 months. A percutaneous drainage of a pseudocyst was performed, leading to a subsequent enterocutaneous pancreatic fistula. Several ERCP were performed in order to treat the pancreatic fistula but the pancreatic duct could not be stented. The patient was discharged after sealing of the fistula and sent to our Pancreatic Unit for follow up. Clinical evaluation and MRI/ endoscopic ultrasonography were performed on an outpatient basis during the following 2 years. She then developed abdominal pain and a marked increase of the pancreatic duct was observed in MRI. An endoscopic ultrasonography revealed a clear increase of the distal pancreatic duct suspicious of IPMN and surgical exploration was indicated. At surgery a complete transection of the pancreas was demonstrated with absence of any tissue between the head and neck of the pancreas and therefore distal pancreatectomy with splenectomy was carried out. After an uneventful recovery the patient was discharged after 7 days. The histological evaluation did not confirm the presence of IPMN but chronic pancreatitis was diagnosed. Discussion and conclusions: DPDS is a complication diagnosed more frequently in acute pancreatitis. There is limited information on the natural history, clinical characteristics, and outcomes of DPDS. Therefore there is little consensus about the appropriate management of this pathology and whether it should be endoscopic or surgical. Endoscopy is associated with a low morbidity and high rate of relapses, but surgery has a higher rate of success with an increase of morbidity.
21. Pseudoaneurysm of the superior mesenteric artery: A life-threatening complication after pancreatic surgery ~ oz 1, J.M. Gamez del O. Ferro 1, J. Soria 1, J. Guijarro 2, M. Garc es 1, E. Mun Castillo 1, L. Sabater 1, J. Ortega 1 1 Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario de Valencia, Spain 2 Servicio de Radiología Intervencionista, Hospital Clínico Universitario de Valencia, Spain
Introduction: Postpancreatectomy haemorrhage is one of the most dangerous complications after pancreatic surgery. An infrequent but potentially life-threatening cause of such haemorrhages is the rupture of a pseudoaneurysm of the superior mesenteric artery (SMA). The traditional surgical approach is associated with a high mortality rate. Aim: The aim of this presentation is to report the treatment of a pseudoaneurysm of the SMA after pancreatoduodenectomy successfully treated by endovascular techniques.
Abstracts / Pancreatology 15 (2015) e1ee17
anemia and alterations in bone metabolism, which are also common in the exocrine pancreatic insufficiency (EPI). Objectives: To assess the existence of IPE in patients with CRD stage 4, 5 and dialysis have been transplanted or not. Material and methods: The patients who have been watching prospectively in the Nephrology Department of Hospital General ManchaCentro, and had no previous pancreatic surgery or surgery were included gastroduodenal framework. All of them underwent breath test 13C-MTG, and the coefficient 13CO2 / 12CO2 was determined by spectrometry normally considered if the percentage of 13CO2 recovery was> 29%. Results: 36 patients (24H / 12M), with a mean age of 71 ± 12 years were analyzed. Mean creatinine was 4.13 ± 1.13 mg / dl. 34 patients had arterial hypertension and diabetes mellitus past 16. Only pancreatic function test in 30 patients (22H / 8M), as 6 refused to do so. 19 patients were stage 4 or 5, and received dialysis or transplant 11. IPE was found in 12 patients: 6 CRD stage 4 or 5 (31.5%) and the other 6 in patients on dialysis or kidney transplant (54.5%). Of patients with IPE, 6 were smokers or former smokers, and of these, 4 were also former drinkers. The mean test pancreatic function in CRD stage 4 or 5 was 33%, while in dialysis patients was 23.7%. Conclusions: IPE in CRD has had more prevalence than expected, being more frequent in patients on dialysis or have received it. There seems to be bad relationship between renal function and an increased frequency of IPE. But these data do not indicate chronic pancreatitis.
19. Malnutrition and diabetes in biliopancreatic malignancy: Multimodal support (nutritional-digestive-metabolic) M. Molina-Vega, J.M. Garcia-Almeida, Y. Eslava-Cea, J. Roldan de la Rua, ~ oz, F. Tinahones-Maduen ~o M.A. Suarez-Mun Hospital Universitario Virgen de la Victoria, Malaga, Spain Objective: To evaluate the evolution of a group of patients entered into a medical-surgical protocol for patient care after pancreatectomy. Treatment of malnutrition, hyperglycemia and exocrine pancreatic insufficiency is performed. Material and methods: 25 patients with pancretectomy 2013-2015. We analyzed demographic, clinical-analytic and surgical data. We compared the nutritional status and metabolic control in the preoperative period and in the immediate postoperative period. Results: Our 25 patients: 28% women, 72% men. Mean age 63.56±10 years. Tobacco and alcohol use: 52% no, 8% alcohol, 24% tobacco, 16% alcohol and tobacco. 32% type 2 diabetes mellitus (DM-2). Other comorbidities: 66.7% no, 12.5% 2 comorbidities, 20.8% over 2 comorbidities. Mean Barthel index: 91.6±18.59. Histopathological diagnosis: 52% adenocarcinoma, 16% neuroendocrine tumors, 24% others. Tumor stage: IA 17%, IB 24%, IIA 6%, IIB 47%, IV 6%. Surgical techniques: Cephalic duodenopancreatectomy with preservation of the pylorus (CDPP) and pancreaticojejunal anastomosis 26%, CDPP and pancreatico-gastric anastomosis 17.4%, total duodenopancreatectomy 26%, corporeo-caudal pancreatectomy and splenectomy 30.6%. Nutritional status in the preoperative period and in the immediate postoperative period (table 1): we observed statistically significant differences in BMI, albumin and CPR. Subjective Global Assessment (SGA): preoperative period: 56.4% well nourished, 21.8% risk of malnutrition, 21.8% obvious signs of malnutrition; immediate postoperative period 100% malnourished. From 68% of nondiabetic patients at baseline time, 17.6% require insulin therapy at hospital discharge. Conclusions: Significant deterioration of nutritional status in patients undergoing pancreatectomy requires protocols involvig all professionals to ensure proper approach. In many cases, these patients develop diabetes requiring insulin therapy.
20. Complete pancreatic transection secondary to severe acute pancreatitis ndez 1, R. Villagrasa 2, F. J.M. Gamez del Castillo 1, O. Ferro 1, M.C. Ferna es 1, V. Sanchiz 2, L. Sabater 1, J. Ortega 1 Morera 1, M. Garc 1 Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario de Valencia, Spain 2 Servicio de Gastroenterología, Hospital Clínico Universitario de Valencia, Spain
Introduction: Disconnected pancreatic duct syndrome (DPDS) is characterized by the absence of pancreatic duct continuity such that a viable left side of the pancreas does not drain downstream into the gastrointestinal tract. The most common causes of this syndrome are severe acute pancreatitis and pancreatic trauma, with an estimated incidence of 10-30% in pancreatitis. Nevertheless, the best diagnosis method and management are still controversial. The aim of this presentation is to report an extremely severe grade of DPDS such as the complete transection of the pancreatic parenchyma in acute pancreatitis. Clinical case: A 56 year-old female, was admitted at a community hospital due to acute severe pancreatitis and treated accordingly during 3 months. A percutaneous drainage of a pseudocyst was performed, leading to a subsequent enterocutaneous pancreatic fistula. Several ERCP were performed in order to treat the pancreatic fistula but the pancreatic duct could not be stented. The patient was discharged after sealing of the fistula and sent to our Pancreatic Unit for follow up. Clinical evaluation and MRI/ endoscopic ultrasonography were performed on an outpatient basis during the following 2 years. She then developed abdominal pain and a marked increase of the pancreatic duct was observed in MRI. An endoscopic ultrasonography revealed a clear increase of the distal pancreatic duct suspicious of IPMN and surgical exploration was indicated. At surgery a complete transection of the pancreas was demonstrated with absence of any tissue between the head and neck of the pancreas and therefore distal pancreatectomy with splenectomy was carried out. After an uneventful recovery the patient was discharged after 7 days. The histological evaluation did not confirm the presence of IPMN but chronic pancreatitis was diagnosed. Discussion and conclusions: DPDS is a complication diagnosed more frequently in acute pancreatitis. There is limited information on the natural history, clinical characteristics, and outcomes of DPDS. Therefore there is little consensus about the appropriate management of this pathology and whether it should be endoscopic or surgical. Endoscopy is associated with a low morbidity and high rate of relapses, but surgery has a higher rate of success with an increase of morbidity.
21. Pseudoaneurysm of the superior mesenteric artery: A life-threatening complication after pancreatic surgery ~ oz 1, J.M. Gamez del O. Ferro 1, J. Soria 1, J. Guijarro 2, M. Garc es 1, E. Mun Castillo 1, L. Sabater 1, J. Ortega 1 1 Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario de Valencia, Spain 2 Servicio de Radiología Intervencionista, Hospital Clínico Universitario de Valencia, Spain
Introduction: Postpancreatectomy haemorrhage is one of the most dangerous complications after pancreatic surgery. An infrequent but potentially life-threatening cause of such haemorrhages is the rupture of a pseudoaneurysm of the superior mesenteric artery (SMA). The traditional surgical approach is associated with a high mortality rate. Aim: The aim of this presentation is to report the treatment of a pseudoaneurysm of the SMA after pancreatoduodenectomy successfully treated by endovascular techniques.