Perdigón CG, Pérez JE, Rojas RC, Pérez GJC, Rodríguez BR, Fernández PL

Language: Spanish
References: 16
Page: 265-269
PDF size: 667.62 Kb.

ABSTRACT

Introduction: Patients with pancreatitis are assessed jointly by the practitioner and the radiologists, by using laboratory and office diagnosis methods. Amongst those methods, the helicoidal tomography is preferred along with the evaluation of the Ramson criteria and the Atlanta classification of 1992. An adequate assessment will result in an efficient treatment.
Material and Methods: 30 patients from the Hospital General Manuel Gea González, diganosed with severe acute pancreatitis, Balthazar DE, and/or complicated pancreatitis were included. The studies were performed with Simatzu Helicoidal CT equipment, in the simple and contrast phases. Percutaneous puncture was directed by CT and the Seldinger technique was applied.
Results: Out of the 30 patients, 10 received medical treatment, seven presented changes due to bleeding pancreatitis and underwent surgery. The remaining 13 patients developed pancreatic pseudo-cyst, one of which was infected and the other received percutaneous treatment. Pre-surgical preparation was completed on six patients; nine of the 30 patients showed clear and favorable results; more than one drain was placed to tour patients. All punctures were performed with the Cook drain set and 12- and 14-Fr pigtail catheters.
Conclusion: Interventionists offer diagnosis, treatment and prognosis. At times they provide the adequate pre-surgical conditions, which may be important since pancreatitis is a condition with a very high morbiditymortality rate. These procedures are aimed at reducing the hospital stay times and complications.
Discussion: Mortality depends on lethal complications which may coexist as from the start of the attack. Complications relate to abdominal pathology, retroperitoneal and septicemia, associated with necrosis of peripancreatic fat and the formation of pseudo-cysts. When early percutaneous drain of peripancreatic collections is performed, an important improvement in mortality rates is observed.

REFERENCES

1. Prokop Mathias, Galanski Michael, et al. Spiral and Multislice Computed Tomography of the Body. THIEME. Stuttgart-NY. 2003.

2. Ferrucci III Joseph T, Mueller Peter R. Interventional approach to pancreatic fluid collections. Radiologic Clinics of North America 2003;41 Nov.

3. Page by: E.J. Mayeaux, Jr., M.D. Louisiana State University Medical Center Shreveport, Louisiana.

4. Balthazar Ej, y cols. Acute Pancreatitis: Prognostic of CT. Radiology 1985. 156:767.

5. Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med 1994;330:1198.

6. Balthazar EJ, Ranson JHC, Naidich DP, et al. Acute pancreatitis: prognostic value of CT. Radiology 1985;156:767-72.

7. McKay CJ, Evans S, Sinclar M, et al. High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 1999;86:1302-6.

8. Lowham A, Lavelle J, Leese T. Mortality from acute pancreatitis. Int J Pancreatol 1999;25:103-6.

9. Talamini G, Bassi C, Falconi M, et al. Risk of death from acute pancreatitis. Int J Pancreatol 1996;19:15-24.

10. Beger HG, Rau B, Mayer J, et al. Natural course of acute pancretitis. World J Surg 1997;21:130-5.

11. Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis. Gastroenterol 1986;49:433-8.

12. Bassi C. Infected pancreatic necrosis. Int J Pancreatol 1994;16:1-10.

13. Gerzof SG, Banks PA, Robbins AH, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterol 1987;93:1315-20.

14. Freeny PC, Hauptmann E, Althaus SJ, et al. Percutaneous CT guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR 1998;170:969-75.

15. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994;193:297-306

16. Bittner R, Block S, Buchler M, et al. Pancreatic abscess and infected pancreatic necrosis: different local septic complications in acute pancreatitis. Dig Dis Sci 1987;32:1082-7.