Bidiuk, Furtak, and Mykush: Rare Combinations of Late Complications of Acute Pancreatitis and Other Diseases



Problem statement and analysis of the recent research

Acute pancreatitis is a serious surgical disease which often is accompanied by complications, incapacitation and high mortality rates among patients. Pancreatitis – both acute and chronic - can be complicated by gastrointestinal bleeding, bleeding from pancreatic pseudocysts, intestinal obstruction, or perforation of peptic ulcers. The cases in which the aforementioned pathological processes were the main cause of hospitalization and lesions of the pancreas (abscess, pseudocyst) were diagnosed during treatment as a background disease are noteworthy.

The objective of the research was based on the analysis of clinical cases to draw attention to the possibility of the development of non-pancreatic pathological processes (peptic ulcers with perforation and bleeding, intestinal obstruction, myelofibrosis, splenomegaly) on the background of persistent late complications of acute pancreatitis.

Materials and methods

There was made a prospective analysis and description of 5 clinical cases in which late complications of acute pancreatitis were coincidentally detected. All the patients underwent inpatient treatment in surgical departments of Lviv Clinical Municipal Communal Emergency Hospital during the period 2014-2016. All the patients underwent clinical and instrumental examination: ultrasonography, X-ray radiography; fibrogastroscopy and computed tomography, in necessary.

Results

During the period of one year, 5 patients were admitted to different inpatient departments. Among them there were 2 persons with peptic ulcer complicated by perforation, 1 person with peptic ulcer complicated by bleeding, 1 person with acute adhesive intestinal obstruction and 1 patient with myelofibrosis and splenomegaly. In all these patients, the diagnosis was verified clinically, instrumentally and intraoperatively. It is important to note that each patient was previously diagnosed with pancreatic lesions which were successfully treated in surgical department. Nevertheless, in 2 patients with perforated peptic ulcers of the stomach pancreatic pseudocyst as a concomitant disease was found in one patient and pancreatic abscess was detected in the second one. Pancreatic pseudocyst was detected using a CT scan during the preoperative preparation. The suture of the perforated hole, external drainage of pancreatic pseudocyst and drainage of the abdominal cavity were done.

In patient with gastric ulcer perforation, symptoms of pancreatic abscess manifested themselves after the initial closure of the perforation and resulted in reoperation.

Another patient was admitted with the signs of bleeding duodenal ulcer. The pathological process was successfully cured by conservative treatment and endoscopic hemostatic procedures. A week after hemostasis, a rapid development of clinical symptoms of obstructive jaundice due to a pseudocyst of the pancreatic head was observed. The patient was cured by percutaneous drainage of pseudocyst.

The fourth patient was hospitalized with the manifestations of adhesive intestinal obstruction; he was surgically treated by the separation of adhesion in the area of ​​the small intestine. In the postoperative period, symptoms of systemic inflammatory response appeared, the source of which - an “old” pancreatic abscess - was detected using a CT scan. The patient was successfully treated by percutaneous drainage involving puncture.

The fifth patient was transferred from the hematology department with verified myelofibrosis and splenomegaly. During the course of treatment abdominal symptoms occurred, which were caused by bleeding of the tail of the pancreas into pseudocyst. Angiography was used to verify the pathological process which was treated by endovascular embolization of the affected vessels.

It should be emphasized that none of the patients had obvious symptoms of acute pancreatitis at admission to the hospital; it manifested itself as a background pathological process during treatment of the main disease.

Discussion

Late complications of acute pancreatitis being the indications for urgent hospitalization and treatment have been described in medical literature [2, 4-6, 9, 12]. In particular, cases of paralytic ileus and bowel obstruction [3], gastrointestinal bleeding [10], and ulcer perforation [11] have been described. The listed pathological processes appear as a complication of the underlying disease - acute pancreatitis, which is the object of primary surgical aggression [1, 7, 8]. We have described clinical cases that were initially manifested without the symptoms of acute pancreatitis and its complications (pseudocyst, abscess). According the anamnesis data, all patients had past pancreatic lesions which were successfully treated. However, as our observations shows (5 cases during the period of one year), they were not cured but treated to the point of asymptomatic course. The symptoms of abscesses and pseudocysts began to manifest themselves on the background of concomitant diseases thereby complicating the clinical course of the main pathological process and requiring the correction of the diagnostic and treatment tactics.

Conclusions

  • Modern therapy for acute pancreatitis improves the effectiveness of treatment of the disease, however, at the same time, results in the development of complications in the form of abscesses and pseudocysts.

  • The development of late complications of acute pancreatitis can occur uncontrollably and asymptomatically.

  • There are cases of acute surgical pathology in which complications of destructive pancreatitis begin to manifest as a background disease thereby changing and aggravating the course of the underlying disease.

Prospects for further research

The problem of the complications of acute pancreatitis requires further study and improvement of the diagnosis and treatment.

References

1 

DV Andriushchenko. Acute pancreatitis as a multidisciplinary issue of emergency abdominal surgery. Naukovyi visnyk Uzhhorodskoho universytetu, seriia "Medytsyna". 2014;2(50):26-30.

2 

PA Banks, ThL Bollen, Ch Dervenis, HG Gooszen, CD Johnson, MG Sarr, GG Tsiotos, SSw Vege. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111. doi:10.1136/gutjnl-2012-302779.

3 

DM Bidiuk, VP Andriushchenko, YuS Lysiuk, et al. Pathological process of duodenum in destructive pancreatitis. Bukovynskyi medychnyi visnyk. 2001;5(3):6-8.

4 

DM Bidiuk, AI Furtak. Clinical and epidemiological characteristics of late complications of acute pancreatitis. Pratsi NTSh Med Nauky. 2015;XLII:94-100.

5 

P Brahmbhatt, J McKinney, J Litchfield, M Panchal, T Borthwick, M Young, L Klosterman. Mediastinal pancreatic pseudocyst with hemorrhage and left gastric artery pseudoaneurysm, managed with left gastric artery embolization and placement of percutaneous trans-hepatic pseudocyst drainage. Gastroenterol Rep (Oxf). 2016;4(3):241-245. doi:10.1093/gastro/gou084. Cited in: PubMed; PMID 25502760. PMCid: PMC4976671

6 

K Eliason, DG Adler. Endoscopic ultrasound-guided transmural drainage of infected pancreatic necrosis developing 2 years after acute pancreatitis. Endosc Ultrasound. 2015;4(3):260-265. doi:10.4103/2303-9027.163020.

7 

P Gotzinger. Management der akuten Pankreatitis. Journal fur Gastroenterologische und Hepatologische Erkrankungen. 2010;8(1):14-18.

8 

IA Kryvoruchko, VM Kopchak, OYu Usenko. Classification of acute pancreatitis: revision of the Atlanta classification by international consensus in 2012. Klinichna khirurhiia. 2014;9:19-24.

9 

ML Cui, KH Kim, HG Kim, J Han, H Kim, KB Cho, et al. Incidence, Risk Factors and Clinical Course of Pancreatic Fluid Collections in Acute Pancreatitis. Dig Dis Sci. 2014 May;59(5):1055-1062. doi:10.1007/s10620-013-2967-4

10 

SS Rana, V Sharma, DK Bhasin, R Sharma, R Gupta, P Chhabra, M Kang. Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome. Trop Gastroenterol. 2015;36(1):31-35. doi:10.7869/tg.242. Cited in: PubMed; PMID 26591952

11 

JY Sun, DJ Sun, XJ Li, K Jiso, ZW Zhai. Laparoscopic treatment experience of severe acute pancreatitis complicated by peptic ulcer perforation. Eur Rev Med Pharmacol Sci. 2016;20(2):285-290. Cited in: PubMed; PMID 26875897

12 

E Upchurch. Local complications of acute pancreatitis. Br J Hosp Med (Lond). 2014;75(12):698-702. doi:10.12968/hmed.2014.75.12.698. Cited in: PubMed; PMID 25488533



Copyright (c) 2017 D. M. Bidiuk, A. I. Furtak, A. M. Mykush

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


IFNMU Logo

Free counters!