Pancreatitis aguda: costos en un hospital universitario en Chile / Acute pancreatitis: costs in a university hospital in Chile

Background: Acute pancreatitis (AP) is a common disease. There is no information available on the costs of treatment in Chile. Aim: To obtain information on the cost of hospitalization for AP and identify the factors that influence the account, to analyze health insurance coverage and the economic charge for the patient. Patients and Method: Retrospective and descriptive study. Patients treated at the Hospital Clínico Universidad de Chile with diagnosis of AP between May 1, 2014 and April 30, 2016 were included. The clinical records were reviewed after the patient's discharge. Demographic characteristics, clinical evolution, the account issued, the insurance payment and patient's copayment were registered. Results: In the period studied, 176 patients (90 women) were discharged with diagnosis of AP. The dominant etiology was biliary in 61%. According to the Atlanta 2013 classification, 78.4% of the cases were mild, 10.2% moderate, and 11.4% severe. 3 patients (1.7%) died. The median cost in Chilean pesos was $ 2,537,918 (1,383,151-3,897,673) (p25-75). The total sum of the accounts of 176 patients was $ 885,261,241, with an average of $ 5,029,893. The average coverage of the health system (FONASA or ISAPRE) was $ 4,293,113, leaving a copayment of $ 801,661. The final cost was related to the severity of the disease, the length of hospitalization and the need for a high-complexity bed. Discussion: Hospitalization costs for PA are high. It is advisable to rationalize the critical care bed indication.

Introducción: La pancreatitis aguda (PA) es una patología frecuente. No hay información disponible del costo de su tratamiento en Chile. Objetivo: Obtener información del costo de hospitalización por PA, identificar los factores que influyen en la cuenta, estudiar la cobertura por seguros de salud y el cargo económico para el paciente. Pacientes y Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes tratados en el Hospital Clínico Universidad de Chile con diagnóstico de PA entre 01 de mayo de 2014 y 30 de abril de 2016. Las fichas clínicas fueron revisadas después del alta del paciente, se registraron sus características demográficas, evolución clínica, la cuenta emitida, el pago del seguro y el copago del paciente. Resultados: En el periodo estudiado 176 pacientes (90 mujeres) fueron dados de alta con diagnóstico de PA. La etiología dominante fue biliar en 61% . Según la clasificación de Atlanta 2013, 78,4% de los casos fueron leves, 10,2% moderados y 11,4% severos. Fallecieron 3 pacientes (1,7%). La mediana de costos fue de $2.537.918 (1.383.151-3.897.673) (p25-75). La suma total de las cuentas de 176 pacientes fue de $ 885.261.241, con un promedio de $ 5.029.893. La cobertura promedio del sistema de salud (FONASA o ISAPRE) fue de $ 4.293.113 dejando un copago de $ 801.661. El costo final se correlacionó con la severidad de la enfermedad, la duración de la hospitalización y la necesidad de cama de alta complejidad. Discusión: Los costos de hospitalización por PA son elevados. Es recomendable racionalizar la indicación de cama crítica.

Pancreatitis aguda por hipertrigliceridemia severa, caracterización en un hospital terciario / Acute pancreatitis due to severe hypertriglyceridemia, characterization in a tertiary hospital

La hipertrigliceridemia severa es una de las principales causas etiológicas de la pancreatitis aguda, donde la literatura internacional la posiciona como la tercera causa. Sus causas gatillantes, comorbilidades, severidad y evolución son importantes de conocer para evitar futuros episodios. En Chile, a nuestro entender, no tenemos literatura sobre esta asociación, por lo que presentamos datos de un hospital terciario, destacando 15 casos de pancreatitis aguda en 5 años de estudio, casi la mitad de ellos con antecedentes previos de hipertrigliceridemia, un porcentaje importante de los casos con cuadros graves y con complicaciones intrahospitalarias y que la diabetes mellitus tipo 2 fue la principal condición asociada a la hipertrigliceridemia severa.

Severe hypertriglyceridaemia is one of the main aetiological causes of acute pancreatitis, with international literature ranking it as the third leading cause. Its triggering causes, comorbidities, severity and evolution are important to know in order to avoid future episodes. In Chile, to our knowledge, we have no literature on this association, so we present data from a tertiary hospital, highlighting 15 cases of acute pancreatitis in 5 years of study, almost half of them with a previous history of hypertriglyceridaemia, a significant percentage of cases with severe symptoms and in-hospital complications, and that type 2 diabetes mellitus was the main condition associated with severe hypertriglyceridaemia.

Incidencia de litiasis vesicular asintomática en pacientes con complicaciones biliares / Incidence of asymptomatic gallstones in patients with biliary complications / Incidência de cálculos biliares asintomáticos em pacientes com complicações biliares

Introducción: Las complicaciones de la litiasis biliar (LB) son una causa importante de morbilidad en nuestro país y en el mundo entero y generan elevados costos en salud. Objetivo: El objetivo de este trabajo fue determinar, que pacientes con una complicación de su patología litiásica de la vía biliar (colecistitis, colangitis aguda, pancreatitis aguda), fueron previamente asintomáticos, resultando dicha complicación el debut de la enfermedad. Lugar: Sanatorio Asociación Española de Socorros Mutuos, Montevideo Uruguay. Diseño: Estudio observacional descriptivo, retrospectivo, análisis de historias clínicas. Materiales y Métodos: Se analizaron 234 casos clínicos. Se constató en este grupo de pacientes, características epidemiológicas, metodología diagnóstica, tratamientos recibidos y complicaciones. Resultados: Del total de pacientes (n=234), 109 (46.6%) tenían una litiasis vesicular asintomática (LVA) y la complicación biliar, fue el debut de su enfermedad. La colecistitis aguda fue la complicación más frecuente (68%), en segundo lugar, la colangitis aguda (22%) y en tercer lugar la pancreatitis aguda (10%). La edad promedio de presentación de la enfermedad fue los 59 años. Conclusiones: Casi la mitad de los pacientes (46.6%) que presentaron una complicación de su litiasis biliar eran asintomáticos. Este sería un argumento importante para indicar la colecistectomía laparoscópica con un criterio profiláctico en pacientes con una LVA.

Introduction : Complications of gallstones are an important cause of morbidity in our country and throughout the world and generate high health costs. Objective: The objective of this study was to determine which patients with a complication of their bile duct stone pathology (cholecystitis, acute cholangitis, acute pancreatitis) were previously asymptomatic, and this complication resulted in the onset of the disease. Place: Sanatorium Asociación Española de Socorros Mutuos, Montevideo Uruguay. Design: Descriptive and retrospective observational study with an analysis of medical records. Materials and Methods: 234 clinical cases were analyzed. Epidemiological characteristics, diagnostic methodology, treatments received, and complications were assessed in this group of patients. Results: Of the total number of patients (n=234), 109 (46.6%) had an asymptomatic gallbladder lithiasis and the biliary complication was the debut of their disease. Acute cholecystitis was the most frequent complication (68%), followed by acute cholangitis (22%) and third by acute pancreatitis (10%). The average age of presentation of the disease was 59 years. Conclusions: Almost half of the patients (46.6%) who presented a complication of their gallstones were asymptomatic. This would be an important argument to indicate laparoscopic cholecystectomy with a prophylactic criterion in patients with asymptomatic gallbladder lithiasis.

Introdução: As complicações dos cálculos biliares são uma importante causa de morbidade em nosso país e em todo o mundo e geram altos custos de saúde. Objetivo: O objetivo deste estudo foi determinar quais pacientes com uma complicação de sua patologia de cálculo do ducto biliar (colecistite, colangite aguda, pancreatite aguda) eram previamente assintomáticos, e essa complicação resultou no aparecimento da doença. Local: Sanatório Asociación Española de Socorros Mutuos, Montevidéu - Uruguai. Desenho: Estudo observacional descritivo, retrospectivo, análise de histórias clínicas. Materiais e Métodos: Foram analisados ​​234 casos clínicos. Características epidemiológicas, metodologia diagnóstica, tratamentos recebidos e complicações foram avaliadas neste grupo de pacientes. Resultados: Do total de pacientes (n=234), 109 (46,6%) apresentavam litíase vesicular assintomática e a complicação biliar foi o início da doença. A colecistite aguda foi a complicação mais frequente (68%), seguida da colangite aguda (22%) e a terceira da pancreatite aguda (10%). A idade média de apresentação da doença foi de 59 anos. Conclusões: Quase metade dos pacientes (46,6%) que apresentaram complicação de seus cálculos biliares eram assintomáticos. Esse seria um argumento importante para indicar a colecistectomia laparoscópica com critério profilático em pacientes com litíase vesicular assintomática.

Epidemiología de la pancreatitis aguda en Chile entre los años 2013 y 2018 / Epidemiology of acute pancreatitis in Chile between 2013 and 2018

Background: The worldwide incidence of acute pancreatitis (AP) is increasing. Aim: To determine the national incidence of AP between 2013 and 2018. Material and Methods: Analysis of hospital discharge records available at the web page of the Statistical and Information Service of the Chilean Ministry of Health. We recorded the number of patients discharged with a diagnosis of AP, excluding chronic pancreatitis and pancreatic cancer, between 2013 and 2018. We also recorded length of hospital stay, age, etiology, and lethality. Rates of raw and age-adjusted incidence were calculated. Results: During the study period, 46,420 patients with AP were discharged, with an incidence rate ranging between 39 and 43.7/100,000 inhabitants, and a non-significant increase along time of 8.6%. There are important differences between the average adjusted rates of Northern (Arica to Metropolitan) and Southern regions (O'Higgins to Magallanes), with rates of 36.9 and 53.6/100,000 inhabitants respectively (p < 0.01). The average hospital stay was 11 days. Two thirds of cases were aged between 20 and 64 years. The case fatality was 4.2%, with no decrease between 2013 and 2018. The mortality rate was 1.6/100,000 inhabitants. Conclusions: The annual incidence of AP is 42.6/100,000 inhabitants, with geographical differences from North to South, which can be associated with the high frequency of biliary tract disease in aboriginal ethnic groups. The age distribution and length hospital stay were stable over time.

Perfil clínico y resultados de la pancreatitis aguda en la Unidad de Cuidados Intensivos e Intermedios de un hospital general / Clinical profile and results of acute pancreatitis in the Intensive and Intermediate Care Unit of a general hospital

RESUMEN La pancreatitis aguda (PA) es un proceso inflamatorio agudo del páncreas que, de acuerdo con la clasificación de Atlanta del 2012, puede ser leve, moderada o grave. Objetivo: Describir las características epidemiológicas, clínicas, terapéuticas y los resultados de pacientes con PA ingresados a la unidad de cuidados intensivos e intermedios de un hospital general y compararlos con los descritos en la literatura nacional e internacional. Materiales y métodos: Estudio observacional de pacientes con PA atendidos en un periodo de 3 años. Resultados: Se incluyeron 59 casos; predominó el sexo femenino (54,2%), la edad media fue de 59,3 años, la etiología más frecuente fue biliar (84,7%). Los puntajes de severidad promedio al ingreso fueron APACHE II de 12,4 puntos, SOFA de 4,9 puntos y Marshall modificado de 2,8 puntos; la falla orgánica más frecuente fue la respiratoria (47,5%). La estancia media en cuidados fue 13,9 días y en el hospital fue de 23,3 días. Ningún paciente con PA leve o moderada falleció durante su estancia hospitalaria, 6 pacientes con PA grave fallecieron durante su estancia hospitalaria (20% de los casos de PA grave). Conclusión: Los casos de nuestro hospital tuvieron un perfil clínico y terapéutico semejante al descrito en la literatura mundial y latinoamericano. Se evidenció una estancia hospitalaria mayor a la descrita en trabajos recientes, pero nuestra mortalidad fue menor.

ABSTRACT Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that, according to the 2012 Atlanta classification, can be mild, moderate or severe. Objective: Describe the epidemiological, clinical, therapeutic and outcomes of patients with AP admitted to the intensive care and intermediate care unit of a general hospital and compare them with those described in the national and international literature. Materials and methods: Observational study of patients with AP treated over a period of 3 years. Results: 59 cases were included; the female sex prevailed (54.2%), the average age was 59.3 years, the most frequent etiology was biliary (84.7%). Average entry severity scores were APACHE II of 12.4 points, SOFA of 4.9 points and Marshall modified of 2.8 points; The most frequent organ failure was respiratory (47.5%). The average stay in care was 13.9 days and in the hospital it was 23.3 days. No patients with mild or moderate AP died during their hospital stay, 6 patients with severe AP died during their hospital stay (20% of cases of severe AP). Conclusion: The cases of our hospital had a clinical and therapeutic profile similar to that described in the world and Latin American literature. A hospital staying was greater than that described in recent works, but our mortality was lower.

Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes / Pancreatite aguda e pancreatite aguda recorrente: uma exploração de fatores clínicos e etiológicos e desfechos

ABSTRACT Objective: To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children. Methods: Observational and retrospective study with an analytical component. Patients were classified into two groups: Acute pancreatitis and recurrent pancreatitis. The relationship with each parameter obtained was analyzed using the chi-squared test, Student's t-test, or the Mann-Whitney U test. Results: There were 130 patients with acute pancreatitis; recurrent pancreatitis was diagnosed in 23.8% of the cases. The most frequent causes were anatomical (29.6%), pharmacological (19.2%), and biliary (14.6%), although in 29.2% etiology was not identified. Fasting lasted 3.5 ± 3.8 days and parenteral nutrition was indicated in 26.9% of the cases for 10.8 ± 11.3 days. A statistical association with anatomical (p = 0.02) and pharmacological causes (p = 0.01) was found in the recurrent pancreatitis group; no other differences between acute pancreatitis and recurrent pancreatitis groups were observed. The mortality rate was 3.1%, it was not attributable to acute pancreatitis in any cases. Conclusion: Acute pancreatitis is associated with a high frequency of acute recurrent pancreatitis. Severity and complications did not show statistically significant differences in this investigation. Anatomical etiologies were the most relevant cause in this cohort. Fasting time and parenteral nutrition use were relevant. Genetics testing is required in this population.

RESUMO Objetivo: Descrever a epidemiologia e as características clínicas da pancreatite aguda e da pancreatite aguda recorrente em crianças. Métodos: Estudo observacional e retrospectivo com um componente analítico. Os pacientes foram classificados em dois grupos: pancreatite aguda e pancreatite recorrente. A relação com cada parâmetro obtido foi analisada com o teste de qui-quadrado, teste t de Student ou teste U de Mann-Whitney. Resultados: Foram analisados 130 pacientes com pancreatite aguda; pancreatite recorrente foi diagnosticada em 23,8% dos casos. As causas mais frequentes foram anatômicas (29,6%), farmacológicas (19,2%) e biliares (14,6%), embora em 29,2% a etiologia não tenha sido identificada. O jejum durou 3,5 ± 3,8 dias e a nutrição parenteral foi indicada em 26,9% dos casos por 10,8 ± 11,3 dias. Uma associação estatística com causas anatômicas (p = 0,02) e farmacológicas (p = 0,01) foi encontrada no grupo com pancreatite recorrente; não foram observadas outras diferenças entre os grupos pancreatite aguda e pancreatite recorrente. A taxa de mortalidade foi de 3,1% e nenhum caso foi atribuível à pancreatite aguda. Conclusão: A pancreatite aguda está associada à alta frequência de pancreatite aguda recorrente. A gravidade e as complicações não apresentaram diferenças estatísticas nesta investigação. Etiologias anatômicas foram a causa mais relevante nesta coorte. O tempo de jejum e o uso de nutrição parenteral foram relevantes. Testes genéticos são necessários em nossas populações.

Impacto socioeconómico del manejo actual de la pancreatitis aguda de origen biliar severa: estudio comparativo / Socioeconomic impact of the current management of severe biliary acute pancreatitis: comparative study

RESUMEN Objetivo La pancreatitis aguda de origen biliar es una patología gastrointestinal común, en donde el tratamiento oportuno es el pilar más importante a pesar de sus discrepancias. El objetivo del estudio es establecer el impacto socioeconómico en el manejo actual de esta patología, comparando dos hospitales de tercer nivel de estrato socioeconómico alto y bajo de la ciudad de Bogotá, Colombia. Materiales y Métodos Se realizó un estudio retrospectivo, comparativo de corte transversal entre enero de 2012 y diciembre de 2017, en dos hospitales de Bogotá D. C. Se evaluaron sus características socioeconómicas, género, tiempo de evolución al momento de la consulta, Marshall score, estancia en UCI, estancia hospitalaria, complicaciones, manejo quirúrgico y mortalidad. Resultados Se analizaron 101 pacientes de dos estratos socioeconómicos diferentes (alto y bajo). Se encontró que los pacientes de estrato bajo tienen un riesgo diez veces mayor de requerir un procedimiento quirúrgico. Asimismo, registraron una mayor mortalidad en comparación con pacientes de estrato alto (11,3% vs. 4,2%). También se evidenciaron más complicaciones en el grupo de nivel socioeconómico bajo con respecto al alto, como en la falla exocrina (81,1% vs. 31,3%) y el síndrome compartimental (35,8% vs. 4,2%). Conclusión Se encuentra mayor morbimortalidad en los pacientes de bajo nivel socioeconómico en el contexto de esta patología. Este estudio puede guiar a nuevas investigaciones acerca del impacto socioeconómico en los desenlaces de pancreatitis aguda severa.(AU)

ABSTRACT Objetive Acute pancreatitis of biliary origin is a common gastrointestinal pathology, in which timely management still is the most important. The aims of this research is establish the socioeconomic impact in the current management of severe acute pancreatitis of biliary origin comparing two centers of the third level, one of high socioeconomic population and another of low in Bogotá, Colombia. Materials and Methods A retrospective, cross-sectional comparative study was conducted between January 2012 and December 2017, in two hospitals of Bogotá DC. We evaluated their socioeconomic characteristics, gender, time of evolution at the time of consultation, Marshall score, ICU stay, hospital stay, complications, surgical management and mortality. Results 101 patients from two different socioeconomic strata (high and low) were analyzed, where a 10 times higher risk of requiring a surgical procedure in the group of patients with low stratum was found, as well as a higher mortality compared with those of high stratum. (11.3% Vs 4.2%). There were also more complications in the low socioeconomic group with respect to the high, as in the exocrine failure (81.1% vs 31.3%) and the compartment syndrome (35.8% vs 4.2%). Conclusion There is greater morbidity and mortality in patients of low socioeconomic status in the context of this pathology. This study can guide new research that increases the clarity of the socioeconomic impact on the outcomes of severe acute pancreatitis.(AU)

Analysis of influencing factors of severity in acute pancreatitis using big data mining

SUMMARY OBJECTIVES To evaluate the epidemiological characteristics of acute pancreatitis (AP) and explore potential relationships between these factors and severity. METHODOLOGY Data-sets of 5,659 patients with AP from health statistics and the Information Center of Jiangsu province, between 2014 and 2016, were analyzed. A self-organizing map (SOM) neural network was used for data clustering. RESULTS Biliary acute pancreatitis (BAP) (86.7%) was the most frequent etiological factor. A total of 804 (14.2%) patients had severe acute pancreatitis (SAP). The mean age of patients was 53.7 + 17.3 (range 12~94y). Most of the AP patients were married (75.4%); 6% of mild /moderately severe AP (MAP/MASP) patients were unmarried, which was less than SAP patients (P=0.016). AP patients with blood type AB in the general population (8.8%) was significantly lower than that of AP cases (13.9%) (P=0.019) and SAP cases(18.7%) (P=0.007). The number of AP patients in southern Jiangsu was much higher than that in northern Jiangsu province, especially in Nanjing (1229, 21.7%). The proportion of acute alcoholic pancreatitis (AAP) in the north of Jiangsu (Xuzhou 18.4%) was much higher than that in southern Jiangsu (Suzhou 2.6%). The whole sample was divided into five classes by SOM neural network. If BAP patients were male, old, divorced, and blood type AB or B, they were more likely to develop SAP. Middle-age, unmarried or divorced male patients with blood type B/AB who suffered from HAP or AAP were also more likely to develop SAP. CONCLUSIONS The number of unmarried patients with MAP/MASP was smaller than that of SAP. Blood types AB and B were more frequent in AP, especially in SAP. The differences between southern Jiangsu and northern Jiangsu, in number of AP patients and the proportion of AAP, were significant. In class I and class IV, the ratio of SAP was much higher than in other classes and the whole sample.

Factores de riesgo para pancreatitis aguda en el Hospital Comandante Faustino Pérez de Matanzas / Risk factors for acute pancreatitis in the Hospital Comandante

Introducción: la pancreatitis aguda constituye causa de ingresos frecuentes en las unidades de atención al grave del Hospital "Comandante Faustino Pérez Hernández" de Matanzas. En ocasiones presentan complicaciones que prolongan la estadía y elevan la mortalidad. Objetivo: determinar el comportamiento clínico epidemiológico de la Pancreatitis Aguda en unidades de atención al grave. Materiales y Métodos: se realizó un estudio descriptivo, observacional, prospectivo desde enero 2013 a diciembre 2014, en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas, a los pacientes ingresados con diagnóstico de Pancreatitis Aguda. Se operacionalizaron las variables: edad, factores de riesgos y estado del paciente al egreso. Resultados: predominaron los hombres y el grupo etario de 35 - 44 años (25,40 %); el alcoholismo fue el factor de riesgo más representado (38,10 %). La mortalidad fue de un 9,6 %. Conclusiones: en el estudio predominaron los jóvenes, el sexo masculino y el alcoholismo como factor de riesgo más frecuente. La pancreatitis aguda crítica constituyó la forma más frecuente. La sobrevida constatada fue favorable, siendo superior a los reportes de la literatura (AU).

Introduction: acute pancreatitis is the cause of frequent admissions in the units of seriously-ill patients' care of the Hospital "Comandante Faustino Pérez Hernández" of Matanzas. Sometimes they have complications causing extension staying and increasing mortality. Objective: to determine the clinical epidemiological behavior of acute pancreatitis in seriously-ill patients´ care units. Materials and Methods: a prospective, observational, descriptive study was carried out from January 2013 to December 2014, in the University Hospital "Comandante Faustino Pérez Hernández" of Matanzas, with patients who entered the hospital diagnosed with acute pancreatitis. The studied variables were age, risk factors, and patient´s status at discharging. Results: men predominated and also the age group ranging between 35 and 44 years (25,40 %). Alcoholism was the most represented risk factor (38,10 %). Mortality was 9,6 %. Conclusions: there they were predominant young people, male sex and alcoholism was the most frequent risk factor. Acute critical pancreatitis was the most frequent form. The showed survival was favorable, being higher than the one reported in the literature (AU).

Epidemiologia, manejo y evolución de la pancreatitis aguda en el Hospital Nacional Rosales 2013 a 2015 / Epidemiology, management and evolution of acute pancreatitis in the Rosales National Hospital 2013 to 2015

La Pancreatitis Aguda es una patología frecuente siendo su forma grave hasta entre en un 20 a 30% de los casos, con alta mortalidad. Las etiologías más frecuentes son la de origen biliar y alcohólica. En la literatura se encuentran guías de práctica clínica internacionales basadas en la evidencia que dictan sugerencias de manejo. Nuestro centro no ha actualizado sus datos con respecto a esta patología por lo que se plantea el presente estudio con el objetivo de conocer la epidemiologia, el manejo y la evolución de pacientes que consultaron con pancreatitis aguda en el Hospital Nacional Rosales. Se realizó un estudio de tipo observacional, descriptivo, de seguimiento de una cohorte (pacientes con pancreatitis aguda) del Hospital Nacional Rosales en el periodo de junio del 2013 a mayo de 2015. Muestra de 205 pacientes, con relación femenino/masculino de 1.8:1, con edad media de 48.34 años, de etiología biliar 74.7%. Cuadro clínico similar al reportado en la literatura. El estudio de imagen más empleado es la ultrasonografía en 66.47%. No se evaluó la severidad con algún score en 42% de los pacientes. El manejo en relación a la nutrición, cirugía, uso de antibióticos no concuerdan con los dictados en las guías de manejo a nivel internacional. Tasa de mortalidad global de 11.5%. En nuestra serie la epidemiologia de la PA es similar a lo reportado en población hispana y la mortalidad es similar a las reportadas en la literatura mundial, con diferencias en su forma de manejo

Prevalencia de pancreatitis aguda en el embarazo / Prevalence of acute pancreatitis in pregnancy

Objetive: The aim of this study was to determine the prevalence and characteristics of acute pancreatitis during pregnancy in the Hospital de Alta Especialidad de Veracruz in Mexico. Methods: A retrospective, descriptive study of all pregnant patients diagnosed with acute pancreatitis from January to December 2013 treated in our hospital was conducted. Results: 4.478 records of pregnant women were reviewed, 6 had acute pancreatitis during pregnancy, it corresponds to 1 in 746.33 pregnant patients. The age of our patients was 28 +/- 6.30 years (range 15-32 years). The weeks of gestation had a mean of 16.3 +/- 8.7 weeks (range 10-30 weeks). In all cases was mild pancreatitis secondary to gallstones disease. The time of hospital stay was 8.79 +/- 4.26 days (range 7-18 days). Five patients underwent laparoscopic cholecystectomy; a patient did not accept surgery. One fetal death was presented. Conclusion: Acute pancreatitis during pregnancy is a rare complication. The ideal time to perform a cholecystectomy is the second trimester. The prognosis is generally good for both mother and the product.

Objetivo: Determinar la prevalencia y características de la pancreatitis aguda durante el embarazo en el Hospital de Alta Especialidad de Veracruz, México. Material y Métodos: Se realizó un estudio retrospectivo, descriptivo de todas las pacientes embarazadas diagnosticadas con pancreatitis agudas de enero tratadas en este Hospital. Resultados: Se revisaron 4.478 expedientes de mujeres gestantes, de las cuales 6 presentaron pancreatitis aguda durante su embarazo, esto corresponde a una de cada 746,33 pacientes embarazadas. La edad de nuestros pacientes fue de 28 +/- 6,30 años (rango 15-32 años). Las semanas de gestación tuvieron una media de 16,3 +/- 8,7 semanas (rango 10-30 semanas). En todos los casos la pancreatitis fue leve y de origen biliar. El tiempo de estancia intrahospitalaria fue de 8,79 +/- 4,26 días (rango 7-18 días). Cinco pacientes fueron sometidas a colecistectomía laparoscópica y una no aceptó procedimiento quirúrgico. Se presentó un óbito. Conclusión: La pancreatitis aguda durante el embarazo es una complicación poco frecuente. El tiempo ideal para realizar una colecistectomía es el segundo trimestre. El pronóstico es, en general, bueno tanto para la madre como para el producto.

Acute Biliary Pancreatitis: A Case Report.

Acute biliary pancreatitis (ABP) a condition caused by gallstones; can be a life-threatening condition if not treated early (mortality ~2-7%). Complications and symptoms of ABP can be ranging from mild (nausea, vomiting, and fever) to severe (necrosis, infections, hemorrhage, abscesses, renal failure, and adult respiratory distress syndrome). Th is paper presents a specifi c case of a middle-aged male diagnosed with ABP to illustrate the disease in a clinical setting, mainly looking at its presentation, diagnosis and focusing more on treatment and management. Clinical examinations and radiological investigations are crucial to recognize the diagnosis and foresee the prognosis of this condition. Th e medications that are administered to patients suff ering from this condition include analgesics (like morphine), intravenous fl uids, and antibiotics (e.g. ciprofl oxacin). Th e limitations and lack of knowledge described above are immense concerns. It is highly encouraged that future research opportunities will compensate for the present gap in knowledge, contributing to current literature, as well as having practical implications for treatment and management of ABP.

Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute / Factores de riesgo con el desarrollo de la hiperamilasemia y pancreatitis post PCRE en el Cuban National Institute

Contexto: La pancreatitis aguda es la complicación más frecuente de la PCRE y algunos factores de riesgo son asociados con el desarrollo de hiperamilasemia y pancreatitis post PCRE. Objetivos: Identificar factores nuevos asociados con hiperamilasemia y pancreatitis post PCRE en pacientes que acudieron a nuestro centro. Material y métodos: Un estudio retrospectivo de cohorte se llevó a cabo en 170 pacientes en quienes se realizó una CPRE diagnóstico-terapéutica por enfermedad biliopancreática. 67 pacientes desarrollaron hiperamilasemia (39,4%) y 6 pancreatitis post PCRE (3,5%). Se aplicaron los siguientes criterios diagnósticos: Hiperamilasemia: elevación de la amilasa sérica por encima del valor normal (90IU).Pancreatitis aguda post PCRE: dolor abdominal continuo por más de 24 horas y elevación de la amilasa tres veces por encima del valor normal. Resultados: El número de canulaciones, más de 4 (19 pacientes), (p=0,006; RR= 3,00) se asoció significativamente con el desarrollo de la hiperamilasemia y la puesta de stents biliares (14 pacientes) se asoció como un factor protector (p=0,00; RR= 0,39). Los factores asociados con el desarrollo de la pancreatitis post PCRE se relacionaron con el paciente (localización peridiverticular de la papila (p=0,00; RR= 2,00) y disfunción del Esfinter de Oddi (p=0,000; RR=1,20). Conclusiones: Factores técnicos fueron asociados con el desarrollo de la hiperamilasemia, sin embargo, los relacionados con el desarrollo de la pancreatitis post PCRE fueron mayoritariamente relacionados al paciente.

Context: Acute pancreatitis is the most common complication in ERCP, and some risk factors were associated with the development of hyperamylasemia and post-ERCP pancreatitis. Objectives: identifying new factors associated with the development of hyperamylasemia or post-ERCP pancreatitis in patients attended at our center. Material and methods: A (retrospective) cohort study was carried out in 170 patients on which a diagnostic-therapeutic ERCP was done due to biliopancreatic disease. 67 patients developed hyperamylasemia (39.4%) and 6 post-ERCP pancreatitis (3.5%). The following diagnostic criteria were applied: Hyperamylasemia: increase in the serum amylase level above the normal value (90I/U). Acute post-ERCP pancreatitis: clinical: continuous abdominal pain for over 24 hours and biochemical: elevation of amylase 3 times above normal value (90U/I). Results: The number of cannulations more than 4 (19 patients), (p=0.006; RR= 3.00) was associated significantly with the development of hyperamylasemia and the placing of biliary stent (14 patients), (p=0.00; RR= 0.39) was a protective factor. The factors associated with the development of post-ERCP pancreatitis were related with the patient (peridiverticular location of the papilla (p=0.00; RR= 2.00) and the sphincter of Oddi dysfunction (p=0.000; RR=1.20). Conclusion: Technical factors were associated with the development of hyperamylasemia, however, the factors associated with the development of post-ERCP pancreatitis in our universe of study were related mainly with the patient.

Pancreatite aguda em pediatria: revisão sistemática da literatura / Acute pancreatitis in pediatrics: a systematic review of the literature

OBJETIVO: Descrever os principais aspectos epidemiológicos, clínicos, diagnósticos e do tratamento de crianças com pancreatite aguda. FONTES DOS DADOS: Realizada revisão sistemática das bases de dados MEDLINE e SciELO nos últimos 5 anos sobre pancreatite aguda em crianças, bem como consultadas referências relevantes dos textos obtidos. SÍNTESE DOS DADOS: Os casos de pancreatite aguda em crianças recebem crescente atenção nos últimos anos, sendo verificado um aumento na incidência da doença em diversos estudos. As principais etiologias em crianças envolvem doença biliar, pancreatite secundária a medicamentos, pancreatite hereditária recorrente e trauma, sendo até 30% dos casos sem etiologia definida. O diagnóstico baseia-se na combinação de aspectos clínicos, laboratoriais com elevação das enzimas acinares e testes radiológicos. Tratamento de suporte inicial, com reposição volêmica adequada e correção dos distúrbios metabólicos, além de terapêutica nutricional específica, são os pontos fundamentais no manejo dos quadros agudos. Complicações a longo prazo são incomuns, e as taxas de mortalidade, inferiores às da população adulta. CONCLUSÃO: O diagnóstico precoce e o manejo apropriado podem contribuir para a melhor evolução da criança com pancreatite e prevenir as complicações imediatas e tardias relacionadas à doença. Mais estudos são necessários para melhor elucidar aspectos relacionados ao diagnóstico clínico e radiológico da pancreatite em crianças, bem como aspectos da terapêutica nutricional nessa faixa etária.

OBJECTIVE: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis. SOURCES: Systematic review of MEDLINE and SciELO databases in the last 5 years on acute pancreatitis in children, as well as consultation of relevant references on the texts obtained. SUMMARY OF THE FINDINGS: Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. The main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. The diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population. CONCLUSION: The early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group.

Clinical Effects of Bile Aspiration Just before Contrast Injection during Endoscopic Retrograde Cholangiopancreatography / 대한소화기학회지

BACKGROUND/AIMS: This study was designed to determine whether bile aspiration before contrast injection cholangiogram prevent of post-ERCP cholangitis, liver function worsening, cholecystitis and pancreatitis. METHODS: One hundred and two patients in the bile aspiration group before contrast injection from December 1, 2008 to December 30, 2009 and 115 patients in the conventional control group from January 1, 2010 to June 30, 2010 were analyzed. The incidence of post-ERCP cholangitis, liver function worsening, cholecystitis, pancreatitis, and hyperamylasemia only were compared between these two groups. RESULTS: In the 102 patients with the bile aspiration group, post-ERCP cholangitis in 3 patients (2.9%), liver function worsening in 4 patients (3.9%), cholecystitis and pancreatitis in none, and hyperamylasemia only in 6 patients (5.8%) occurred. In the 115 patients with control group, post-ERCP cholangitis in 1 patient (0.4%), liver function worsening in 9 patients (7.8%), cholecystitis in none, pancreatitis in 3 patients (2.6%), hyperamylasemia only in 10 patients (8.6%) developed. The two groups did not significantly differ in terms of the incidence of post-ERCP cholangitis, liver function worsening, pancreatitis, and hyperamylasemia only (p>0.05). CONCLUSIONS: Initially bile juice aspiration just before contrast injection into the bile duct rarely prevented post-ERCP cholangitis, liver function worsening, and pancreatitis in patients with the extrahepatic bile duct obstruction.

Alta frecuencia de pancreatitis aguda asociada a patología biliar en niños chilenos / Elevated frequency of acute pancreatitis associated to biliary illness in Chilean children

Acute Pancreatitis (AP) in children presents significant morbimortality. Most common etiologies in this age group are trauma, systemic illness and idiopathic pancreatitis. This is different from adult AP, where lithiasis and alcohol consumption are the predominant causes. In Chile, where billiary disease is highly prevalent, there is little information regarding AP among children. Objective: To determine the main clinical characteristics of acute pancreatitis in a group of Chilean children. Patients and Methods: A retrospective study (1998-2008) of patients hospitalized with the diagnosis of AP. The diagnosis was confirmed by elevation of pancreatic enzymes and through images. Demographic data, etiology, complications and resolutions, need for parenteral nutrition, and use of antibiotics were examined. Results: Eighteen patients were identified (8,3 +/- 4 y.o.). Etiology of AP was listed as: lithiasis and alterations of biliary duct: 38,8 percent, idiopathic: 22,2 percent, secondary to medications: 22,2 percent and other: 16.8 percent. Two patients presented peripancreatic infected collections; a similar number formed pancreatic pseudocysts. Six patients (33,3 percent) required one type of surgical procedure as part of their treatment. Two-thirds of all patients required treatment in ICU. One half of the patients required parenteral nutrition, and two thirds received IV antibiotics. The median length of hospital stay was 20 days (ave 24,9 +/- 14,3 ds). There was no mortality in this serie. Conclusions: Unlike previously described, biliary AP was the most common cause in this serie. Biliary pathology should be actively studied among Chilean children with AP.

La pancreatitis aguda (PA) en niños presenta una morbimortalidad considerable. Las etiologías más frecuentes en este grupo etario son la PA secundaria a trauma, por enfermedades sistémicas y la PA idiopática, a diferencia de la población adulta en que predomina la litiasis biliar y el consumo de alcohol. En Chile, donde la patología biliar es altamente prevalente, existe escasa información clínica respecto de la PA en niños. Objetivo: Determinar las características clínicas de la pancreatitis aguda en un grupo de niños chilenos. Método: Estudio retrospectivo (1998-2008) de pacientes hospitalizados con PA. Se confirmó el diagnóstico por elevación de enzimas pancreáticas e imágenes; se obtuvieron los datos demográficos y se analizó: etiología, complicaciones y su resolución, necesidad de nutrición parenteral y uso de antibióticos. Resultados: Se identificaron 18 pacientes (8,3 +/- 4 años). Etiología de la PA: litiasis y alteraciones anatómicas de la vía biliar (38,8 por ciento), idiopática (22,2 por ciento), drogas (22,2 por ciento), otras (16.8 por ciento). Dos pacientes presentaron colecciones peripancreáticas infectadas; igual número evolucionó con formación de pseudoquistes pancreáticos. Seis pacientes (33,3 por ciento) requirieron algún tipo de procedimiento quirúrgico como parte de su tratamiento. Dos tercios de los pacientes ingresaron a la Unidad de Pacientes Críticos. La mitad de los pacientes recibió nutrición parenteral y dos tercios antibióticos endovenosos. La mediana de hospitalización fue de 20 días (promedio 24,9 +/- 14,3 días). No hubo mortalidad en la serie. Conclusiones: A diferencia de lo descrito en la literatura, la PA biliar fue la etiología más frecuente en esta serie. La patología biliar debe ser estudiada activamente en niños chilenos con PA.

Changing Pattern of Incidence; Aetiology and Mortality from Acute Pancreatitis at Kalafong Hospital; Pretoria; South Africa;1988-2007: A Retrospective Evaluation

Background: Literature reports from Western countries suggest an increasing incidence of acute pancreatitis (AP) and changing pattern over the past two decades. The aim of thisstudy was to document the incidence; aetiology and mortality from AP over two decades and to examine any emerging trends.Methods: A retrospective study of all confirmed cases of AP admitted over a 20-year period to thesurgical department was performed. Patients' demographics; year of admission;number of attacks; aetiology; management and outcome were entered on a specialstudy proforma.Results: Altogether 707 attacks of AP (M: F; 5.7: 1) were recorded. The proportion of gallstone APincreased (3.1to 12.7) and that of alcohol-related AP decreased (84to 67.6). Alcohol was themain aetiological factor for AP. Drugs; hyperlipidaemia; human immunodeficiency virus (HIV) andendoscopic pancreatography-related AP increased in the second decade. The in-hospital mortality rateduring the respective periods was 6.5and 3.1.Conclusion: Gallstone AP increased during second decade from more Caucasian admissions and increased gallstones among Blacks. The reduced mortality was attributed to changing trends in the nature and aetiology of AP recorded; heightened awareness of the condition and improved management

Pancreatitis aguda: Análisis de 97 pacientes / Acute pancreatitis: Analysis of 97 patients

La pancreatitis aguda (PA) es una patología con múltiples etiologías y de curso clínico diverso. En nuestro medio son escasas las comunicaciones acerca de esta entidad y en general abordan temas puntuales dentro del amplio espectro del cuadro. El objetivo de este trabajo es determinar las características clínicas, la etiología, el manejo y la evolución de los pacientes internados en nuestra institución con diagnóstico de PA. Se analizaron retrospectivamente los registros clínicos de los pacientes con diagnóstico de PA entre abril de 2004 y abril de 2007. Se evaluaron los datos poblacionales, etiología, tratamiento instaurado, gravedad y morbimortalidad. En el período analizado, 97 pacientes fueron internados con diagnóstico de PA. Cuarenta y nueve fueron de sexo masculino (50.5%). La edad promedio fue de 58.5 ± 1.6 años (rango 21-93). Noventa y dos pacientes presentaron un solo episodio de PA, y 5 pacientes dos o más episodios (pancreatitis recurrente). Según su etiología, 48 fueron de origen biliar, 23 idiopáticas, 11 post-procedimientos en la vía biliar, 2 de origen alcohólico y 13 de otras causas. La mediana de estadía hospitalaria fue 7 días. El 25% requirió internación en Unidad de Terapia Intensiva. Según la escala de Ranson la mayoría de los pacientes (n: 66; 72%) presentaron cuadros leves. La mediana de inicio de alimentación oral fue de 3 días. Con respecto a las complicaciones, 13% presentaron falla multiorgánica, 8% necrosis pancreática (4 infectadas), sólo un paciente desarrolló un seudoquiste y otro un absceso pancreático. La mortalidad fue 7.2% (7 casos, todos con Ranson ≥ 3). La PA de origen biliar resultó ser la más común y si bien la presente es una serie pequeña, llama la atención el bajo número de PA de origen alcohólico. Aunque el número de complicaciones locales fue menor, la mortalidad fue similar a la descripta en la literatura. Nuestros datos también son coincidentes en cuanto al manejo y pronóstico de la PA. El presente trabajo actualiza la casuística en Argentina.

Acute pancreatitis (AP) is a disease with several causes and diverse clinical course. In our environment there are not many papers on this entity and they approach punctual features inside the broad spectrum picture. The aim of this study is to determinate clinical features, etiology, handling and evolution of patients diagnosed with AP admitted in our Hospital during a three years period. The clinical records of patients with AP admitted at the British Hospital of Buenos Aires between April 2004 and April 2007 were retrospectively analyzed. Demographic data, etiology, treatment, severity of the illness, morbidity and mortality were evaluated. Ninety seven patients were diagnosed with AP during the analyzed period. Forty nine were male (50.5%). The average age was 58.5 ± 1.6 years (range 21-93). Ninety two patients presented only one episode of AP and five patients suffered two or more (recurrent pancreatitis). According to the etiology, 48 had a biliary origin, 23 were idiopathic, 11 post biliary tract procedures, 2 recognized an alcoholic origin and 13 other causes. The median hospital stay was 7 days. Twenty five percent required admission in Intensive Care Unit. Most of the patients (n: 66; 72%) presented mild episodes according to the Ranson Score. The median of beginning oral feeding was 3 days. Regarding to complications, 13% have multiple organ failure, 8% pancreatic necrosis (4 infected), only one patient had a pseudocist and another patient a peripancreatic abscess. Mortality rate was 7.2% (7 cases, all with Ranson = 3). Although this is a short series, the biliar origin is still the most prevalent etiology in our population. The low number of alcoholic origin caught our attention. Mortality was similar to that described in other series, but the number of local complications was lower. Our data are consistent with other papers regarding management and prognosis, and update the Argentine casuistic.

Pancreatitis Aguda en la Unidad de Cuidados Intensivos e Intermedios: Revisión y evolución de 36 casos. Hospital Víctor Lazarte E. - Trujillo, Perú / Acute pancreatitis in the Intensive and Intermediate Care Unit: Review and evolution of 36 cases. Victor E. Lazarte Hospital - Trujillo, Peru

INTRODUCCIÓN. La pancreatitis aguda (PA) es un proceso inflamatorio localizado que puede generalizarse produciendo disfunción multiorgánica y fallecimiento del paciente. OBJETIVO. Describir las características epidemiológicas, clínicas, terapéuticas y evolución de los pacientes con PA de nuestra unidad y compararlos con los descritos en la literatura nacional e internacional. MATERIAL Y MÉTODOS. Se realizó una revisión de los casos de PA manejados en la UCI-UCIN del Hospital Víctor Lazarte Echegaray Hule durante el periodo 1° de Enero del 2004 al 30 de Abril del 2007. RESULTADOS. Se hospitalizaron 40 pacientes con PA, recuperando 36 historias clínicas, 24 tuvieron PA Grave (PAG) y 12 tuvieron PA Leve (PAL). La edad promedio de los pacientes fue 55 ± 16,7 años (27-84 años), siendo similar el número de pacientes varones y mujeres (18o). La etiología predominante fue biliar con 26 casos (72,2%). El 100% de los pacientes tuvo dolor abdominal estando en 94,4% (34/36 casos) asociado a nauseas y vómitos. El valor promedio de la amilasa sérica fue de 2580 ± 1507,1 UA/L (380-6883 UA/L). El score de Ranson promedio fue 2,92 ± 1,71 puntos (0-6 puntos) y el score APACHE II fue 11,86 ±8,27 puntos (0-31 puntos). La Tomografía contrastada fue realizada a 22 pacientes, el Índice de Severidad Tomográfica promedio fue 4,41 ± 2,79 puntos (0-10 puntos). Se identificó pseudoquiste pancreático en 4 pacientes con PAG (11,1 por ciento). La disfunción respiratoria fue la complicación sistémica más frecuentemente encontrada en 36,1% (13/36 casos). La disfunción multiorgánica (DMO) se encontró en 8 pacientes (22,2%), todos con PAG. La mortalidad fue de 4 casos (11,1%) de los 36 revisados; los 4 ingresaron con DMO de 4 a más órganos. CONCLUSIÓN. Las características epidemiológicas, clínicas, terapéuticas y evolución de los pacientes con PA fueron semejantes a los descritos en la mayoría de los reportes nacionales e internacionales.

INTRODUCTION. Acute pancreatitis is a local inflammatory process that could be generalizedby producing mild to severe gastroenteral manifestations, like multiple organ dysfunction anddeath. OBJECTIVE. To describe epidemiological, clinical, therapeutical characteristics and evolution ofpatients with AP of our unit and to compare with other studies of Peru and other countries. MATERIALS AND METHODS. We realized a review of all cases with AP treated in ICU-INCU ofVictor Lazarte Echegaray Hospital over 1° January of 2004 to April, 30 of 2007.RESULTS. At the time of this study were admitted 40 patients with AP, just 36 clinics records were recovered, 24 of these were Severe Acute Pancreatitis (SAP) and 12 were Mild AcutePancreatitis (MAP). Age mean was 55 ± 16,7 years old (range 27-84 y.o.), male and female had equal predominance 18 (503). Biliar compliances were the most frequent etiology with 26 cases(72,2%). All patients (100%) had abdominal pain, 34 de 36 cases (94,4%) had nauseas and/orvomits. Seric amylase mean was 2580 ± 1507,1 UA/L (range 380-6883 UA/L). . Two patients with SAP were performed to surgery after AP was detected: one casewas cholecystectomized for perfored pyocholecist and other one was cholecystectomizedand drain of choledoco; no one of these dead.CONCLUSIÓN. Epidemiological, clinical, therapeutical characteristics and evolution of thepatients with AP were similar to the majority of national and international reports.