ABSTRACT
AIM: Central pancreatectomy is a pancreas-sparing alternative to standard pancreatic resections, and it is associated with substantial morbidity. The aim of the present study is to assess the utility of the POSSUM scoring system in the prediction of the postoperative complications after central pancreatectomy, which would help identify the patients who are at the highest risk of developing complications. METHODS: A retrospective analysis of 24 patients who underwent central pancreatectomies (2002-2010) was performed. The POSSUM score was calculated for each patient and was correlated with observed morbidity. RESULTS: The mean POSSUM score was 32, thus predicting morbidity in 9 out of 24 patients. This risk assessment proved to be quite accurate, as 13 patients (54%) actually developed postoperative complications (chi-squared = 3.2101, p = 0.073). The predictive value of the POSSUM was strongest for the < or = 20%, 60-80% and > or = 80% morbidity risk cohorts (O/E ratio 1). CONCLUSIONS: The identification of a scoring system to predict the development of severe complications after central pancreatectomy may stratify the patients' risk and lead to a tailored approach of this surgical procedure. Although POSSUM seems to predict morbidity after central pancreatectomy, further studies involving larger numbers of patients should be conducted to confirm this effect.
Subject(s)
Pancreatectomy , Pancreatic Neoplasms/diagnosis , Severity of Illness Index , Adolescent , Adult , Aged , Algorithms , Female , Humans , Male , Middle Aged , Pancreatectomy/mortality , Pancreatic Diseases/diagnosis , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/surgery , Prognosis , Retrospective Studies , Risk Assessment , Romania/epidemiologyABSTRACT
AIM: To evaluate results of ultrasound guided percutaneous catheter drainage (PCD) for local septic complications of chronic pancreatitis. MATERIAL AND METHOD: Between 1999 and 2002, PCD was used in 19 patients with chronic pancreatitis for 6 infected acute pseudocysts, 3 post-necrotic abscesses, 3 abscesses following pancreatic resections, 6 abscesses with none of the precipitating factors present (no acute episode or recent surgical/endoscopic interventions) and a tuberculous peritoneal empyema. In 17 patients, collections were unilocular. RESULTS: Trocar technique was used in 14 patients and Seldinger technique in 5. Sixteen patients were successfully treated with PCD alone (mean drainage duration = 32 days) without abscess recurrence during the follow-up period (mean = 35.6 month). Surgical treatment was necessary in 3 patients. Pseudocyst recurrence occurred in another patient after 9 months. CONCLUSION: PCD should be considered as the initial therapy for chronic pancreatitis local septic complications. Surgery is reserved for patients in whom PCD fails.
Subject(s)
Abscess/therapy , Drainage/methods , Pancreatic Diseases/therapy , Pancreatic Pseudocyst/therapy , Pancreatitis, Chronic/complications , Ultrasonography, Interventional , Abscess/diagnosis , Abscess/surgery , Adult , Drainage/instrumentation , Female , Humans , Male , Middle Aged , Pancreatic Diseases/diagnosis , Pancreatic Diseases/surgery , Pancreatic Pseudocyst/diagnosis , Pancreatic Pseudocyst/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
AIM: To describe the natural history of alcoholic chronic pancreatitis (ACP) patients form north-western Romania. METHODS: We performed a retrospective analysis and a subsequent prospective follow-up (mean = 7.3 years) of 99 patients with ACP. Average duration of ACP was 15.6 years. RESULTS: Patients were mostly men (93%), with a mean age of 42.9 years at the time of operation and 35.7 years at the disease onset. Indications for surgery were: intractable pain (12%), complications (83%) and suspicion of malignancy (5%). During the evolution, 35 patients needed two to four surgical procedures. Calcifications developed in 63.6% of patients, steatorrhea in 41.4% and secondary diabetes in 43.4%. CONCLUSION: ACP in north-western Romania is characterized by early onset of the disease and a severe evolution with multiple complications needing repeated surgery. The "burnout" of the disease, with calcifications, secondary diabetes and marked exocrine insufficiency leads to lasting pain relief.
Subject(s)
Pancreatitis, Alcoholic/diagnosis , Pancreatitis, Alcoholic/surgery , Abdominal Pain/etiology , Adult , Calcinosis/etiology , Diabetes Mellitus/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Pancreatectomy , Pancreatitis, Alcoholic/complications , Pancreatitis, Alcoholic/mortality , Pancreatitis, Alcoholic/physiopathology , Reoperation , Retrospective Studies , Risk Factors , Romania/epidemiology , Severity of Illness Index , Steatorrhea/etiology , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The liver is the most common site of hydatid disease. Complications like cyst rupture and infection may occur, sites of rupture including: bile ducts, gastrointestinal tract, bronchi, peritoneal and pleural cavity. Rupture into the subcutaneous tissue followed by external fistula is an extremely rare complication. CASE REPORT: A 71-year-old diabetic woman was referred for a progressive growing mass in the right hypochondrium, with a central fistula draining clear liquid with cystic elements and white membranes. No history of fever or jaundice was present. Abdominal ultrasound (followed by CT scan) revealed a liver hydatid cyst in the right lobe, in contact with the anterior abdominal wall, and a parietal fistula track. Cystic fluid exam showed protoscolices and serological ELISA test was positive for hydatid disease. At surgery, the lesion was approached through an incision starting from the fistula site. Partial cystectomy and external drainage of the residual cavity were performed. The fistula track was totally resected. After an uneventful recovery and six months of anti - parasitic treatment, the patient is symptoms- free (3 years after surgery). CONCLUSIONS: Spontaneous cyst-cutaneous fistula is an extremely rare complication of hydatid liver cyst, usually occurring silently, in elder people. Surgery is required to achieve complete evacuation of the cyst contents and resolution of the residual cavity. To the best of our knowledge, this is the seventh case published, and the first one in the Romanian literature.