ABSTRACT
AIM: Evaluating the importance of intraabdominal pressure measurement in cases of severe acute pancreatitis and its use in determining indication for surgery. METHODS: A retrospective evaluation of the treatment of patients with severe acute pancreatitis hospitalised at the Department of Surgery or the Department of Anaesthesiology and Resuscitation of the Charles University hospital in Pilsen during the last two years (from January 1 (st), 2002 to December 31 (st), 2003) was performed. RESULTS: During this period, 63 patients with severe acute pancreatitis were hospitalised at both departments, among which 18 patients underwent an operation (28.6 %), eight of them died (12.7 %). In four of the 18 patients who underwent an operation the surgery was indicated due to progression of abdominal compartment syndrome (ACS) and all of these patients survived. CONCLUSIONS: At present, basic treatment of severe acute pancreatitis is considered to be conservative. The only generally accepted indication for surgery is an established infection of the necrotic tissue. In our presentation, we draw attention to those cases where the general condition of the patient deteriorates combined with a progression of ACS and where a decompressive laparotomy can improve the prognosis of the disease.
Subject(s)
Abdomen , Compartment Syndromes/etiology , Decompression, Surgical , Pancreatitis/diagnosis , Pancreatitis/surgery , Abdomen/physiopathology , Acute Disease , Adult , Aged , Aged, 80 and over , Drainage , Female , Follow-Up Studies , Humans , Laparotomy , Male , Middle Aged , Multiple Organ Failure/etiology , Pancreatitis/complications , Pancreatitis/mortality , Pancreatitis/therapy , Pressure/adverse effects , Prognosis , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
The authors report on the prevalence of acute cholecystitis in the absence of calculi with special attention paid to the development of this disease as a complication of prolonged parenteral nutrition. In 1990-1993 at the Surgical Clinic in Plzen 125 cases of acute cholecystitis were operated, incl. 14 acalculous ones (11.2%). These 14 patients comprised 5 (28.6%) who were on parenteral nutrition for a prolonged period. The authors analyze the causes of the development of acute acalculous cholecystitis. They deal with the problem of diagnosis where in severe postoperative and posttraumatic cases ultrasonography proved useful.
