[Diagnostic and management algorithm of acute pancreatitis].

The analysis of diagnostics and treatment of 602 patients with destructive pancreatitis has shown that definition of etiological and pathogenetic forms of pancreatitis defines strategy of treatment. In this way, patients with biliary pancreatitis require emergency operative treatment with use of endoscopic interventions without dependence from a stage of disease. To patients with alcoholic or alimentary pancreatitis in the stage of enzymatic toxemia conservative treatment should be spent only, until shock and/or delirium won't be reduced. Endoscopic retrograde cholangiopancreatography + endoscopic papillosphincterotomy with concrement removal from common bile duct--is the operation of choice in case of acute biliary pancreatitis at the first stage. Laparoscopic cholecystectomy is the operation of choice at the second stage of disease. At destructive pancreatitis of other origin in a stage of the infection or necrotic suppurative inflammation use of open and closed small invasive methods of intervention is most proved. Given tactics of treatment has allowed to lower severity of clinical course, frequency of complications and lethality.

[Erroneous laparotomies in emergency surgery]. / Oshibochnye laparotomii v ékstrennoi khirurgii.

The retrospective analysis of case histories of 28 patients subjected to erroneous laparotomies in 1988-1992 has been done. The total number of patients, who had urgent abdominal operations for this period of time, was 5115. Atypical clinical course of the disease, improper diagnosis and interpretation of the disease symptoms, senile age of the patient are major causes of the erroneous laparotomies. To avoid erroneous laparotomy laparoscopy and ultrasound examination of abdominal cavity should be used widely, other medical specialists (urologist, gynaecologist) should be involved in diagnosis, especially in senile patients.