Management of acute severe hyperlipidemic pancreatitis.

BACKGROUND/AIM: Hypertriglyceridemia is rare and can provoke acute severe hyperlipidemic pancreatitis when triglyceride levels exceed 11.3 mmol/l. In 10 patients we evaluated the therapeutic guidelines for severe hyperlipidemic pancreatitis. METHODS: Ten patients (8 men and 2 women) were admitted to the intensive care unit with a diagnosis of acute severe hyperlipidemic pancreatitis. They underwent standard treatment. Heparin, insulin and antihyperlipidemic drugs were used to lower the triglyceride levels. The patients underwent plasmapheresis within 48 h of admission, and fat-free parenteral nutrition was used. Two of the patients underwent surgery because of infection of necrotic segments. RESULTS: Standard treatment was essential for all the patients but plasmapheresis was the procedure that lowered the triglyceride and lipid levels in all cases. It improved abdominal pain, clinical state, and signs and symptoms of the disease. Two patients underwent surgery due to infection of the necrotic segments and one of them died. Follow-up lasted 4-54 months with no recurrences of pancreatitis. CONCLUSION: Our study shows that standard treatment is essential, but plasmapheresis successfully lowered lipid levels with no complications and relieved the patients from the symptoms in the acute phase of the disease. Hyperlipidemic pancreatitis should initially be treated conservatively. Plasmapheresis is a method that has lately been used successfully for hyperlipidemic pancreatitis. It seems that all therapeutic measures should be applied as early as possible, within the first 48 h.

Splenic artery aneurysm rupture.

BACKGROUND: Splenic artery aneurysms are uncommon even though they are second only to those of the aorto-iliac system. There is also controversy regarding their management. METHODS: We report the case of a 50-year-old patient with ruptured splenic artery aneurysm and review the literature regarding its diagnosis and management. RESULTS: The patient underwent emergency laparotomy and splenectomy was performed. CONCLUSION: Resuscitation and an aggressive surgical approach should be taken in order to save the life of the patients.

Respiratory failure after pneumonectomy in a patient with unknown hyperlipidemia.

IMPLICATIONS: We report the case of a patient who had increased lipids in his blood and who complained of dyspnea the first postoperative day after resection of his left lung. As the blood lipids were decreased, his respiration was improved. We conclude that when respiration deteriorates postoperatively, increased blood lipids should be considered as a cause.

[Surgical treatment of ruptures of hydatid cysts of the liver]. / Traitement chirurgical des ruptures des kystes hydatiques du foie.

During the last 20 years (1972-1992), 421 patients underwent surgery for hydatid disease of the liver. 96 out of 421 patients had a rupture such as, intrabiliary rupture 49 patients, intrathoracic rupture 43 patients and free rupture in the peritoneal cavity 4 patients. The surgical treatment required a variety of procedures: 1) Prolonged tube drainage of the residual cavity and exploration of the common bile duct followed by either T tube drainage or sphincteroplasty or choledocho-duedonostomy if it was necessary, for intrabiliary rupture. 2) Lung resection if it was necessary, and evacuation plus drainage and the hepatic cavity followed by suture of the diaphragmatic rupture of closure of the bronchial opening if present for intrathoracic rupture. 3) Lavage and prolonged tube drainage of the hepatic cavity for free rupture in the peritoneal cavity. Five patients died in the postoperative period one from suppurative cholagitis, one from pulmonary embolism and 3 from M.O.F.