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Complications of chronic pancreatitis prior to and following surgical treatment:A proposal for classification

World Journal of Clinical Cases 2022年第22期10卷 7808-7824页

作者： Marko Murruste Ülle Kirsimägi karri kase Tatjana Veršinina Peep Talving Urmas Lepner Department of Surgery Tartu University HospitalTartu 50406Estonia Department of Surgery BoardNorth Estonia Medical CentreTallinn 13419Estonia

BACKGROUND Chronic pancreatitis(CP)is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological *** The aims of this study were to:Propose a pathophysiological classification of the complications of CP;evaluate their prevalence in a surgical cohort prior to,and following surgical management;and assess the impact of the surgical treatment on the occurrence of new complications of CP during *** hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications,with the exclusion of pancreatic *** primary outcomes were prevalence of complications of CP at baseline(prior to surgical treatment)and occurrence of new complications during *** After institutional review board approval,a prospective observational cohort study with long-term follow-up(up to 20.4 years)was *** consecutive single-center adult patients(≥18 years of age)with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021,were *** prevalence of CP complications evaluated,according to the proposed classification,in a surgical cohort of 166 *** of the pathophysiological classification was based on a literature review on the clinical presentation,course,and complications of CP,as well a review of previous classification systems of *** We distinguished four groups of complications:Pancreatic duct complications peripancreatic complications,pancreatic hemorrhages,and pancreatic insufficiency(exocrine and endocrine).Their baseline prevalence was 20.5%,23.5%,10.2%,31.3%,and 27.1%,*** treatment was highly effective in avoiding new complications in the first and third *** the group of peripancreatic complications,the 15-year Kaplan-Meier prevalence of new complications was 12.1%.The prevalence of pancreatic exocrine and en

关键词： Chronic pancreatitis Complications Classification Pathophysiology Surgical treatment

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‘Short’pancreaticojejunostomy might be a valid option for treatment of chronic pancreatitis in many cases

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1673-1684页

作者： Marko Murruste Ülle Kirsimägi karri kase Tatjana Veršinina Peep Talving Urmas Lepner Department of Surgery Tartu University HospitalTartu 50406Estonia Faculty of Medicine University of TartuTartu 50411Estonia Division of Acute Care Surgery Department of SurgeryNorth-Estonia Medical CentreTallinn 13419Estonia

BACKGROUND The Partington-Rochelle pancreaticojejunostomy(PJ)is an essential management option for patients with chronic pancreatitis(CP)associated with intractable pain and a dilated pancreatic duct(PD).Wide ductotomy and long PJ(L-PJ)have been advocated as the standard of care to ensure full PD ***,the role of short PJ(S-PJ)in a uniformly dilated PD has not yet been *** To evaluate the possible advantages and disadvantages of S-PJ and L-PJ and to interpret the perspective of S-PJ in the treatment of *** A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side *** length of the PJ was adapted to anatomical alterations in PD.A comparison was made of S-PJ(<50 mm)for uniformly dilated PD and L-PJ(50-100 mm)in the setting of multiple PD strictures,calcifications and *** hypothesized that S-PJ and L-PJ ensure comparable clinical *** primary outcomes were pain relief and quality of life(QOL);the secondary outcomes were perioperative characteristics,body weight,patients’satisfaction with treatment,and readmission rate due to *** Overall,91 patients underwent side-to-side PJ for CP,including S-PJ in 46 patients and L-PJ in 45 patients.S-PJ resulted in better perioperative outcomes:Significantly shorter operative time(107.5 min vs 134 min),lower need for intraoperative(0%vs 15.6%)and total(2.2%vs 31.1%)blood transfusions,and lower rate of perioperative complications(6.5%vs 17.8%).We noted no significant difference in pain relief,improvement in QOL,body weight gain,patients’satisfaction with surgical treatment,or readmission rate due to *** Based on our data,in the setting of a uniformly dilated PD,S-PJ provides adequate decompression of the *** the clinical outcomes following S-PJ are not inferior to those of L-PJ,S-PJ should be preferred as a surgical option in the case of a uniformly dilated PD.

关键词： Chronic pancreatitis Surgical treatment Pancreaticojejunostomy Partington-Rochelle Length of anastomosis

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Torsion of Meckel's diverticulum as a cause of small bowel obstruction: A case report

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World Journal of Gastrointestinal Surgery 2014年第10期6卷 204-207页

作者： Marko Murruste Geidi Rajaste karri kase Department of General and Plastic Surgery Surgery Clinic Tartu University Hospital Tartu 51014 Estonia Surgery Clinic Tartu University Hospital Tartu 51014 Estonia

Axial torsion and necrosis of Meckel's diverticulum causing simultaneous mechanical small bowel obstruc-tion are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel's diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and re-tention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography(CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral con-trast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proxi-mal to the obstruction, and a large(12 cm × 14 cm) Meckel's diverticulum at the site of obstruction. Meckel's diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel's diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postopera-tive day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel's diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; de-lay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.

关键词： Meckel’s diverticulum Axial torsion Gangrene Bowel obstruction Emergency surgery

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