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World Journal of Clinical Cases 2021年第29期9卷 8906-8914页

作者： Long Yang Yue Lin Xiang-Qun Zhang Bo Liu Jun-Yu Wang Department of Emergency Medicine Clinical Research Center Beijing Chao-Yang HospitalCapital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral ResuscitationBeijing Chaoyang District Gongti South Street 100020China Department of Radiology China-Japan Friendship HospitalBeijing 100029China

BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported,acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the literature.CASE SUMMARY We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk,without apparent abdominal pain or bloating,no jaundice and decreased blood pressure at the outset.The patient was ultimately diagnosed with moderately severe acute pancreatitis(according to the revised Atlanta classification of acute pancreatitis)combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome.After active treatment of acute pancreatitis,massive fluid resuscitation,resection of parathyroid and uterine malignant tumors,neoadjuvant chemotherapy and other treatments,her serum calcium eventually returned to the normal level.The patient was successfully discharged from hospital.CONCLUSION This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.

关键词： acute pancreatitis Humoral hypercalcemia Primary hyperparathyroidism Paraneoplastic syndrome Case report

acute pancreatitis with pulmonary embolism:A case report

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World Journal of Clinical Cases 2021年第4期9卷 904-911页

作者： Xue-Ling Fu Fa-Ke Liu Ming-Dong Li Chang-Xue Wu Emergency Intensive Care Unit The Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina Department of Critical Care Medicine The Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina Department of Radiology The Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina

BACKGROUND acute pancreatitis(AP)is a common critical disease of the digestive system that is often associated with multiple complications.Vascular complications are relatively rare and are one of the causes of death.AP complicated with pulmonary embolism(PE)is even rarer,and there are no reports of AP complicated with PE in elderly patients.CASE SUMMARY We describe a rare case of AP complicated with PE and review the literature.A 68-year-old woman was diagnosed with AP due to widespread abdominal pain.During the course of treatment,the patient had shortness of breath and progressively worsening dyspnea without chest pain or hemoptysis with a progressive increase in D-dimer and fibrin degradation product.Respiratory failure and right heart failure occurred,and refractory hypoxemia remained after mechanical ventilation.Plain chest computed tomography revealed a small amount of left pleural effusion and external pressure atelectasis in the lower lobe of the left lung but no findings that could lead to refractory hypoxemia.Color Doppler ultrasound indicated pulmonary hypertension and extensive venous thrombosis in the lower extremities.Chest computed tomography angiography finally suggested pulmonary thromboembolism.The patient’s dyspnea symptoms disappeared after anticoagulation treatment.CONCLUSION During the diagnosis and treatment of AP,it is necessary to dynamically monitor D-dimer and consider PE.

关键词： acute pancreatitis Pulmonary embolism Vein thrombosis D-dimer Diagnosis Case report

Natural Chinese herbs for the prevention and treatment of acute pancreatitis:a narrative review

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Journal of Pancreatology 2022年第4期5卷 186-197页

作者： Jiaqi Cui Di Wu Huimin Zhou Haiyan Chen Zhixia Dong Jun Yang Department of General Surgery Wuxi Institute of Hepatobiliary SurgeryAffiliated Hospital of Jiangnan UniversityWuxi 214000China

acute pancreatitis(AP)is a disease characterized by local inflammation in the pancreas,followed by trypsin activation,and may result from multiple etiologies.Approximately 20%of AP can progress to severe acute pancreatitis(SAP),which can lead to systemic inflammatory response syndrome(SIRS)and multiple organ dysfunction syndromes(MODS).SAP mortality rates have remained high in recent years,but there are currently no specific drugs designed to reduce these rates.Clinical studies have shown that patients can reduce the symptoms of the disease and slow down the development of the disease after taking the Chinese medicine decoction.Basic studies have shown that in AP or SAP disease models,the use of Chinese medicine monomers can improve the condition of rates.These natural Chinese herbal products can improve pancreatitis,given their ability to act on multiple targets.However,they have not been widely employed clinically and studied sufficiently and thoroughly.Therefore,this review aimed to summarize the pathophysiological mechanisms underlying pancreatitis and review the potential role of natural Chinese herbs(monomers and decoctions)in clinical and basic research.

关键词： acute pancreatitis Chinese herbs Natural product

acute venous thromboembolism in acute pancreatitis based on the severity:a retrospective cohort study

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Journal of Pancreatology 2022年第1期5卷 10-17页

作者： Hassam Ali Swethaa Manickam Rahul Pamarthy Muhamad Fahd Farooq William Leland Department of Internal Medicine East Carolina University/Vidant Medical CenterGreenvilleNC Department of Gastroenterology East Carolina University/Vidant Medical CenterGreenvilleNCUSA

Objective: acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods: We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results: The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3,P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1,P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4,P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1,P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81,P <.001).Conclusion: VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes;however, AP without necrosis does not increase upper and lower extremity VTE risk.

关键词： acute pancreatitis Deep venous thrombosis Necrosis Severity Venous thromboembolism

acute pancreatitis and small bowel obstruction caused by a migratory gastric bezoar after dissolution therapy: A case report

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World Journal of Clinical Cases 2021年第13期9卷 3114-3119页

作者： Ting-Ting Wang Jia-Jun He Jun Liu Wei-Wei Chen Chao-Wu Chen Department of Gastroenterology The First Clinical Medical CollegeDalian Medical UniversityDalian 116044Liaoning ProvinceChina Endoscopy Center Department of GastroenterologyClinical Medical CollegeYangzhou UniversityYangzhou 225009Jiangsu ProvinceChina

BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.acute pancreatitis secondary to bezoar is rare.Here,we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain,which revealed a huge bezoar and a gastric ulcer 10 d prior.The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d,without repeat gastroscopy.However,she suddenly developed epigastric pain,nausea and vomiting for 3 d.Abdominal computed tomography(CT)revealed mild inflammation of the pancreas.Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct.The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment.Abdominal CT re-examination suggested intestinal obstruction.Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen,and we used the basket and net to fragment the bezoar.She was discharged with a good outcome.CONCLUSION Endoscopic therapy is the first choice for gastric bezoars.When mechanical disintegration cannot be achieved,timing of repeat endoscopy is important during Coca-Cola dissolution therapy.

关键词： Bezoar Intestinal obstruction acute pancreatitis Dissolution therapy Endoscopy Case report

acute necrotizing pancreatitis: challenges and interventions-a narrative review

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Journal of Pancreatology 2022年第3期5卷 40-82页

作者： Yan Luo Le Li Rui Kong Yuhang Sui Bei Sun Department of Pancreatic and Biliary Surgery the First Affiliated Hospital of Harbin Medical UniversityHarbinChina Key Laboratory of Hepatosplenic Surgery Ministry of Educationthe First Affiliated Hospital of Harbin Medical UniversityHarbinChina

acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.

关键词： acute pancreatitis acute necrotizing pancreatitis step-up approach postoperative residual infection infected pancreatic necrosis

acute pancreatitis in pregnancy:An unresolved issue

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World Journal of Gastroenterology 2010年第16期16卷 2065-2066页

作者： Pankaj Jain Department of Gastroenterology Fortis Modi Hospital

Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of acute pancreatitis is not rare.Hemoconcentration as a marker of fluid def icit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure,cardiac and respiratory system.Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis.

关键词： acute pancreatitis Pregnancy Sedation Nonbiliary cause

acute pancreatitis during SARS CoV 2 Infection

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Open Journal of Gastroenterology 2023年第1期13卷 28-32页

作者： Marie Louise Bassène Marième Poléle Fall Alioune Badara Fall Salamata Diallo Coumba Kouba Cissé Téné Sidibé Aï ssé Thioubou Mamadou Ngoné Gueye Hô pital Aristide Le Dantec Avenue Pasteur Dakar Sénégal Hô pital de la Paix Ziguinchor Sénégal Hô pital Général Idrissa Pouye Dakar Sénégal

Introduction: Covid-19 is a systemic disease that can spread to all systems. Among the gastrointestinal manifestations, pancreatic involvement can have a major prognostic impact. We report 3 acute pancreatitis cases occurring during Covid-19, in Dakar. Case 1: 65-year-old woman who presented with intense atypical epigastric pain. Physical examination revealed obesity, high blood pressure and abdominal tenderness. Biological tests found increase CRP (134 mg/l) and lipasemia (312 UI/l). Abdominal CT scan showed findings of Balthazar grade C acute pancreatitis. RT-PCR for SARS CoV 2 RT-PCR was positive. The outcome was favorable. Case 2: 56-year-old woman patient with history of nephroangiosclerosis who presented with dyspnea, cough, fever and moderate epigastric pain. Physical examination revealed epigastric tenderness, high blood pressure, anuria. Biological testing, noted increase CRP (96 mg/l), lipasemia (793 UI/l), creatinine (227 mg/l) and urea (3.84 g/l). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Case 3: 27-year-old man who presented with physical asthenia, headache, and epigastric pain. Physical examination found epigastric tenderness. Elevated CRP level was of 102 mg/l and lipasemia level was of 427 UI/l (7N). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Conclusion: acute pancreatitis can occur during Covid-19 infection. However, the imputability to the Covid-19 disease necessitates to rule out the most common causes.

关键词： acute pancreatitis SARS CoV 2 Covid-19

Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review

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World Journal of Gastrointestinal Endoscopy 2022年第7期14卷 443-454页

作者： Emmanouil Psaltis Chris Varghese Sanjay Pandanaboyana Manu Nayar Department of HPB and Transplant Surgery Newcastle upon Tyne NE77DNUnited Kingdom Department of Surgery Freeman HospitalNewcastle upon Tyne NE77DNUnited Kingdom Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland 1010New Zealand Population Health Sciences Institute Newcastle UniversityNewcastle upon Tyne NE17RUUnited Kingdom Department of Gastroenterology Freeman HospitalNewcastle upon Tyne NE77DNUnited Kingdom

BACKGROUND Treatment for severe acute severe pancreatitis(SAP)can significantly affect Health-related quality of life(HR-QoL).The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated.AIM To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP.METHODS A literature search was performed on PubMed,Google^(TM) Scholar,the Cochrane Library,MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with SAP.Data collected included patient characteristics,outcomes of interventions and HR-QoL-related details.RESULTS Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 patients.Three studies were randomized trials,four were prospective cohort studies and four were retrospective cohort studies with prospective follow-up.Four studies compared HR-QoL following surgical and endoscopic necrosectomy.Several metrics of HR-QoL were used including Short Form(SF)-36 and EuroQol.One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy.One prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the patients.On the other hand,a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36>60%.In the only study that examined patients following endoscopic necrosectomy,the HR-QoL was also very good.Three studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost effectiveness.Finally,regarding HR-QoL between open necrosectomy and minimally invasive approaches,patients

关键词： acute pancreatitis Pancreatic necrosis Surgical necrosectomy Endoscopic necrosectomy Minimally invasive drainage Quality of life

Early prediction and prevention of infected pancreatic necrosis

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World Journal of Gastroenterology 2024年第9期30卷 1005-1010页

作者： Cheng Lv Zi-Xiong Zhang Lu Ke Department of Critical Care Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210000Jiangsu ProvinceChina Research Institute of Critical Care Medicine and Emergency Rescue Nanjing UniversityNanjing 210000Jiangsu ProvinceChina

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the acute Physiology and Chronic Health Evaluation II and pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

关键词： acute pancreatitis Infected pancreatic necrosis Biomarker Scoring system Nutrition therapy Selective digestive decontamination Probiotics Antibiotics Immune enhancement therapy