Acute Pancreatitis Research Papers - Academia.edu (original) (raw)

2025, International Journal of Molecular Sciences

Opioids are widely used for the pain management of acute pancreatitis (AP), but their impact on disease progression is unclear. Therefore, our aim was to study the effects of clinically relevant opioids on the severity of experimental AP. Various doses of fentanyl, morphine, or buprenorphine were administered as pre- and/or post-treatments in rats. Necrotizing AP was induced by the intraperitoneal injection of L-ornithine-HCl or intra-ductal injection of Na-taurocholate, while intraperitoneal caerulein administration caused edematous AP. Disease severity was determined by laboratory and histological measurements. Mu opioid receptor (MOR) expression and function was assessed in control and AP animals. MOR was expressed in both the pancreas and brain. The pancreatic expression and function of MOR were reduced in AP. Fentanyl post-treatment reduced necrotizing AP severity, whereas pre-treatment exacerbated it. Fentanyl did not affect the outcome of edematous AP. Morphine decreased vacu...

2025, Indian Journal of Endocrinology and Metabolism

Primary hyperparathyroidism (PHPT) in India, unlike in the Western world, is largely asymptomatic disease. Due to lack of awareness and routine calcium estimation, delayed presentation and co-existing calcium and Vitamin D (Vit D) deficiency, bone and other systemic involvement are more commonly seen. With greater awareness among physicians, widespread use of AutoAnalyzers, and increasing trend of

2025, Frontiers in Pharmacology

Recently, the stable gastric pentadecapeptide BPC 157 was shown to counteract major vessel occlusion syndromes, i.e., peripheral and/or central occlusion, while activating particular collateral pathways. We induced abdominal compartment syndrome (intra-abdominal pressure in thiopental-anesthetized rats at 25 mmHg (60 min), 30 mmHg (30 min), 40 mmHg (30 min), and 50 mmHg (15 min) and in esketamine-anesthetized rats (25 mmHg for 120 min)) as a model of multiple occlusion syndrome. By improving the function of the venous system with BPC 157, we reversed the chain of harmful events. Rats with intra-abdominal hypertension (grade III, grade IV) received BPC 157 (10 µg or 10 ng/kg sc) or saline (5 ml) after 10 min. BPC 157 administration recovered the azygos vein via the inferior–superior caval vein rescue pathway. Additionally, intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were reduced, as were the grossly congested stomach and major hemorrh...

2025, Journal of Gastrointestinal Surgery

Background Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. Methods All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005-2015) were segregated into NJ or PEG-J. Results A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001). Conclusion In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.

2025, Surgery

Background: Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis. Design: An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single-institution database between 2005 and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n ¼ 57, 9%) and patients lost to follow-up (n ¼ 12, 2%). Results: A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow-up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was required in 230 (40%) patients. Conclusion: Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.

2025, Hpb

Results: The CBD defect was successfully repaired with a gallbladder wall free flap. The patient remains well 2.5 years later on follow up with normalization of liver enzymes and without sign of a bile leak. Conclusion: Mirizzi's syndrome and laparoscopic CBD injury can happen in patients with significant comorbidity. Usually hepaticojejunostomy is required to repair the bile duct, which has a high complication and mortality rates in this subgroup of patients. Gallbladder wall free flap is a reasonable choice to repair the defects with good result and free flap survival like our case. The technique should be considered as an alternative to avoid morbidity and mortality in high-risk patients. Two giant gallstones found within the gallbladder causing compression of the common bile duct and Mirizzi's Syndrome with cholecholedochal fistula.

2025, Gastroenterology

and hepatobiliary isotope scanning before and after reconstructive surgery and trans-surgical liver biopsy which was classified according to the index of histological activity: inflammation, cholestasis, ductular proliferation and fibrosis. In order to evaluate the outcome, the McDonald classification, was used 3, 6 and 12 months after reconstructive surgery. Results: 207 patients were included, all of them classified as Strasberg E. Time of evolution was significant ( p=0.000) predominating ductular proliferation and fibrosis in those with more than 120 days. Also, 62% of them had vascular injury associated while only 2.2% of those with inflammation (p=0.000). In the cholestasis, ductular proliferation and fibrosis groups, the mechanisms of injury that caused obstruction of the bile flow were obstruction with suture, staple or burn at 59.7%, 86.6% and 100% respectively (p=0.000). By correlating histological damage with hepatic impairment at 3, 6 and 12 months it was observed, in the inflammation group that at 3 months 82.2% had McDonald B and at 12 months 100% had McDonald A. In the cholestasis group, at 3 months 96.1% had McDonald B and at 12 months 86.3% of the total of patients in the group were classified as McDonald A. At 3 months, 73.3 % with ductular proliferation was classified as McDonald C-D and at 12 months 97.6% had B and 2.4% A. In the fibrosis group, 100% had McDonald C-D at 3 months and at 12 months 84.2% reverted to McDonald B. When analyzing liver function in each histological degree with the Kaplan-Meier method, all patients had liver failure upon admission. After biliodigestive reconstruction, in the inflammation group, the percentage of patients with liver failure decreased to 8% at 3 months and none had it from 6 months on. In the cholestasis group, liver failure was present in 20% of the patients at 3 months and only 2% from 6 months on. In the ductular proliferation group, 60% persisted with liver failure at 3 months, 20% at 6 months and 2% at 12 months. And in the fibrosis group, 88% of the patients had it at 3 months, 50% at 6 months and 18% at 12 months. Discussion: liver biopsy must be done at the time of bilioenteric repair to correlate with liver function in their follow-up.

2025, HPB

Background: We hypothesized that the development and implementation of an ERAS pathway targeting next day discharge following distal pancreatectomy (DP) would reduce length of stay (LOS) without affecting post-operative morbidity or mortality. Methods: The ERAS pathway was carried out by one surgeon over a 23-month period starting in March 2016 (ERAS group). Outcomes in this group were compared to patients operated on by other surgeons not following the pathway during the same time period (contemporary group) and to a retrospective cohort (retrospective group) of patients operated on by the same single surgeon, between December 2013 to February 2016. A prospectively maintained database with documentation of 60-day complications and 90-day mortality was retrospectively reviewed and analyzed. Analysis was performed using chi-squared for categorical variables and Mann Whitney testing for continuous variables. Results: Among 120 patients included in the study; 42 were in the ERAS group, 42 in the retrospective group, and 36 in the contemporary group. No significant differences in patient demographics, co-morbidities, or fistula risk scores existed between groups. Implementation of the pathway reduced median LOS by 43% in the ERAS group compared to the retrospective group (2 vs 3.5 days, P < 0.001) and by 50% compared to the contemporary group (2 vs 4 days, P < 0.001). Within the ERAS group, post-operative pancreatic fistulas were reduced compared to both the retrospective group (9.5% vs 26.2%, P = 0.0031) and the contemporary group (9.5% vs 36.1%, P = 0.006), however, no difference in clinically relevant fistulas was present. Urinary retention occurred more frequently among patients in the ERAS group at 14.3% (contemporary: 0%, P = 0.024; retrospective: 2.4%, P = 0.052). There were no other differences in post-operative complications, rates of re-operation, re-admission, or 90-day mortality. Conclusion: Utilization of an ERAS pathway targeting next day discharge following distal pancreatectomy significantly reduced LOS without affecting morbidity or mortality.

2025, American journal of surgery

Over the past decade, the treatment of necrotizing pancreatitis (NP) has incorporated greater use of minimally invasive techniques, including percutaneous drainage and endoscopic debridement. No study has yet compared outcomes of patients treated with all available techniques. We sought to evaluate the evolution of NP treatment at our high volume pancreas center. We hypothesized that minimally invasive techniques (medical only, percutaneous, and endoscopic) were used more frequently in later years. Treatment strategy of NP patients at a single academic medical center between 2005 and 2014 was reviewed. Definitive management of pancreatic necrosis was categorized as: 1) medical treatment only; 2) surgical only; 3) percutaneous (interventional radiology - IR) only; 4) endoscopic only; and 5) combination (Surgery ± IR ± Endoscopy). 526 NP patients included biliary (45%), alcoholic (17%), and idiopathic (20%) etiology. Select patients were managed exclusively by medical, IR, or endoscop...

2025, Journal of Evidence Based Medicine and Healthcare

Acute pancreatitis (AP) is one of the most common diseases in gastroenterology. Two percent of all patients admitted to hospital are diagnosed with AP. During the last decade, an increasing incidence was observed, mostly because of a higher sensitivity of diagnostic tests. Treatment of Acute Pancreatitis is still symptomatic and no specific medication is available today. As a result of popular belief that the pancreas should be put to rest during acute pancreatitis, the parenteral route for nutrition is still predominantly used in Acute Pancreatitis. There has been increasing evidence; however, about gut being main source of microorganisms causing infectious pancreatic complications and multiorgan failure. In patients with severe pancreatitis, oral intake is inhibited by nausea and subileus. Although some reports show that enteral feeding is possible in acute pancreatitis and associated with fewer septic complications. Although the evidence is inconclusive to support enteral nutrition in all patients with severe acute pancreatitis, the enteral route may be used if tolerated. Supportive treatment is the most important line of management in acute pancreatitis. The aim is to study the management of acute pancreatitis in a peripheral tertiary hospital and to assess the outcome of the management. Data Collection: Patients with acute abdominal pain are admitted in hospital and diagnosed as acute pancreatitis based on blood investigations and radiological findings. Patients categorised-Revised Atlanta Classification. Different medical management modes followed and outcomes recorded, tabulated and analysed.

2025, Indian Journal of Psychiatric Social Work

From the very beginning of the Social Work, human needs have long been part of the social work theory, practice and research as an implicit conceptual foundation but practically it has long been a neglected and contested concept in the published literature of social work though social work has been instrumental in meeting the various needs of individuals. Social Work Practice in the field of mental health is also not an exception for the same. The need of an hour is to explicitly discuss the role of social work in meeting the human needs on the research and literature; the practice of which has already begun. It will have a significant influence on the contemporary practice of Psychiatric Social Work as well in India.Â Â Â Â Â Â Â Keywords: Psychiatric social work, psychosocial intervention, needs

2025, World Journal of Surgery

2025, Journal of Personalized Medicine

Background: The Delta variant (Pango lineage B.1.617.2) is one of the most significant and aggressive variants of SARS-CoV-2. To the best of our knowledge, this is the first paper specifically studying pulmonary morphopathology in COVID-19 caused by the B.1.617.2 Delta variant. Methods: The study included 10 deceased patients (40-83 years) with the COVID-19 Delta variant. The necrotic lung fragments were obtained either by biopsy (six cases) or autopsy (four cases). Tissue samples were subjected to virology analysis for identification of the SARS-CoV-2 variant, histopathology, and immunohistochemistry (anti-SARS coronavirus mouse anti-virus antibody). Results: Virology analysis identified B.1.617.2 through genetic sequencing in eight cases, and in two cases, specific mutations of B.1.617.2 were identified. Macroscopically, in all autopsied cases, the lung had a particular appearance, purple in color, with increased consistency on palpation and abolished crepitations. Histopathologic...

2025, Pancreatology

Background/objectives: Pancreatic acinar cells are major targets of IL-22. Our aim is to study early plasma levels of IL-22, of pro-and anti-inflammatory cytokines in acute pancreatitis, and their association with severity or necrosis... more

2025, Journal of Hepatology and Gastrointestinal disorders

Introduction: Bile stone is the main cause of acute pancreatitis (AP) and one of the few etiologies that can benefit from specific and curative treatment. The purpose of our work is to evaluate our experience of endoscopic treatment of acute biliary pancreatitis. Retrospective study performed in the hepatogastroenterology "C" department of Ibn Sina hospital in Rabat, we included patients who had acute biliary pancreatitis and endoscopically treated. We included 42 patients, the women/man sex ratio=3.2, the mean age was 51.5 years. A history of acute pancreatitis (AP) was reported in 8 cases and cholecystectomy in 15 cases. Arguments for retaining biliary origin were cytolysis greater than 3 times normal in 18 cases, presence of retentional jaundice in 4 cases, cholangitis in 3 patients, primary biliary stone on ultrasound in 8 cases and choledochal dilatation without obstacle image in 15 cases. Bili-MRI was performed in 6 patients with confirmation of biliary origin in 2 patients. The degree of severity of AP was Balthazar stage A in 14 cases, stage B in 7 cases, stage C in 4 cases and E in 6 cases. In 7 cases severity was not specified. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stone image in 17 cases, dilatation of the bile duct in 31 cases. Stone extraction was successful in 38 patients. Sphincterotomy was performed in 34 cases, of which 4 cases benefited from placement of pancreatic or biliary prosthesis. Immediate complications are marked by a minor bleeding stopped spontaneously. In patients with gallbladders in place, a cholecystectomy was scheduled in the subsequent ERCP. The endoscopic treatment of acute biliary pancreatitis in our experience, proved its efficacy without added morbidity.

2025, Indian Journal of Pediatrics

2025

Background: Angiotensin converting enzyme inhibitors (ACEIs) are commonly used in the treatment of hypertension. We describe the first cases of angiotensinconverting enzyme inhibitor (ACEI) -induced intestinal angioedema in the postpartum period. Both patients presented with hypovolemic shock and acute abdominal complaints. The first patient underwent laparotomy because of the suspicion of internal bleeding. Only large amount of ascites was found. After exclusion of other causes, the diagnosis of ACEI-induced intestinal angioedema was made. Pattern recognition in our second patient prevented invasive examinations. Both patients made full recovery after discontinuation of angiotensin converting enzyme inhibitor and with supportive therapy. Identification of ACEI-induced intestinal angioedema as a cause of abdominal complaints and hypovolemic shock may avoid unnecessary invasive examinations. ACEIs should not be first choice in the treatment of hypertension in the postpartum period.

2025, Endocrine Abstracts

2025, Journal of Thrombosis and Thrombolysis

The original version of this article unfortunately contained a mistake in the family name of the co-author. The author name should be Genady Drozdinsky instead of Genady Drozidnsky. This has been corrected in the original version of the... more

2025, Uva Clinical Research Lab 2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198

Simethicone is a widely used, over-the-counter, non-systemic medication indicated for the relief of gastrointestinal gas-related symptoms such as flatulence, bloating, and postprandial discomfort. It functions as a surface-active agent that facilitates the aggregation and expulsion of gas bubbles from the gastrointestinal tract, thereby alleviating distension and pressure. With its FDA approval dating back to 1952, simethicone has an established role in clinical practice, not only for symptomatic relief but also as an adjunct in diagnostic imaging. The compound is pharmacologically inert, lacking systemic absorption, metabolism, or excretion through the kidneys, which contributes to its outstanding safety profile across all age groups, including infants and pregnant individuals. Though adverse effects are rare and usually limited to minor gastrointestinal symptoms, clinicians must remain aware of isolated case reports of altered drug bioavailability, notably with carbamazepine and levothyroxine. This paper reviews the indications, pharmacodynamics, administration strategies, safety profile, contraindications, toxicity considerations, and the critical role of interprofessional collaboration in optimizing patient outcomes with simethicone therapy.

2025, Journal of Nepal Medical Association

Introduction: Understanding a child with any episode of febrile seizure is important so that special attention could be given. The objective of this study was to find the prevalence of febrile seizure in children attending a tertiary centre in western Nepal. Methods: A descriptive cross-sectional study was performed in a tertiary care centre at the department of Pediatrics after taking approval from the Institutional Review Committee. Study was conducted among the children presented with febrile seizure from 18th October 2017 to 12th April 2020. Patient files were retrospectively reviewed. Convenience sampling method was used. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Of the total 4701 admitted children during a study period, 217 (4.61%) (3.41-5.81 at 95% Confidence Interval) children had febrile seizure. O...

2025, British Journal of Surgery

Background Acute pancreatitis is a catabolic illness and patients with the severe form have high metabolic and nutrient demands. Artificial nutritional support should therefore be a logical component of treatment. This review examines the evidence in favour of initiating nutritional support in these patients and the effects of such support on the course of the disease. Methods Medline and Science Citation Index searches were performed to locate English language publications on nutritional support in acute pancreatitis in the 25 years preceding December 1999. Manual cross-referencing was also carried out. Letters, editorials, older review articles and most case reports were excluded. Results and conclusion There is no evidence that nutritional support in acute pancreatitis affects the underlying disease process, but it may prevent the associated undernutrition and starvation, supporting the patient while the disease continues and until normal and sufficient eating can be resumed. The...

2025, Cureus

C-reactive protein (CRP) has been reported as a predictor of the severity of acute pancreatitis (AP). However, there is conflicting evidence in the literature. The proposed cut-off values and intervals for best prediction include an absolute value of 150 at 48 hours; an absolute value of 190 at 48 hours; and the interval change in CRP of 90 at 48 hours. The current study assesses the value of CRP at different intervals and cutoffs in predicting complicated acute pancreatitis (CAP) and compares its performance against other available predictors like neutrophil to lymphocyte ratio (NLR); Glasgow scoring system and modified CT severity index (MCTSI). Analysis of prospectively maintained data for index episodes of acute pancreatitis managed in 225 patients over a period of five years (2014-2018) was done. CAP was defined by using revised Atlanta classification and included all the AP patients with local and or systemic complications. It was used as a gold standard. Diagnostic and predictive performance of different biochemical markers and multifactorial scoring systems were determined by analyzing receiving operating curves (ROCs), the area under the curve (AUC), sensitivity, specificity, and predictive values (positive and negative). Out of 225 patients, 122 were female while 103 patients were male. CAP developed in 47 patients (20.9%) while 178 (79.1%) patients had mild AP. Overall, in-hospital mortality rate was 1.8% (n=4). ROC analysis demonstrated that CRP at admission had low discriminatory value (AUC= 0.54, p-value=0.74). CRP at 48 hours had AUC of 0.70 (p-value=0.007). At a cut-off of 150, the positive predictive value (PPV) of 150 was 30 %. The PPV of CRP at 48 hours at a cut-off of 190 was 28%. Interval change in CRP at 48 hours greater than 90 had a PPV of 26 %. Further comparison of CRP with other scoring systems like Glasgow scoring system (AUC= 0.65), NL ratio (AUC=0.54), and MCTSI was performed. Among the single predictors, although, NL ratio showed good sensitivity at a cut-off value of 4.7 (87.23%), however, its discriminatory power was negligible (AUC=0.542, p-value=0.513). The overall best performance was achieved by the MCTSI scoring system at a cut-off of 3 (AUC=0.90, sensitivity=83.33 %, specificity=100%, diagnostic accuracy=94.49%). CRP measured at admission or at 48 hours has a very limited role in the prediction of CAP. Along with other scoring systems, its negative predictive value should be used to predict cases with mild AP which can help in clinical decision making for early discharge or management of such patients on ambulatory care basis. MCTSI scoring system can be used in cases with high suspicion of CAP.

2025

An often encountered surgical emergency is acute pancreatitis and poses a significant therapeutic challenge for the health care providers. It requires high clinical suspicion and careful monitoring to treat patients diagnosed with acute pancreatitis effectively. Bedside Index for Severity in Acute Pancreatitis (BISAP) is a s scoring system which is simple and has 5 variables that would precisely predict severity as early as within the first 24 hours of the course of acute pancreatitis. Balthazar et al., introduced a grading system, Computed tomography Severity Index(CTSI) for acute pancreatitis which included the entire estimation of the contour, density and size of pancreas, pancreatic necrosis, peripancreatic collection in computed tomography to assess the prognosis in acute pancreatitis. The present study uses the Bedside Index for Severity in Acute Pancreatitis scoring system for grading the severity of acute pancreatitis in patients within 24 hours of hospital admission compare...

2025, Medicina Fluminensis

Sažetak. Cilj: Osvijestiti o mogućnosti postojanja sindroma Rapunzel u adolescentica s akutnim pankreatitisom. Prikaz slučaja: U hitnu pedijatrijsku ambulantu javila se petnaestogodišnja djevojka zbog povremenih bolova u gornjem dijelu abdomena koji su se intenzivirali par dana pred dolazak. Prilikom fizikalnog pregleda nađena je u epigastriju i lijevom hipohondriju bolna rezistencija veličine otprilike 10 cm u promjeru. Opsežnom laboratorijskom analizom našle su se povišene koncentracije enzima gušterače te se postavila dijagnoza akutnog pankreatitisa. Daljnjom obradom indicirala se gastroskopija kojom se prikazala masa kose na ulazu u želudac. Kompjutoriziranom tomografijom uočilo se da ona seže sve do bulbusa duodenuma. Nakon provedenog konzervativnog liječenja pankreatitisa abdominalni bolovi su regredirali, došlo je do normalizacije enzima gušterače te je bilo indicirano operativno liječenje. Učinila se eksplorativna laparotomija i gastrotomija. Ekstirpirao se trihobezoar težine 1 kg i dužine 25 cm oblika odljeva lumena želuca i početnog dijela duodenuma. Postavila se dijagnoza sindroma Rapunzel. Dječji psihijatar potvrdio je prisutnu trihotilomaniju i trihofagiju te se djevojku uključilo u psihoterapijski tretman. Zaključak: Sindrom Rapunzel vrlo je rijetko stanje, ali treba biti uključeno u diferencijalnu dijagnozu akutnog pankreatitisa u adolescenata. Specifični simptomi trihotilomanije i trihofagije u kombinaciji s nespecifičnim simptomima, poput dugotrajnog bola u abdomenu, trebali bi pobuditi sumnju na razvoj trihobezoara.

2025

Acute pancreatitis is a disease that is becoming increasingly recognized in the pedi- atric population. There are numerous differences between the pediatric and adult disease, including etiology, natural history and prognosis. Nevertheless, the current approach to the disease and its treatment is mostly based on adult studies. Currently, many studies are aimed at finding the characteristics of the pediatric type of the disease. In this review we summa- rize the current concepts on the etiopathogenesis, diagnosis, treatment and prognosis of pediatric acute pancreatitis.

2025, PubMed

43 cases of consecutive bilary acute pancreatitis were treated by early endoscopic sphincterotomy and laparoscopic cholecystectomy within first 48 hours after admission. The basic cause of disturbance of bile outflow was microlithiasis. Course of the disease was monitored by level of proinflammatory interleukins in the blood serum of analysed patients. Marked decrease of their level after endoscopic sphincterotomy was observed. This decrease was progressed after laparoscopic cholecystectomy followed by continuos closed lavage of abdominal cavity. Our results indicated that minimally invasive techniques should be done in the early stage of mild and moderate cases of acute biliary pancreatitis.

2025, GE Portuguese Journal of Gastroenterology

2025, Journal of Antimicrobial Agents

Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii characterized by fever, maculo-papular rash and a black eschar at the site of the tick bite (tache noire). Acute pancreatitis is a rare complication of MSF. We report a 45 year old man admitted with fever, maculopapular rash, and eschar (tache noire). The working diagnosis at admission was MSF. Five day after admission, the patient developed signs of an acute abdomen, amylase and lipase elevation, and ultrasound hypoechoic pancreas. CT scan revealed a stage B pancreatitis. An immunofluorescence antibody test confirmed Rickettsia conorii infection. Diagnosis of MSF was made and treatment with oral doxycycline was started. After five days of therapy, there was completed remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with MSF. Much rarer is pancreatic involvement. Inflammation may play a role in the pathogenesis of pancreatitis. This suggests that pancreas should be explored in MSF patients even in the absence of underlying risk factors.

2025, Nutrición Hospitalaria

Hernia enlargement and pancreatitis in a patient with short bowel syndrome treated with teduglutide: a case report Crecimiento de hernias y pancreatitis en una paciente con síndrome de intestino corto tratada con teduglutida: caso clínico

2025, Medeniyet Medical Journal

Although autoimmune pancreatitis is not seen in children frequently, it is included in the etiology of chronic pancreatitis. A 16-year-old girl who was diagnosed with chronic pancreatitis 4 months previously, presented to the outpatient clinic with abdominal pain on the epigastric region, and left lower abdominal quadrant and bloody defecation. Remarkable laboratory test results were as follows: amylase: 109 U/L, lipase: 196 U/L, Ig G:13.70 g/L, IgG4:2.117 g/L, fecal calprotectin 573 µg/g. In the MRCP examination, revealed enlarged pancreas with a heterogeneous appearance, dilated main pancreatic duct. Colonoscopic and histopathological findings were consistent with inflammatory bowel disease. The case was diagnosed as Crohn's disease coursing with autoimmune pancreatitis. Clinical and laboratory findings regressed after steroid treatment. Autoimmune pancreatitis is important in that it is rarely seen in children and though less frequently it is associated with Crohn's disease. It should be kept in mind that inflammatory bowel disease may develop in the follow-up of autoimmune pancreatitis and autoimmune pancreatitis may be present in the etiology of chronic pancreatitis.

2025, Hpb

BACKGROUND Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP. METHODS MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration. RESULTS A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29-0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27-0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21-0.44, p < 0.001) in comparison with hydroxyethyl starch (HES). High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41-5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04-1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51-5.19, p = 0.001) compared to moderate fluid rate infusion. CONCLUSIONS In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high-rate infusion.

2025, Journal of surgical case reports

The authors report a case of a 62-year-old man with upper abdominal pain with few hours of onset and vomits. The initial serum amylase was 2306 U/L. The first CT showed signs of a non-complicated acute pancreatitis. He suffered clinical deterioration and for this reason he was admitted on the intensive care unit where he progressed to multiple organ failure in <24 h. A new CT scan was performed that showed pneumoperitoneum and pneumoretroperitoneum. He underwent an exploratory laparotomy and pancreatic necrosectomy and vacuum pack laparostomy were performed. Intraoperative peritoneal fluid culture was positive for Clostridium perfringens confirming the diagnosis. He was discharged from hospital after 61 days. According to our research this is the second case reported in literature of a spontaneous acute necrotizing pancreatitis caused by C. perfringens, with pneumoretroperitoneum and pneumoperitoneum on evaluation by CT scan, that survived after surgical treatment and vigorous re...

2025, JOP : Journal of the pancreas

2025, JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Introduction: Chronic Pancreatitis (CP) is a long-standing inflammation of the pancreas that presents as episodes of acute inflammation or chronic damage, leading to alterations in the organ’s normal structure and function. Numerous studies have focused on inflammatory and oxidative stress markers in Acute Pancreatitis (AP), but similar studies in CP are rare. Aim: The aim of this study was to compare the serum levels of acute inflammatory and oxidative stress markers in CP patients with healthy controls, and to investigate the correlation between acute inflammatory markers and oxidative stress markers. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Institute of Postgraduate Medical Education Research (JIPMER), Puducherry, India, from January 2018 to December 2021. Forty-five patients diagnosed with CP, based on clinical manifestations, Contrast-Enhanced Computed Tomography (CECT) of the abdomen, and histopathology reports, were enrolled along with 45 ...

2025, Life Sciences

Aims: Acute pancreatitis (AP) is an inflammatory condition wherein pro-inflammatory mediators, oxidative stress, and NF-κB signaling play a key role. Currently, no specific therapy exists and treatment is mainly supportive and targeted to prevent local pancreatic injury and systemic inflammatory complications. This study was aimed to examine whether 1,8-cineole, a plant monoterpene with antioxidant and anti-inflammatory properties could ameliorate cerulein-induced acute pancreatitis. Main methods: AP was induced in Swiss mice by six one hourly injections of cerulein (50 μg/kg, i.p.). 1,8-cineole (100, 200 and 400 mg/kg, p.o.) was administered 1 h prior to first cerulein injection, keeping vehicle and thalidomide treated groups as controls. Blood samples were taken 6-h later to determine serum levels of amylase and lipase, and cytokines. The pancreas was removed for morphological examination, myeloperoxidase (MPO) and malondialdehyde (MDA) assays, reduced glutathione (GSH) levels, and for nuclear factor (NF)-κB immunostaining. Key findings: 1,8-cineole effectively reduced the cerulein-induced histological damage, pancreatic edema and NF-κB expression, levels of MPO activity and MDA, and replenished the GSH depletion. Cerulein increased serum levels of amylase and lipase, and pro-inflammatory cytokines TNF-α, IL-1β, and IL-6 were also decreased by 1,8-cineole pretreatment, similar to thalidomide, a TNF-α inhibitor. The anti-inflammatory IL-10 cytokine level was, however, enhanced by 1,8-cineole. Significance: These findings indicate that 1,8-cineole can attenuate cerulein-induced AP via an anti-inflammatory mechanism and by combating oxidative stress. Further studies are needed to clearly elucidate its benefits in patients on acute pancreatitis.

2025, Updates in Surgery

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment...

2025, Updates in Surgery

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients' management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.

2025, Canadian Journal of Gastroenterology and Hepatology

Aim.To study serum triglyceride level as a predictor of complications and outcomes in acute pancreatitis.Methods.In this retrospective observational study, 582 patients admitted with acute pancreatitis, who had serum triglyceride levels measured within the first 24 hours, were divided into two groups. The study group consisted of patients with a triglyceride level ≥2.26 mmol/L (group 2) and the control group consisted of triglyceride level of <2.26 mmol/L (group 1). We collected data for baseline demographics, laboratory values, incidence of complications (local and systemic), admission to the intensive care unit (ICU), ICU length of stay, length of total hospital stay, and death in the two groups.Results.A triglyceride level of ≥2.26 mmol/L was found to be an independent predictor of developing altered mental status (p: 0.004), pancreatic necrosis (p: 0.001), acute respiratory distress syndrome (p: 0001), systemic Inflammatory response syndrome (p: 0.001), acute kidney injury (p...

2025, Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)

To evaluate the effect of early enteral nutritional therapy on time to return to voluntary intake, maximum food consumption, incidence of gastrointestinal intolerance (GI), and total hospitalization time for dogs with acute pancreatitis. Retrospective analysis of dogs with pancreatitis at a veterinary teaching hospital between 2010 and 2013. Thirty-four client-owned dogs diagnosed with acute or acute-on-chronic pancreatitis. Medical records of dogs evaluated for inappetence, anorexia, and GI for which a diagnosis of pancreatitis was recorded were reviewed. The time to initiation of food offerings since hospitalization were recorded in addition to signalment, historical medical conditions, chief complaint, physical examination findings, diagnostic results, treatments provided, timing of food offering (within 48 h of hospitalization, early feeding group (EFG) versus delayed feeding group (DFG), diet therapy (low fat versus high fat), caloric intake (% resting energy requirement), inci...

2025, Journal of the Pakistan Medical Association

Objective: To determine the clinical presentation, aetiology and outcome of pancreatitis in paediatric population. Method: The retrospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of children with pancreatitis presenting between 2013 and 2018. Medical records were reviewed and findings of clinical, laboratory workup and management were noted on a specifically developed proforma. Data was analysed using SPSS 23. Results: Of the 51 subjects, 28(54.9%) were boys. The overall mean age was 10.6+4.9 years. The most frequent clinical symptom was epigastric pain 39(76.5%). The most common aetiology was gallstones/pancreatic stones 19(37.25%). Mean hospital stay was 5.1± 1.8 days, and it was longer in children aged up to 5 years compared to older children (p<0.05). Acute pancreatitis was seen in 23(45.09%) patients, followed by recurrent 19(37.25%) and chronic 9(17.64%). There was no mortality. Conclusion: Timely diagnosis and prompt m...

2025, D51. STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS

ABSTRACT Abdominal pain is a frequent manifestation in patients presenting with Diabetic Ketoacidosis (DKA). Usually it is attributed to severe metabolic acidosis but it can be due to underlying abdominal pathologies (i.e., pancreatitis, appendicitis). We report a case of a 19-year-old female who presented with DKA and severe abdominal pain and was found on further examination to have underlying pancreatitis and visceral vein thrombosis. The patient improved with treatment for the mentioned co-morbidities, including anticoagulation.

2025, Frontiers of medicine

We report here the rare case of a 61-year-old man with multiple organ dysfunction caused by an aspirin overdose (4 g orally). The patient presented with a fever that reached 39.2 °C, a peptic ulcer, and massive upper gastrointestinal bleeding. His blood test results were as follows: white blood cell count, 1.8 × 10(9)/L; absolute lymphocytes, 0.4 × 10(9)/L; absolute neutrophils, 1.2 × 10(9)/L; and electrolyte disturbances. A computed tomography (CT) scan showed evidence of bilateral inferior pulmonary infection and acute pancreatitis. Thick dark bile with visible floccule was drawn via a percutaneous transhepatic cholangiodrainage (PTCD). Klebsiella pneumoniae was detected in microbiological bile tests. Two years later, the patient died of chronic liver failure.

2025, Turkish journal of trauma & emergency surgery

BACKGROUND: Acute pancreatitis (AP) is inflammation of pancreas in which pancreas enzymatic activity is increased. Parasympathetic innervation of pancreas plays an important role in several functions of pancreas. Botulinum toxin (BTx) might be a tool to suppress the pancreas activity in AP. In the preliminary experimental study, BTx (15U/kg) was administered directly and intraductal ways. After 10 days, blood amylase, lipase, trypsinogen, insulin, and glucagon levels were compared and no significant difference was seen between groups. Intraductal BTx administration is preferred for experimental AP model in rats; control, AP, intraductal BTx, and AP with Intraductal BTx (AP+BTx). AP was created by intraperitoneal injection of cerulean 20 µg/kg/injection (5 times). After 24 h, serum amylase, lipase, IL-6, IL-1β, TNF-α, and IL-10 were measured and pancreas tissue was evaluated for inflammation and necrosis. Mean serum amylase, lipase IL-6, IL-1β, and TNF-α levels of the AP group were significantly higher compared to the other groups (p<0.05). However, there was no significant difference between the amylase and lipase levels of control, BTx, and AP+BTx groups. Serum insulin and glucagon levels in AP group were significantly higher than control and BTx groups (p<0.05). However, there is no significant difference between the insulin and glucagon levels of AP and AP+BTx groups. in pathological evaluation. In AP+ BTx group, there is less amount of centrilobular necrosis and there is mild inflammation and hyperplasia of pancreatic duct epithelium. CONCLUSION: Administration of intraductal BTx suppressed the AP without making significant suppression in endogenous activity of pancreas.

2025, Advances in Therapy

It is well known that rifampicin can cause nephrotoxicity. Rifampicin-related pancreatitis and hyperthyroidism are rarely reported in the same patient in the presence of tubulointerstitial nephritis. Reported herein is the medical management of a patient with hemolytic anemia, acute renal failure, pancreatitis, and hyperthyroidism during with rifampicin therapy. A 50-year-old man was admitted to the hospital owing to abdominal colic and acute renal failure. He was treated with 2 courses of tetracycline-rifampicin for brucellosis 3 weeks and 4 months prior to admission. Physical examination showed blood pressure of 130/70 mm Hg, pulmonary crackles, and edema. Laboratory findings are detailed in the case report. Findings of abdominal ultrasonography suggested edematose pancreatitis and thyroid ultrasonography showed several solid nodules. Renal biopsy showed tubulointerstitial nephritis. Although rifampicin-related tubulointerstitial nephritis and acute renal failure are not uncommon during rifampicin therapy, the convergence of hyperthyroidism, pancreatitis, tubulointerstitial nephritis, and acute renal failure rarely presents in the same patient. Although pancreatitis, tubulointerstitial nephritis, and acute renal failure were ameliorated with corticoid therapy within 2 months, hyperthyroidism continued and required antithyroid therapy. In conclusion, rifampicin may trigger hyperthyroidism in patients with goiter.