Ultrasonography in the diagnostic algorithm of acute destructive pancreatitis
Valchinskaya A.B.1 Latysheva A.Y.2
1 The department of surgery doctors qualification improvement N2 FSBMEIHE Military Medical Academy named after S.M. Kirov the Ministry of defence of RF; 194044, St. Petersburg, Academician Lebedev St. 6, e-mail: email@example.com, (812) 292-32-73
2 The department of roentgenology and radiology (with the course of ultrasound diagnosis) Military Medical Academy named after S.M. Kirov the Ministry of Defence of RF
The purpose of the study. To study the dynamics of ultrasound signs of acute fluid сollection - infiltration with pancreatitis (PPI) of patients with acute pancreatic necrosis of moderate severity and develop diagnostic scale of PPI severity predict the course and outcomes of patients with acute destructive pancreatitis of moderate severity in the reactive phase of the disease.
Materials and methds of the study. There were analyzed the results of ultrasound picture frame for 8 th, 10 th ,14 th ,18 th ,22-th day of the disease of 148 patients who has been receiving treatment for acute pancreatic necrosis of moderate severity in the City Pancreatology Center of "St. Petersburg research Institute of emergency care named after I. I. Dzhanelidze" in the period from 2015 to 2017.
The results of the study. The analysis of the dynamics of ultrasonic characteristics of PPI acute fluid сollection on 8th, 10th, 14th, 18 th, 22-th day of disease showed the influence of the initial ULTRASOUND characteristics and their changes under the influence of complex treatment of ODP on the outcome of PPI acute fluid сollection and the disease itself. This in turn allowed us to identify four groups of patients with difference between the ultrasonic indications of the formation of PPI acute fluid сollection on the 8th day of the disease and on the 14th, 18th and 22nd days of outcomes of PPI acute fluid сollection.
The findings of the study. Such subdivision of PPI -acute fluid сollection on types according to ultrasonic indications, allows surgeons to predict the infection and unfavourable outcome, to adjust treatment and diagnostic tactics, in turn it allows to ultrasonic specialists to assess correctly changes in the pancreatic tissue, the stomach wall and the pancreas in the reactive phase of acute pancreatic necrosis and direct them to search ultrasound signs of the predicted outcome of the disease.
1. Acute Pancreatitis Classification Working Group / Banks P.A., Bollen T.L., Dervenis C. [et al.] // Gut. - 2013. Vol. 62. - N1. - R. 102-111.
2. Mishra A., Saigal S., Gupta R., Sarin S.K. Acute pancreatitis associated with viral hepatitis: A report of six cases with review of literature///Am. Y. Gastroenterol.-1999.- Vol.94, N8.- P. 2292-2295.
3. Sainio V., Kemppainen C., Puollokkainen P., Taavitsainen W. Early antibiotic treatment in acute necrotizing pancreatitis (see comments) // The Lancet. 1995, Vol. 346, N 9.- P. 663-667.
4. Sakorafas G.H., Tsiotos G.G., Brower T.C., Sarr M.G. Ischemic necrotizing pancreatitis. Two case reports and review of the literature.// Int. J. Pancreatol. 1998.- Vol. 24, N 2.- P. 117-121.
14. Zybarev A. R., Grigoryan R. A. Yltrazvykovoe angioskanirovanie. - M.: Medicina, 1990.
15. Badea R. Pancreasul. In: Ultrasonografie clinicã.Badea R, DudeaSM, Mircea PA, Stamatian F (eds). Vol.I, Ed. Medicalã, Bucureti,2000.
16. Finstad TA, Tchelepi H, Ralls PW. Sonography of acute pancreatitis: prevalence of findings and pictorial essay. Ultrasound Q 2005;21(2):95-104.
17. Minniti S, Bruno C, Biasiutti C, Tonel D, Falzone A, Falconi M, Procacci C (2003) Sonography versus helical CT in identifi cation and staging of pancreatic ductal adenocarcinoma. J Clin Ultrasound 31:175-182.
18. Bennett GL, Hann LE (2001) Pancreatic ultrasonography. Surg Clin North Am 81:259-281.
19. Panzironi G, Franceschini L, Angelini P, Ascarelli A, De Siena G (1997) Role of ultrasonography in the study of patients with acute pancreatitis. G Chir 18:47-50.