Necrotizing pancreatitis: Diagnose, treat, consult

Background and Aim Acute pancreatitis (AP) is a common disease, but data on outcomes in octogenarians are scarce in the literature. The aim of this study is to analyze results from patients aged 80 years old and over who were treated for AP at a single center. Methods Patients aged 80 years and older diagnosed with AP from April 2010 to October 2015 were considered. Demographics, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), serum biochemistry at 24 and 48 h after admission, and revised Atlanta severity score were analyzed and correlated with hospital mortality rate and length of stay using the multiple regression and Kaplan–Meier tests. Results A total of 100 consecutive patients were included in the study. There were 52 women, and the mean age was 87.5 years (range 80–95). Gallstones were the most common cause of AP (69.7%). The ASA score was ≥III in 51 patients. Eight patients had severe, disease and all of them died in hospital. A CCI > 4 was associated with higher disease severity and mortality (P < 0.00001). The median hospital stay was 9 days (range 1–59). Longer hospital stay was associated with serum C‐reactive protein ≥242 mg/L (P = 0.01) and serum albumin ≤30 g/L (P = 0.01) at 48 h. Over a 5‐year period, 22% of patients were readmitted to hospital with recurrent AP. Gallstones were the main cause of disease (63.6%). Conclusions AP in octogenarians has low mortality. Higher death rate is associated with disease severity. In the presence of gallstone disease, cholecystectomy is recommended whenever possible as the risk of disease recurrence is significant.

Acute recurrent pancreatitis may have a indication for surgical treatment? dr. eduard cristian Popa 1 , dr. alexandra Popa 1 , drd. dr. Mihai ierima 1 , dr. cristina Pîrvulescu 1 , dr. ruxandra avram 1 , conf. dr. Sorin Păun 1,2 , Şef Lucr. dr. Bogdan Gaspar 1,2 , asist. univ dr. ioan tănase 1,2 , dr. alexandru Laurențiu chiotoroiu 1

Pancreatitis is an obvious but a rare event in pregnancy. From mild disease to multiorgan failure and sepsis acute pancreatitis has numerous causes and an often unpredictable outcome. The authors present a case of 22-year-old pregnant woman with severe pancreatitis due to biliary sludge. An unusual clinical manifestation of pancreatitis in our patient is worth emphasizing: massive bleeding from upper alimentary tract and concomitant two pancreatic fistulas. The bleeding is a manifestation of the pancreatic juiceinduced injury to the splenic artery, whereas the fistulas are consequence of the disconnected duct syndrome and superficial necrosis of the pancreatic head. After two and a half years lasting treatment the patient was on regular oral diet with supplementation of pancreatic enzymes, and showed normal glycaemia level. She returned to fully physical activity.