Imaging guidelines for acute pancreatitis: when and when not to image
AbstractIn patients with acute pancreatitis (AP), diagnostic imaging is performed for various reasons, including the detection of the etiology (e.g., biliary obstruction caused by gallstones), diagnosis of pancreatitis in an unclear clinical setting, assessment of the severity of the process, and evaluation of its complications. In spite of the potential benefits of these imaging studies in the setting of AP, especially economic consequences but also medical risks are associated with diagnostic imaging, including increase of the effective radiation dose received by patients with AP and rising health care costs, frequently without impact on management. The rising incidence of acute pancreatitis in the Western world is escalating its financial burden with national health care expenses of over 2.5 billion dollars annually. Despite evidence-based national recommendations on utilization of diagnostic imaging in patients with AP, unnecessary imaging studies are still frequently performed, especially in the early hospital course. The purpose of this article is, therefore, to review the imaging guidelines for acute pancreatitis with regards to when and when not to image, with the aim to minimize inappropriate utilization.
Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
Gallstone pancreatitis (GP) or choledocholithiasis (CD) with acute cholecystitis (AC) has been described. Clinical implications of concurrent AC remain poorly defined. We tested the null hypothesis that AC is not associated with increased morbidity during cholecystectomy (CCY) for GP or CD.
Authors: Wang SY, Yeh CN, Jan YY, Chen MF Abstract Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid compositi...
Authors: Sandru F, Carsote M, Valea A, Albu SE, Petca RC, Dumitrascu MC Abstract Somatostatinoma is a tumour mainly originating from pancreas or duodenum; overall with an incidence of 1/40 million persons. We introduce a narrative review of literature of somatostatinoma including the relationship with neurofibromatosis type 1. Clinical presentation includes: Diabetes mellitus, cholelithiasis, steatorrhea, abdominal pain, and obstructive jaundice while papillary tumour may cause acute pancreatitis. The neoplasia may develop completely asymptomatic or it is detected as an incidental finding during an imaging or a sur...
Abstract Bochdalek hernias rarely contain an intrathoracic kidney, and there are few reports of their operative repair. A woman presented with progressive dyspnoea limiting her quality of life. Imaging showed a Bochdalek hernia containing omentum, large bowel and the left kidney. The woman was unexpectedly admitted to the intensive care unit with respiratory failure secondary to gallstone pancreatitis whilst awaiting elective repair of her hernia. Surgical repair of the hernia was performed via laparotomy with cholecystectomy to treat both problems. The woman recovered well and is independently mobile without any ...
Conclusion: The present study confirmed a novel mutation of the EPB41 gene that plays an important role in expanding the mutational distribution in HE-1. It could also be helpful for understanding the correlation between the genotype and phenotype in HE. PMID: 32807033 [PubMed - in process]
CONCLUSION: LPAC syndrome is easy to diagnose and treat; therefore, it should no longer be overlooked. To increase its detection rate, all patients who experience recurrent biliary symptoms following an episode of acute pancreatitis should undergo an ultrasound examination performed by a radiologist with knowledge of the disease. PMID: 32742573 [PubMed]
Conclusions Laparoscopic cholecystectomy can be performed safely and effectively for pancreatitis, irrespective of severity. The paradigm shift in the management of severe necrotizing pancreatitis away from open necrosectomy toward MIP can be extended to encompass laparoscopic cholecystectomy.
Acute pancreatitis is a common inflammatory pancreatic disorder, often caused by gallstone disease and frequently requiring hospitalization.
Publication date: 18–24 July 2020Source: The Lancet, Volume 396, Issue 10245Author(s): Nicolien J Schepers, Nora D L Hallensleben, Marc G Besselink, Marie-Paule G F Anten, Thomas L Bollen, David W da Costa, Foke van Delft, Sven M van Dijk, Hendrik M van Dullemen, Marcel G W Dijkgraaf, Casper H J van Eijck, G Willemien Erkelens, Nicole S Erler, Paul Fockens, Erwin J M van Geenen, Janneke van Grinsven, Robbert A Hollemans, Jeanin E van Hooft, Rene W M van der Hulst, Jeroen M Jansen