[Acute biliary pancreatitis: mini-invasive treatment].
Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial clearly assessing the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and establishing the severity in order to plan the appropriate treatment. Forty-nine ABP patients were diagnosed by ultrasound (75.5%) or by laboratory findings (22.5%). Following Ranson and APACHE II scoring, 15 cases (30.6%) were classified as severe, 34 (69.3%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hours) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. In severe cases operative endoscopy cured pancreatic inflammation in 11 cases. Subsequent LC never showed serious morbidity, but subcutaneous emphysema in one case. In 4 cases laparotomy was required since pancreatic necrosis was present, with 75% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 8.8% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 80% of cases. In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hours as well as in mild cases (LC + IOC) when surgery is done within 10 days.
Schietroma
M
M
Dipartimento di Discipline Chirurgiche, Università degli Studi di L'Aquila.
Lattanzio
R
R
Risetti
A
A
Di Placido
R
R
Carlei
F
F
Cianca
G
G
Cerimele
M
M
Bellucci
N
N
Pistoia
M A
MA
Simi
M
M
D018806:APACHE; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors
Pancreatite acuta biliare: trattamento mini-invasivo.