title: Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome.
abstract: OBJECTIVE
  To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion (CRAI) via a drug delivery system (DDS) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS).
  
  
  METHODS
  We presented our recent experience in 8 patients with SAP. The patients developed clinical ACS, which required abdominal decompression. During the operation, a DDS was inserted into the peripancreatic artery (the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery). Through this DDS, a protease inhibitor, antibiotics and octreotide were infused continuously. The duration of the regional artery infusion ranged from 8 to 41 d. The outcomes and the changes in the APACHE II score, computed tomography (CT) severity index and intra-abdominal pressure (IAP) of the patients were retrospectively evaluated.
  
  
  RESULTS
  Eight patients with an initial APACHE IIscore of 18.9 (range, 13-27) and a Balthazar CT severity index of 9.1 (range, 7-10) developed severe local and systemic complications. These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension (IAH). After a mean interval of 131.9 ± 72.3 d hospitalization, 7 patients recovered with decreased APACHE II scores, CT severity indexes and IAP. The mean APACHE II score was 5.4 (range, 4-8), the CT severity index was 2.3 (range, 1-3), and IAP decreased to 7.7 mmHg (range, 6-11 mmHg) 60 d after operation. One patient died of multiple organ failure 1 wk after surgery.
  
  
  CONCLUSIONS
  CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.
authors.affiliation: Department of Hepatobiliary Surgery, Xiamen University Zhongshan Hospital, Xiamen 361004, Fujian Province, China.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Deng
authors.forename: Jian-Yin
authors.initials: JY
authors.lastname: Zhou
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Yin
authors.forename: You-Yuan
authors.initials: YY
authors.lastname: Peng
authors.forename: Fu-Qiang
authors.initials: FQ
authors.lastname: Wang
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Wang
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D059325:Intra-Abdominal Hypertension / Q000473:pathology / Q000628:therapy*; D007813:Laparotomy / Q000379:methods*; D008150:Lower Body Negative Pressure / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome