Acute pancreatitis is an inflammation of the pancreas, which causes damage and destruction of its tissues. Why does this inflammation occur? The reason - diseases, because of which the outflow of juice from the pancreas is disturbed, and intra-lateral pressure increases.
The history of the disease in pancreatitis can begin with a stomach, gallbladder and duodenal ulcer, as well as spasms of the pancreatic sphincters, its tumor, reverse casting of the juice, obstruction of the ducts, impaired blood circulation in the gland. This disease can trigger injuries, infections, toxins and allergens. An acute attack sometimes occurs as a reaction to alcohol, fatty and protein foods in large quantities.
Pancreatitis is a life-threatening disease for the patient, so the task of doctors is not only to alleviate the patient's pain, but also to prevent serious complications. Therefore, in some cases, surgical treatment, that is, surgery, is required. But the surgery for this disease doctors resort only in extreme cases, because any surgical intervention, including in such an important body as the pancreas, can not do without consequences.
If the diagnosis of "acute pancreatitis" is established, the patient is hospitalized in the surgical department, where he is given the necessary treatment. This takes into account the history of the disease, the presence of complications and other factors of the disease.
With necrotic and interstitial form of the disease, conservative therapy is usually prescribed, that is, without surgery. But in some cases of interstitial pancreatitis, surgical intervention is a priority treatment. In the case of purulent-necrotic pancreatitis, surgical treatment can not be avoided, since surgery is the only way to save the patient from the problem.
Pancreas surgery is a necessary treatment method that can be applied to certain indicators even at an early period, with a delay for a certain period. Indications for surgical intervention may be severe pain, progression of the disease, mechanical jaundice, concrements in the gallbladder and bile ducts.
If the doctor decides to have an operation on the pancreas, then it is performed on the second day after intensive preparation for surgery. The goal of surgical treatment of pancreatitis is to eliminate pain, preserve the natural functions of the pancreas, release the body from poisonous decomposition products and prevent complications( fistula, pseudocyst, purulent complications, pancreatic pleurisy and ascites).
Surgical operation makes the pathological process stable, that is, slows the progression of the disease, but unfortunately, it can not completely eliminate the inflammation in the pancreas. A good result of surgical intervention with pancreatitis is a reduction in pain on the 2-3 day after the operation, an increase in the amount of urine, an improvement in blood flow.
When the inflammation is localized, a resection( removal of a part) of the pancreas is performed during the operation. In some cases, the spleen is also removed. If the pancreatitis is small-focal, the foci of necrosis are removed additionally. With extensive lesions of the gland tissues, the most affected areas are removed in order to reduce the intoxication of the body with degradation products and enzymes.
Surgical treatment of pancreatitis is contraindicated in the case of a progressive drop in the patient's arterial pressure, which does not eliminate shock, urine output, increased levels of enzymes, high urinary glucose levels( over 140 mg%), and inability to restore blood volume in the body.
Pancreatitis: surgical history of the disease
A standard approach to the treatment of this disease involves conservative tactics, which are usually very effective. However, 15-20% of patients with acute pancreatitis may have signs of purulent-destructive pathology in the pancreas, which indicates the need for surgical intervention. Usually these signs are manifested on the 7-14 day after the exacerbation of the disease.
Diagnostic signs of purulent pancreatitis:
- worsening of the general condition of the patient, persistence or intensification of fever;
- palpation reveals a dense infiltrate in the parapancreatic region;
- shift left in the leukocyte formula;
- hyperglycemia;
- on X-ray - cavity with gas content;
- on ultrasound - a cavity with a liquid content.
Indications for operation with pancreatitis
Based on the medical history, the entire parapancreatic area is inspected and the sanation is complete - drainage of all abscesses. If necessary, it is possible to carry out a limited necrosexcystectomy. In the case of a violation of the supply of bile in the 12-типерстную intestine, the medical history shows the necessity, directly during the operation, to determine the expediency of cholecystostomy. In this case, radical surgical interventions are best avoided due to a severe general condition of the patient, surgical treatment of SCI and other diseases of the gallbladder is best postponed for later. You should not seek a single exposure of all pancreatic ulcers because of the risk of excessive bleeding.
Most patients have gradual maturation of purulent cavities in the retroperitoneal space, which may require bursostomy, a planned sanation of the pancreas region in dynamics. The question of suturing abdominal cavity with bursostomy fixation remains controversial. Postoperative history of the patient's illness provides for regular washing of the retroperitoneal space. If necessary, after 1-2 days a repeated planned sanation of foci of suppuration is performed. Extensive purulent lesion in severe cases may require up to 8-10 repeated planned surgical interventions of this type. Drainage near the pancreatic tissue is carried out through the lumbar region.
Mortality in acute purulent pancreatitis is about 9-10%.The usual conservative tactics in most cases is quite effective. The operation is required in 15-20%.In almost 50% of cases, the acute form of the disease degenerates into a chronic one.