Her pancreas “tissue necrosis” took 2 months to debride. Why is acute pancreatitis so severe?

A 54-year-old female patient went to the emergency department due to infection symptoms such as abdominal pain and fever, and the examination was acute pancreatitis, and a large area of ​​tissue necrosis in the abdominal cavity, the Tri-Service General Hospital used endoscopic ultrasound technology with “double mushroom head metal stents” to develop “endoscopic necrotic debridement” to help the patient remove necrotic tissue and save the patient Suffer a life.

Acute pancreatitis is highly fatal, what are the usual symptoms?

Pancreatitis is an inflammatory disease of the pancreas. Inflammation of the pancreas can be acute or chronic, with acute pancreatitis meaning the pancreas has been damaged by a major injury from something that is urgent and lasting for days to weeks; chronic pancreatitis is caused by toxins, etc. Factors cause chronic damage to the pancreas that is progressive, persists for years, and is difficult to alleviate. Either form of pancreatitis is serious and can lead to complications.

Symptoms of acute pancreas inflammation include epigastric pain, which is usually aggravated after eating and relieved by leaning forward. The pain may be transferred to the back, as well as symptoms such as abdominal distension, nausea, vomiting, and fever. The degree of acute pancreas inflammation may range from mild to quite serious complications, and the mortality rate can even reach 10-20% in severe cases.

There are three symptoms of chronic pancreatitis, one is chronic paroxysmal epigastric pain, which can be exacerbated by diet, but it is usually not urgent, and the severity is not as severe as acute pancreatitis; Diarrhea, abdominal distension, indigestion and weight loss caused by incomplete secretion of digestive enzymes; finally, diabetes caused by insufficient insulin secretion.

Why is acute pancreatitis so severe?

Lin Rongjun, attending physician of the Department of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, said that when the pancreas is inflamed and the digestive juice in the pancreas cannot be discharged, it will “ruminate” to digest its own tissues, and the human body will absorb them on its own if there is a slight inflammation. It is eroded and necrotic by digestive juice, and breaks through to the outside of the pancreas to form a “pseudocyst”, which continues to cause infection and inflammation in the body. According to statistics, 7% of patients will develop pseudocysts.

In the case of a 54-year-old woman, acute pancreatitis was caused by taking drugs, but she was sent to the emergency department only when the inflammation of the pancreas was severe. Severe complications have developed, resulting in infectious septal necrosis. The extent of pancreatic tissue necrosis in this case, From the duodenum to the stomach, the range is nearly 10 centimeters, and the pancreas is inflamed and oppresses the stomach, affecting appetite and making it impossible to digest.

What are the treatments for pancreatitis?

Lin Rongjun said that in the past, there were two treatment methods, including drainage surgery by radiologists, or debridement surgery by surgeons. The advantage of drainage surgery is that the wound is small, but it is difficult to drain cleanly. In the past, plastic drainage tubes were often used, and the effect was not good, especially in cases of severe tissue necrosis. Surgeons are required to assist in debridement, but surgical complications and risks are not low. Doctors and patients are often discouraged.

Lin Rongjun said that because the pancreas is hidden behind the stomach, it is generally not easy to see the lesions when doing ultrasound. With the development of medical materials, ultrasound is combined with an endoscope probe, which can enter the stomach and pancreas for clear scanning and inspection. For treatment, and will not leave external wounds, in recent years, Sanzong has used endoscopic ultrasound, combined with metal stent drainage, as the third treatment option for necrotic debridement, which can be applied to bile duct drainage, gallbladder drainage, and pancreatic hydrops Drainage, input ring syndrome, etc.

Lin Rongjun said that this time, under the guidance of endoscopic ultrasound, the metal stent with double mushroom heads was placed and stretched to 1.6 cm for drainage, and then the necrotic tissue was debrided and a small hole was opened in the stomach to remove the tissue after debridement. Drains to the stomach and is excreted with feces through the normal digestive tract. Due to severe tissue necrosis, this case underwent debridement once a week, and it took 2 months to completely remove it, “the longest debridement in history.” At present, this technique has been used in 7 cases, but the entire operation has not been covered by health insurance, and the out-of-pocket cost is about 100,000 yuan.

After the metal stent is placed, it will stretch out the narrow range and the fixed position will not slip. However, when the doctor performs debridement, it is “in the way”. Then put the metal stent back to improve the efficiency of endoscopic necrotic debridement and deal with accidents. This experience was also published in the internationally renowned journal “Digestive Endoscopy”.

Who are the high-risk groups for pancreatitis? And how to maintain it?

Lin Rongjun said that long-term drinking, stones, high triglycerides, high blood calcium, etc., can easily cause chronic inflammation of the pancreas. Acute pancreatitis may also lead to infection and death due to sepsis. Patients with chronic pancreatitis should be followed up regularly, receive treatment as prescribed by the doctor, and maintain a good life and rest.

These people are prone to pancreatitis:

.Excessive alcohol consumption: Studies have found that people who drink heavily have a higher risk of developing pancreatitis.

.Smoking: Smokers have a higher rate of chronic pancreatitis than non-smokers.

.Obesity: If you are obese, you are more likely to develop pancreatitis.

.Diabetes: Having diabetes increases the risk of pancreatitis.

.Family history of pancreatitis.

If you get pancreatitis, you should take care of it like this:

.Even if the pancreatitis is mild, it is wise to abstain from alcohol during recovery.

.If you smoke, quitting can reduce your risk of pancreatitis.

.Choose a low-fat diet and focus on fresh fruits, vegetables, whole grains, and lean protein. Small, frequent meals throughout the day are recommended to reduce stress on the digestive system.

.Pancreatitis can lead to dehydration, so stay hydrated every day and limit your caffeine intake.

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