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Non-occlusive Mesenteric Ischemia as a Fatal Complication in Acute Pancreatitis: A Case Series.

非闭塞性肠系膜缺血作为急性胰腺炎的致命并发症: 病例系列。

  • 影响因子:2.46
  • DOI:10.1007/s10620-019-05835-9
  • 作者列表:"Reichling C","Nobile L","Pezzullo M","Navez J","Bachir N","D'Haene N","Maris C","Musala C","Fernandez Y Viesca M","Grimaldi D","Delhaye M
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Vascular complications of severe acute pancreatitis are well known and largely described unlike non-occlusive mesenteric ischemia, which is a rare and potentially fatal complication. Non-occlusive mesenteric ischemia is an acute mesenteric ischemia without thrombotic occlusion of blood vessels, poorly described as a complication of acute pancreatitis. METHODS:We retrospectively reviewed a prospectively maintained registry of all pancreatic diseases referred to our center from 2013 to 2018, in order to determine the causes of early death. We identified three patients who died within 48 h after hospital admission from severe acute pancreatitis complicated by irreversible non-occlusive mesenteric ischemia. Their clinical presentation, management, and outcomes were herein reported. RESULTS:Three consecutive patients with severe acute pancreatitis developed non-occlusive mesenteric ischemia within the first 5 days after onset of symptoms and died 48 h after non-occlusive mesenteric ischemia diagnosis despite optimal intensive care management and surgery, giving a prevalence of 3/609 (0.5%). Symptoms were unspecific with consequently potential delayed diagnosis and management. High doses of norepinephrine required for hemodynamic support (n = 3) potentially leading to splanchnic vessels vasoconstriction, transient hypotension (n = 3), and previous severe ischemic cardiomyopathy (n = 1) could be involved as precipitating factors of non-occlusive mesenteric ischemia. CONCLUSION:Non-occlusive mesenteric ischemia can be a fatal complication of acute pancreatitis but is also challenging to diagnose. Priority is to reestablish a splanchno-mesenteric perfusion flow. Surgery should be offered in case of treatment failure or deterioration but is still under debate in early stage, to interrupt the vicious circle of intestinal hypoperfusion and ischemia.

摘要

背景: 重症急性胰腺炎的血管并发症是众所周知的,并且在很大程度上不同于非闭塞性肠系膜缺血,这是一种罕见且可能致命的并发症。非闭塞性肠系膜缺血是一种急性肠系膜缺血,无血栓形成性血管闭塞,很少描述为急性胰腺炎的并发症。 方法: 为了确定早期死亡的原因,我们回顾性地回顾了2013年至2018年我们中心所有胰腺疾病的前瞻性注册。我们发现3例患者在入院后48小时内死于重症急性胰腺炎并发不可逆非闭塞性肠系膜缺血。本文报告了他们的临床表现、治疗和结果。 结果: 连续3例重症急性胰腺炎患者在症状出现后5天内出现非闭塞性肠系膜缺血,尽管进行了最佳的重症监护和手术,但在非闭塞性肠系膜缺血诊断后48小时死亡,患病率为3/609 (0.5%)。症状无特异性,因此可能延迟诊断和治疗。高剂量去甲肾上腺素所需血流动力学支持 (n  =   3) 可能导致内脏血管收缩,短暂性低血压 (n  =   3),和以往严重缺血性心肌病 (n  =   1) 可能涉及的促发因素,非闭塞性肠系膜缺血. 结论: 非闭塞性肠系膜缺血可能是急性胰腺炎的致命性并发症,但诊断也具有挑战性。优先是重新建立splanchno-肠系膜灌注流。在治疗失败或恶化的情况下应该提供手术,但在早期阶段仍在争论中,以中断肠低灌注和缺血的恶性循环。

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DOI:10.1245/s10434-019-07409-5
作者列表:["Letica-Kriegel AS","Leinwand JC","Sonett JR","Gorenstein LA","Taub RN","Chabot JA","Kluger MD"]

METHODS:BACKGROUND:The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities. METHODS:This study retrospectively examined 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The primary end point was overall survival from the initial operative intervention. RESULTS:The median overall survival was 33.9 months from the initial intervention. Female gender and intraperitoneal dwell chemotherapy were independent predictors of overall survival. Within 1 year after the initial diagnosis, second-cavity disease was diagnosed in 52% of the patients. The median time to the second-cavity diagnosis for those with a diagnosis 1 year after the initial diagnosis was 30 months. CONCLUSIONS:Well-selected patients with both pleural and peritoneal mesothelioma have a survival benefit over palliative treatment that is comparable with that seen in single-cavity disease. The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival, whether the disease is diagnosed synchronously or metachronously. Patients with an initial diagnosis of single cavity disease are at the highest risk for identification of second-cavity disease within the first year after diagnosis.

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影响因子:3.60
发表时间:2020-01-01
DOI:10.1245/s10434-019-07425-5
作者列表:["Ali YM","Sweeney J","Shen P","Votanopoulos KI","McQuellon R","Duckworth K","Perry KC","Russell G","Levine EA"]

METHODS:INTRODUCTION:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma. METHODS:This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS:Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052). CONCLUSION:QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.

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影响因子:3.60
发表时间:2020-01-01
DOI:10.1245/s10434-019-07385-w
作者列表:["Bayat Z","Taylor EL","Bischof DA","McCart JA","Govindarajan A"]

METHODS:BACKGROUND:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be associated with decreases in quality of life (QOL). Bowel-related QOL (BR-QOL) after CRS-HIPEC has not been previously studied. The objectives of the current study were to examine the effect of different types of bowel resection during CRS-HIPEC on overall QOL and BR-QOL. METHODS:A prospective cohort study was performed. QOL data were collected using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR-29 questionnaires at 3, 6, and 12 months after CRS-HIPEC. Patients were divided into groups that underwent no bowel resection, non-low anterior resection (LAR) bowel resection, LAR, and LAR with stoma. Primary outcomes were global QOL and BR-QOL. RESULTS:Overall, 158 patients were included in this study. Bowel resections were performed in 77% of patients, with 31% undergoing LAR. Global QOL was not significantly different between groups. LAR patients (with and without stoma) had significantly worse BR-QOL, embarrassment, and altered body image, with LAR + stoma patients having the largest impairments in these domains. Trends toward higher levels of impotence and anxiety were also seen in LAR patients. Although global QOL improved over time, impairments in BR-QOL and sexual and social function did not significantly improve over time. CONCLUSIONS:Although global QOL after CRS-HIPEC was not affected by the type of bowel resection, the use of LAR and ostomies was associated with clinically meaningful and persistent impairments in BR-QOL and related functional domains. Generic QOL questionnaires may not adequately capture these domains; however, targeted questionnaires in these patients may help improve QOL after CRS-HIPEC.

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腹膜疾病方向

腹膜疾病是一类病因复杂的疾病,包括累及腹膜的各种炎性病变,以结核性腹膜炎多见。由于创伤和炎症导致的粘连,大部分为后天性,表现为腹膜皱襞重叠;还包括原发性和继发性肿瘤,良性原发性肿瘤少见,继发性恶性肿瘤多见,腹膜间皮瘤是唯一原发于腹膜间皮细胞的肿瘤。

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