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Khirurgii

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Year 2014 Vol. 22 No 3

GENERAL AND SPECIAL SURGERY

O.A. KUDELICH1, G.G. KONDRATENKO1, A.F. PUCHKOV2

THE CHARACTER AND PECULIARITIES OF COMPLICATIONS OF SEVERE ACUTE PANCREATITIS ACCORDING TO THE RESULTS OF PATHOMORPHOLOGICAL RESEARCHES

EE “Belarusian State Medical University”1,
ME “Minsk City Clinical Mortem Bureau” 2,
The Republic of Belarus

Objectives. To identify the rate, character and peculiarities of structural changes in organs and tissues in case of unfavorable outcomes resulted from a severe acute pancreatitis and work out the ways to reduce mortality on this basis.
Methods. The retrospective analysis of protocols of pathomorphological records of the patients (n=255) died from acute pancreatitis or exacerbation of chronic pancreatitis has been performed by continuous method. The local and systemic complications, changes in organs and tissues in the early and late phases of the disease, the peculiarities of contamination and extension of purulent processes have been studied. The complications were allocated into two groups according to the phases of acute pancreatitis. The first group consisted of the patients with complications occurred not more than two weeks after the disease onset (140 deaths, 62,2%), and the second group - the cases with fatal outcomes occurred more than two weeks after the onset of acute pancreatitis (85 deaths, 37,8%).
Results. The extensive pancreatic necrosis was found in the vast majority of cases (214 deaths, 95,1%), partial necrosis of the pancreas was found only in 4,9%. The expressed signs of parapancreatitis was registered in the vast majority of the patients dead from acute pancreatitis (n=203, 90,2%), peritonitis was diagnosed in 146 dead patients (64.9%), and their combination was found in 187 (83,1%) cases. Infected pancreatic necrosis was found in 65 patients (28,9%) died from acute pancreatitis, in other cases (160 patients – 71.1%) the process was aseptic. In the group of patients died in the early period (till 2 weeks from onset) the infection significantly less observed – 17 (12,1%), it was detected more often in the group with the later mortality – 48 (56,5%) cases.
Conclusions. In patients with severe acute pancreatitis lethal outcomes occurring up to two weeks from the onset of the disease were 1,7 – folds more often than in the late period. Peritoneal and retroperitoneal fluid collections was a specific and constant feature in the patients died from acute pancreatitis in the early period of the disease.

Keywords: severe acute pancreatitis, endogenous intoxication, fluid collection, complications
p. 296 – 305 of the original issue
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Address for correspondence:
220116, Respublika Belarus, g. Minsk, pr. Dzerzhinskogo d.83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», 1-ya kafedra khirurgicheskih bolezney,
e-mail: kudelichsurg@gmail.com,
Kudelich Oleg Arkadevich
Information about the authors:
Kudelich O.A. A post-graduate student of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Kondratenko G.G. MD, professor, a head of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Puchkov A.F. A chief of ME “Minsk City Clinical Mortem Bureau”.
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