Abstract:

Aim: was to study possibilities of transabdominal ultrasonography in the diagnostics of the first phase of acute pancreatitis.

Material and methods: for the period 2010-2016, 7488 patients which required a differential diagnosis of disease with acute pancreatitis were urgently hospitalized. Transabdominal ultrasonography was made in 100% of patients in first hours and days of after hospitalization. 3519(47%) of patients were hospitalized during first 7 days from the beginning of the disease. Acute pancreatitis was confirmed in 458 patients (13%).

Results: new ultrasound signs were discovered and on the basis of them - a new method of transabdominal ultrasonography of acute pancreatitis was developed, which is based on the identification of hypoechoic areas corresponding to the vitreous edema of loose connective tissue, more than 2 mm thickness and more than 5 mm length. When identifying these signs at least in one of fixed parapancreatic areas - we diagnose acute pancreatitis.

Conclusions: the patented new method of transabdominal ultrasonography of acute pancreatitis in the first phase of the disease (patent # 2622611) allows to confirm or reject acute pancreatitis during the direct visualization of the pancreas. The method makes possible to establish an exact diagnosis when it is required to differentiate acute pancreatitis from another urgent pathology ir case of the absence of anamnesis, specific laboratory changes, the inability to apply other visualization methods, with changes in organs caused by concomitant pathology and background diseases, in patients with overweight.

References

1.      Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2): e1-15.

2.      Еrmolov AS, Ivanov PA, Blagovestnov DA. i dr. Diagnosis and treatment of acute pancreatitis. M.: Vidar-M. 2013; 384 [In Russ]

3.      Baker ME, Nelson RC, Rosen MP et al. ACR Appropriateness Criteria® acute pancreatitis. Ultrasound Q. 2014; 30(4): 267-273.

4.      Diagnosis and treatment of acute pancreatitis (Russian clinical guidelines). SPb. 2014 [In Russ].

5.      Fedoruk A.M. Ultrasonography in the diagnosis and treatment of acute pancreatitis. Mn.: Belarus'. 2005; 126 [In Russ].

6.      Savel'ev VS, Filimonov MI, Burnevich SZ. Pancreatonecrosis. M.: Medicinskoe informacionnoe agentstvo. 2008; 264 [In Russ].

7.      Vinnik YU.S., Dunaevskaya S.S., Antyufrieva D.A. Possibilities of modern methods of visualization of acute severe pancreatitis. Novosti hirurgii. 2014; 22(1): 58-62. [in Russ]

8.      Kajsarov VR. Features of the defeat of the retroperitoneal tissue in acute destructive pancreatitis: Cand. Med. sci diss. Sankt-Peterburg, 2005; 106 [In Russ].

9.      Lipatov VA. The severity of parapancreatic fiber, depending on body type. Medicine Online.Ru.- 01.07.2002. URL: http://www.medicina-online.ru/articles/43352/ [In Russ].

10.    Nigaj NG, Borovskij VV. Method for ultrasound diagnosis of acute pancreatitis forms. Patent KZ24337. 2011 [In Russ].

11.    Baranov AI, Еrmolaev YU.D., ZHerlov GK. Method for the diagnosis of acute pancreatitis. Patent RF №2242929. 2004 [In Russ].

12.    Bibik IL, Nikolaev NЕ. Modern algorithm for the diagnosis of acute pancreatitis]. Medicinskij zhurnal. 2006; (2): 23-25 [In Russ].

13.    Block S, Maier W, Bittner R, et al. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut. 1986; 27(9): 10351042.

14.    Bertilsson S, Kalaitzakis E. Use of Pancreatitis - Associated Drugs Is Very Common in Patients With Acute. Pancreatitis but Is Not Related to Pancreatitis Etiology, Severity or Recurrence: A 10-Year Population-Based Cohort Study. Gastroenterology. 2014; 146(5): 95.

15.    Bertilsson S, Kalaitzakis E. Acute Pancreatitis and Use of Pancreatitis - Associated Drugs: A 10-Year Population-Based Cohort Study. Pancreas. 2015; 44(7): 10961104.

16.    Agrawal A, Alagusundarmoorthy SS, Jasdanwala S. Pancreatic Involvement in Critically ill Patients. J Pancreas (Online) 2015; 16(4): 346-355.

17.    Rybachkov VV, Dubrovina DЕ, SHvecov RV, Utkin AK. Pancreas injury and post-traumatic pancreatitis. Al'manah Instituta hirurgii imeni A.V. Vishnevskogo. 2007; Suppl 1: 780-781 [In Russ].

18.    Mathur AK, Whitaker A, Kolli H, Nguyen T. Acute Pancreatitis with Normal Serum Lipase and Amylase: A Rare Presentation. J Pancreas (Online). 2016; 17(1): 98101.

19.    Ranson JHC. The Role of Surgery in the Management of Acute Pancreatitis. Ann Surg. 1990; 211(4): 382393.

20.    Wilson C, Imrie CW, Carter DC. Fatal acute pancreatitis. Gut. 1988; 29(6): 782-788.

21.    Kirillova MS, Novikov SV. Ultrasound diagnosis of acute pancreatitis in the first phase of the disease. Patent RF № 2622611. 2017 [In Russ].

Abstract:

Purpose. For basic, purpose was to develop effective methods of exact diagnostics of an acute pancreatitis (AP), to work out classifications of disease, an establishment of patients' condition definitions, and also productive supervision over dynamics of its process by means of application computed tomography (СТ) and magnetic resonance imaging (MRI). Besides, on the base of obtained data, the optimum tactics of treatment was worked out

Materials and methods. More than 500 patients with AP were underwent CT and MRI with one-stage contrast agents' injection. During the research we have applied different variations of scanning modes and parameters. Results were analyzed in connection with supervision on patients conditions. Treatment tactics depended on obtained data

Results. We have worked out effective methods of AP diagnostics, optimal parameters of research in different clinical currents and we have developed an effective tactics of treatment in patients with severe AP Besides, on the base of obtained data, the optimum tactics of treatment was worked out

Conclusions. CT with intravenous contrasting is the best method of diagnostics or supervision in dynamics, which allows to work out the most productive treatment tactics. Using CT in combination with MRI in some cases can be specifying method of diagnostics.  

References

1.    Араблинский А.В., Черняков P.M., Хитрова А.Н., Богданова Е.Г. Лучевая диагностика острого панкреатита. Медицинская визуализация. 2000;         1-14.

2.    Прокоп М., Галански М. Спиральная компьютерная томография. 2009.

3.    Райан С., МакНиколас М., Юстеис С. Анатомия человека при лучевых исследованиях. 2009.

4.    Шабунин А.В., Мумладзе Р.Б., Чеченин Г.М., Тавобилов М.М. Этапное хирургическое лечение острого панкреатита, панкреонекроза алкогольной этиологии. Неотложная и специализированная хирургическая помощь. 1-й конгресс московских хирургов. Тез. док. М. 19-21 мая 2005 г. М.: ГЕОС. 2005; 122.

5.    Balthazar E. CT diagnosis and staging of acute pancreatitis. RadiolClin. North. Am. 1989; 27 (1): 19-37.

6.    Balthazar E.J., Megibov A.J., Pozzi R. Mucelli Imaging of the pancreas. Medical radiology.2009.

7.    Piironen A. et al. Detection of severe acute pancreatitis by contrast enhanced magnetic resonance imaging. European Radiology. 2000; 2: 354.

8.    Balthazar E. et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174 (2): 331-336.

9.    Bradley E.L. A clinically based classification system for acute pancreatitis. Summary of the international simposium on acute pancreatitis. Atlanta. G., Sept. 11-13. 1992: 586-590.

10.  Багненко С.Ф., Рухляда Н.В., Толстой А.Д., Гольцов В.Р. Лечение острого панкреатита на ранней стадии заболевания. НИИ СП им. И.И. Джанелидзе, С.-Пб. 2002; 24.

11.  Robinson PJ.A., Sheridan M.B. Pancreatitis computed tomography and magnetic resonance imaging. European Radiology. 2000; 3: 401.

12.  Balthazar E.J., Freeny P.C., Sonennberg E. Imaging intervention in acute pancreatitis. Radiology. 1994; 193: 197-306.

13.  Balthazar E.J. et al. Acute pancreatitis. Prognostic value of CT. Radiology. 1985; 156:767-772.

14.  Isenmann R., Rau B., Beger H.G. Infected necroses and pancreatic abscess. Surgical therapy. Kongressbd Dtsch Ges Chir Kongr. 2001; 118: 282-284.

15.  Кармазановский Г.Г., Федоров В.Д. Компьютерная томография поджелудочной