Take Care of Your Pancreas!

Purulent fusion of tissues of pancreatic infiltration is accompanied by a large number of fine irregularly placed echo-free structures with indistinct contours. During dynamic observation we can mark their fusion into larger inclusions of non-uniform density. Purulent fusion of tissues with formation of a cavity is traced approximately within 5-7 days. During formation of an abscess the augmentation of infiltration with an echo-free rim at the periphery is marked due to the gathering of liquid in the omental bursa. Diffusion of the process on adjacent tissues is accompanied with the loss of sharpness of their structure and illegibility of vessel contours.

During abscesses of the abdominal cavity and retroperitoneal space the common nidus of irregular shape and lowered echogenicity is determined. The internal structure of the abscess is non-uniform with individual regular or irregular fine echogenic inclusions. A strip of intensive reflections is marked behind the nidus. Echoginicity is reduced in the parts of the pancreas adjacent to the nidus.

The size of the pancreas is moderately enlarged or normal in case of cystous lumps. Cystous lumps with homogeneous hypoechoic structure up to 20-25 cm in diameter are determined in the parenchyma. During visualization the duct of the pancreac is crimped. The parenchyma surrounding the cyst had an apparent non-uniform structure. Some patients can have caval organs pushed off - the stomach, the duodenal with signs of gastro- and duodenostasis.

Echography shows that empyema of the cyst is heterogenic. On the homogeneous echo-free background the structures are more dense; they are suspended and look like flakes. Alongside with it the capsule is thickened and its internal border is loosened. The reactive process simultaneously develops in adjacent tissues.

Patients with various forms of destructive pancreatitis were examined. They all underwent a complex clinicolaboratory and instrumental investigation.

Among beam diagnostic methods applied were thorax and abdominal cavity radiography, ultrasonic research of abdominal cavity in the grey scale and doppler mapping mode, step-by-step computer tomography (CT). Standard US criteria were used to describe diffusive and focal affection of the pancreas. During fibrogastroduodenoscopy of patients with cystous lumps the opportunity of applying gastrocystostoma was considered. CT was used basically in case of patients with purulent complications before planned medical low-invasive manipulations (LIM) to specify the degree of the pathological process of abscess, phlegmon and pancreatic pseudocyst formation and to obtain information about peripancreatic and retroperitoneal tissue. Diagnostic and medical laparoscopy was carried out with patients with fermentative pancreatitis symptoms.

In order to increase diagnostic accuracy when detecting necrotic zones patients were examined by using color doppler mapping and energy dopplerography with Hitachi ultrasonic equipment. The US-investigation of the pancreas was carried by means of comparative assessment of the amount of doppler signals in the thickness of the pancreas and its surface. The pancreas was conditionally devided into equal parts.

Such separation is justified because of the optimal correlation between topographical anatomy of the pancreas, the opportunity of the maximal visualization of all doppler ultrasonic signals on the surface and in the parenchyma and subsequent spot puncture under ultrasonic guidance. A more than 50 % decrease in the number of doppler signals in a certain part of the pancreas in comparison with other parts serves as a marker of necrosis and gives reason to make spot puncture in this very part.

LIM of different extent under ultrasonic guidance were applied to all patients. For the purpose of morphological verification of the diagnosis multifocal diagnostic puncture biopsy (PB) under ultrasonic guidance was used. The program of biopsy was multifocal. In order to intake cellular material from the pancreas zone without contamination by gastric flora аn original method of step change of intaking multiplicity, duration and rate was applied. Besides, patients with complicated AP were examined by diapeutic and medical low-invasive interventions under ultrasonic guidance.

Bacteriological and cytological examination of the material taken during low-invasive manipulations was hold. The results of ultrasonic, cytological and bacteriological investigation were compared.