Take Care of Your Pancreas!

Exploratory puncture under ultrasonic guidance is of extensive current use in the diagnosis of aseptic and septic pancreatonecrosis types at the early stage.

Our aim is to determine the role of ultrasonic tomography, including puncture biopsy of the pancreas under ultrasonic guidance, in the diagnosis and treatment of acute destructive pancreatitis.

We held one-day puncture biopsy examinations under ultrasonic guidance of 50 hospitalized patients suspected of destructive pancreatitis. The biopsy examination was multifocal: with the signs of the spare fluid the 4 spot intake was made from at least 2 parts of the pancreas and the omental bursa zone with the needle of the Chiba and Angiomed G 22-21 type. 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.

The analysis for infection of the pancreas and parapancreatic structures disclosed negative results with 44 patients. The results of the microbiological investigation of 10 patients were positive. Bacterial flora was presented by conditionally pathogenic gram-negative enterobacteria (E.coli, K.pneumoniae, B.cepacia, P.mirabilis) in 60 per cent of cases. The cases of infection by gram-positive agents (S.epidermidis, S.saprophyticus) covered 40 per cent. Sensitivity of the method used attained 91,7 per cent, specificity – 86,5 per cent, accuracy – 89,4 per cent.

Thus, the microbiological and cytological analysis of the aspirate taken by fine-needle aspiration under ultrasonic guidance allowed to determine the state of the pancreas objectively, to specify the pathologic process and its evolution, to verify the mode of tissue involvement in case of pancreatonecrosis.