Take Care of Your Pancreas!

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.

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.