Percutaneous management of acute necrotizing pancreatitis

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy (PN) performed under ultrasound control and of endoscopic necrosectomy through secondary sinus track (ENTSST) using nephroscope and cystoscope.MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT).RESULTS: Seventeen patients (74%) treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (range 1-4) ENTSST.CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than open necrosectomy and postoperative lavage. Common solution for these methods has not been reached yet

A case of sclerosing mesenteritis mimic mesenteric tumour with small bowel obstruction. a difficult diagnosis

Sclerosing mesenteritis is a rare medical condition, affecting radix mesenterii. Its initial clinical appearance is very atypical. Pathological finding was non-specific and in most cases is associated with inflammatory process. Currently there is no imaging method confirming the diagnosis, which requires in most patients to make laparotomy with biopsy from the changed tissue. At least six months of conservative therapy are needed for the patient to become asymptomatic. The material presents our experience with a patient and brief literature review. Scripta Scientifica Medica 2010;42(2):101-10