Minimally Invasive Interventions for Pancreatic Pseudocysts Complicated with Perforation and Diffuse Enzymatic Peritonitis

Aim. To study the possibility of using minimally invasive  interventions for pancreatic pseudocysts complicated by
perforation and diffuse enzymatic peritonitis.
Material and Methods. We analyzed the results of treatment of 298 patients with pancreatic pseudocysts inclyding 119 cases of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis. To determine the most effective surgical method in treatment of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis combination of minimally invasive procedures (laparocentesis, laparoscopy) for the relief of enzymatic peritonitis followed by ultrasound-assisted pseudocysts drainage and traditional laparotomy with external drainage of pancreatic pseudocyst were compared.
Results. In order to optimize the diagnostic search 57 diagnostic features (clinical, laboratory, instrumental) recorded in 119 patients were selected. After correlation analysis features having moderate or strong association with the occurrence of pancreatic pseudocyst complicated by perforation were selected. Diagnostic scale was developed based on these symptoms. Effectiveness of different methods of surgical treatment of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis was evaluated according to incidence of sepsis and mortality rate. The use of minimally invasive techniques has reduced the incidence of sepsis from 18.8% to 5.9%, mortality from 9.4% to 2.9%.

Conclusion. Diagnostic scale consisting of 5 signs that allows to verify pancreatic pseudocyst perforation with the probability near 95.8% was developed. Method of choice for treatment of enzymatic peritonitis is remedial laparoscopy (laparocentesis). External drainage of pancreatic pseudocysts is advisable to carry out under ultrasound guidance. Remedial laparotomy is indicated if minimally invasive approach is ineffective.

1. Архангельский В.В., Шабунин А.В., Лукин А.Ю. Лечение ложных кист поджелудочной железы. Анналы хирургической гепатологии. 1999; 4 (1): 44–48.

2. Курыгин А.А., Нечаев Э.А., Смирнов А.Д. Хирургическое лечение кист поджелудочной железы. СПб.: Гиппократ, 1996. 144 с.

3. Edward L. Bradley III, MD. A Clinically Based Classification System for Acut Pancreatitis (Summary of the International Symposium on Acute Pancreatitis, Atlanta 1992). Arch. Surg. 1993; 128: 586–590.

4. лекций по хирургии; Под ред. В.С. Савельева ; ред.-сост. Кириенко А.И. М.: Литтерра, 2008. 910 с.

5. Данилов М.В., Федоров В.Д. Повторные реконструктивные операции при заболеваниях поджелудочной железы: Руководство для врачей. М.: Медицина, 2003. 424 с.

6. Гришин И.Н., Гриц В.Н., Лагодич С.Н. Кисты, свищи поджелудочной железы и их осложнения. Минск: Выcшая школа, 2009. 272 с.

7. Филин В.И., Гидирим Г.П. Острый панкреатит и его осложнения. Кишинев: Штиинца, 1982. 148 с.

8. Beger H.G., Matsuno S., Cameron J.L. Diseases of the pancreas, current surgical therapy. Springer: Berlin-Heidelberg. 2008. 950 p.