Page 25 - Acute Pancreatitis (Viêm tụy cấp)

916 PART VII Pancreas

S exocrine insufficiency occurs in 40% of individuals with newly
diagnosed prediabetes or diabetes mellitus after AP. 323 A recent
meta-analysis revealed that 10% of patients with AP and 36% of
those with recurrent AP developed subsequent chronic pancre-
92
atitis.
Abdominal Compartment Syndrome (see Chapter 11)
Abdominal compartment syndrome (ACS) is defined as a sus-
P
tained intra-abdominal pressure greater than 20 mm Hg (typi-
cally determined by a pressure-recording catheter in the urinary
bladder) that is associated with the development of organ dys-
function or failure. 324 The incidence of ACS in AP may be
increasing because of the more widespread use of aggressive IV
volume repletion, allowing more fluid to sequestrate into the
peritoneum. 249 A systematic review found that 38% of patients
with AP developed ACS 325 ; 11% of these received percutaneous
drainage as initial treatment, and 74% received decompressive
Fig. 58.7 CT showing a pancreatic pseudocyst with acute hemor- laparotomy. ACS is associated with increased morbidity and mor-
rhage. A 10-cm pancreatic pseudocyst (P) containing high-density (45 tality in AP. Another review suggested that the ACS is an epiphe-
Hounsfield units) material (arrows) representing acute blood is seen. nomenon observed in severe AP patients with organ failure rather
The pseudocyst is compressing the stomach (S). These findings were than the cause of organ failure. 326
confirmed at surgery.
Miscellaneous Complications
Bowel Compression or Fistula Formation
Pancreatic encephalopathy consists of a variety of central nervous
Pressure necrosis from inflammatory debris from the tail of the pan- system symptoms occurring in patients with AP, including agita-
creas can obstruct or fistulize into the small or large bowel. The tion, hallucinations, confusion, disorientation, and coma. A simi-
most common site is the left colon. Treatment is frequently surgical. lar syndrome may be due to alcohol withdrawal, and other causes
are possible, such as electrolyte disturbances (e.g., hyponatremia)
Long-Term Sequelae of Acute Pancreatitis or hypoxia. Purtsher retinopathy (discrete flame-shaped hemor-
rhages with cotton wool spots) can cause sudden blindness. 181 It
Exocrine and endocrine insufficiency after an attack of AP is is thought to be due to microembolization in the choroidal and
common. A systematic review found that 15% of patients with AP retinal arteries.
developed new onset diabetes mellitus within 12 month period
after the acute event and a >2-fold risk at 5 years. 322 Pancreatic Full references for this chapter can be found on www .expertconsult .com .