Pancreatitis aguda
DOI:
https://doi.org/10.31837/relatos/2Palabras clave:
pancreatitis aguda, fisiología, tratamiento quirúrgico, etiología, herramientas diagnósticas, predictores de severidad, tratamiento médico, colangiografía endoscópica retrógrada, complicaciones abdominales, colecistectomía, infección pancreática, páncreasResumen
Si bien ha pasado más de un siglo desde la descripción de la Pancreatitis Aguda como entidad nosológica particular, (1)(2) la misma sigue siendo un verdadero desafío para el cirujano. Se trata de una enfermedad frecuente, que tiene un curso benigno en la mayoría de los casos; sin embargo, en un 20% de los pacientes la enfermedad es severa, y dentro de ese grupo, la mortalidad es también de alrededor de un 20%.(3) (4)(5)
Gullo, en una revisión multicéntrica en 5 países europeos, (Alemania, Italia, Grecia, Hungría y Francia) encuentra una mortalidad global de 7,8% que asciende a 16% en los pacientes con necrosis pancreática extensa.(6)
Estas cifras de mortalidad ascienden a medida que seleccionamos grupos de enfermos más graves: Bumbasirevic señala una tasa de mortalidad de 53,6% en un grupo de 117 pacientes con pancreatitis aguda severa que presentaban Disfunción Orgánica Múltiple grave.(7) La incidencia de la Pancreatitis Aguda ha aumentado,(8)(9)(10)(11) y si bien las cifras varían en los distintos trabajos, promedialmente la misma es de 16/100.000 habitantes. Yadav, (12) atribuye este aumento de incidencia por un lado, al aumento en las pancreatitis de origen biliar, y por otra parte, a un diagnóstico más certero, derivado del mejor conocimiento de la patología, y a los avances en la Imagenología.
La elevada morbimortalidad de las formas graves (que no ha tenido cambios significativos en los últimos años) hace que la Pancreatitis Aguda continúe siendo un importante problema de salud.
Este problema sanitario también es de importancia para la forma leve de la enfermedad, por el costo social y económico que implica el manejo de la misma. En el año 2003, existieron en EEUU, 226000 admisiones por Pancreatitis Aguda, con un costo directo de hospitalización de más de 2 billones de dólares. ...
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BIBLIOGRAFIA NACIONAL SOBRE PANCREATITIS AGUDA
PUBLICACIONES DE LA SOCIEDAD DE CIRUGIA DEL URUGUAY
(Desarrollado por orden alfabético de autores)
Anavitarte, E. Pancreatitis aguda hemorrágica en un niño de 11 años. Tratamiento quirúrgico, curación. Bol.Soc.Cir. Uruguay, 1944; 15: 179-87
Barquet, A. Pancreatitis aguda. Cir.Uruguay, 1971; 41: 461-8
Benedictti, J.L.; Campos, N.; Chavarría, O. Seudoquiste de páncreas por pancreatitis aguda hemorrágica en el niño. Cir. Uruguay, 1986; 56: 151-4
Cazabán, L.; Baldizán, J.; Carriquiry, L. Secuestrectomía de urgencia en la pancreatitis agudas necrótico hemorrágicas. Cir. Uruguay, 1976; 46: 74
Cazabán, L.; Baldizán, J.; Carriquiry, L. Secuestrectomía de urgencia en la pancreatitis agudas necrótico hemorrágicas. Cir. Uruguay, 1977; 47: 110-2
Chiara, T.; Márquez, M.A. Pancreatitis aguda con tetania por hipocalcemia y diabetes. Contribución al tema "Pancreatitis aguda. Congreso Uruguayo de Cirugía, 5º, Montevideo, 13-19 de dic., 1954. Montevideo: García Morales Mercant, 1955. v.2 p.3-11
Cosco Montaldo, H. Mecanismo del reflujo biliopancreático de acuerdo a nuestras comprobaciones. Bol.Soc.Cir.Uruguay, 1953; 24: 349-66
Cosco Montaldo, H. Pancreatitis aguda experimental por ligadura de los canales pancreáticos. Bol.Soc.Cir.Uruguay, 1954; 25: 343-58
Cosco Montaldo, H. Pancreatitis aguda. Etiopatogenia y Fisiopatolkogía. Tratamiento. Relato. Congreso Uruguayo de Cirugía, 5º, Montevideo, 13-19 de dic., 1954. Montevideo: García Morales Mercant, 1955. v.1 p.533-770.
Cosco Montaldo, H. Pancreatitis aguda. Montevideo: Rosgal, 1956
Cosco Montaldo, H. Pancreatitis aguda. Reflujo bilio pancreático. Crítica a las teorías de su mecanismo. Bol.Soc.Cir.Uruguay, 1953; 24: 221-32
Cosco Montaldo, H.; Folle, J.A. Lesiones iniciales de las pancreatitis agudas. Acción comparativa de la inyección intraductal de bilis y de sustancias inertes. Bol.Soc.Cir.Uruguay, 1956; 27: 496-507
Cosco Montaldo, H.; Folle, J.A. Lesiones iniciales en las pancreatitis agudas. Bol.Soc.Cir.Uruguay, 1956; 27: 199-212
Del Campo, J.C. Sobre colecistitis disecante y pancreatitis aguda (A propósito de la comunicación del Dr. H. Alvarez). Bol.Soc.Cir.Uruguay, 1937; 8: 78-84
Delgado, B.; Trostchansky, J. Patología biliar aguda y pancreatitis aguda. Cir. Uruguay, 1975; 45: 23-7
Delgado, B.; Zerbino, V. Pancreatitis postoperatoria en la cirugía biliar. A propósito de 14 observaciones. Rev.Cir.Uruguay, 1965; 35: 154-61
Dominguez, C.; Bertullo, H.; Olano, E.; Barrial, N.; Imperial, O.; Ferradas, A.; Seijas, R. Alimentación parenteral en las pancreatitis agudas necrótico hemorrágicas. Cir. Uruguay, 1989; 59: 40-4
Emeric, E.E. Diagnóstico de las pancretitis agudas por el laboratorio. Congreso Uruguayo de Cirugía, 5º, Montevideo, 13-19 de dic., 1954. Montevideo: García Morales Mercant, 1955. v.2 p.67-75
Filgueira, J.L.; Larre Borges, U.; Del Campo, A. Pancreatitis postgastrectomía. Aspectos experimentales. An.Fac.Med.Montevideo; 1965; 50: 278
Folle, J.A. Histopatología de las pancreatitis agudas experimentales. Congreso Uruguayo de Cirugía, 5º, Montevideo, 13-19 de dic., 1954. Montevideo: García Morales Mercant, 1955. v.2 p.42-50
Giossa, W.; Bianchi, G.; Rodríguez, F.; Guariglia, R.; Pomata, J.; Lucas, N.; Fontan, L. Ocxlusión de conductos excretores en pancratitis auda experimental. Cir. Uruguay, 1986; 56: 134-6
Laca, E.; Segura, J. Aneurisma de arteria esplénica roto en la evolución de una pancreatitis aguda. Cir. Uruguay, 1979; 49: 154-6
Mañana, J.; Gilardoni, F. Las reintervenciones en cirugía abdominal producidas por la pancreatitis aguda postoperatoria (P.A.P.O.).Congreso Uruguayo de Cirugía, 15º. Montevideo, 1-4 de dic., 1964. Montevideo: Rosgal, 1965. p.94-9
Milies, C. ; Acosta, G.; Gravina, F.; Rossi, J.J.; Pino, J.C.; Rodríguez, A.M. Pancreatitis agudas de hallazgo necrópsico. Revisión de 5.277 necropsias. Análisis de 59 casos. Cir. Uruguay, 1982; 52: 334-6
Misa, R.; Quintana, L.; Quiroga, C.; Bentancourt, S. Valoración de los criterios pronósticos en pancreatitis aguda. Su utilización en la Unidad de Cuidados intensivos del Hospital Pasteur. Cir. Uruguay, 2003, 73: 146-69
Nario, C.V. Pancreatitis aguda. Comentarios sobre una historia. Bol.Soc.Cir.Uruguay, 1936; 7: 35-9
Perdomo, R. Problemas de diagnóstico en pancreatitis aguda. Relación entre valores de amilasuria y estudio del exudado peritoneal. Rev.Cir.Uruguay, 1965; 35: 162-8
Perrier, J.P.; Gateño, J.P.; Delgado, B. Pancreatitis aguda postoperatoria despues de hemicolectomía derecha. Cir. Uruguay, 1981; 51:181-3
Piñeyro, J.P.; Farcic, A.; Geninazzi, H.; Parodi, H.; Delgado, B. Pancreatitis aguda necrótico-hemorrágica y papilitis fibrosa estenosante. Cir. Uruguay, 1977; 47: 256-7
Praderi, R. Cien años de cirugía pancreática. Cir. Uruguay, 2000; 70: 93-107
Stajano, C. La injuria vascular reflexógena en la pancreatitis aguda. Día Med. Uruguay, 1956
Torterolo, E.; Viñuela, E.; Bergalli, L.; Perrier, J.P.; Sarroca, C.; Piñeyro, A.; Klempert, H.; Rinaldi, B. Pancreatitis agudas letales. Correlación anátomo - clínica. Cir.Uruguay, 1981; 51: 101-3
Torterolo, E.; Viñuela, E.; Bergalli, L.; Perrier, J.P.; Sarroca, C.; Piñeyro, A.; Rinaldi, B. Pancreatitis agudas letales. Consideraciones terapéuticas. Cir.Uruguay, 1981; 51: 103-8
Varela, N.B.; Gateño, N. Algunos aspectos de la etiopatogenia de la pancreatitis aguda. Cir. Uruguay, 1970; 40: 453-7
Venturino, W.; Bosch del marco, L.M. Tratamiento de las pancreatitis agudas. Congreso Uruguayo de Cirugía, 5º, Montevideo, 13-19 de dic., 1954. Montevideo: García Morales Mercant, 1955. v.2 p.50-3
