PSEUDOQUISTE EN PANCREATITIS AGUDA

Dra. Claudia Bertrn Fandez Unidad Medicina Infantil HBV 07 Septiembre 2011

PANCREATITIS: DEFINICION
Inflamacin del parnquima Pancretico

AGUDA

CRONICA

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

FISIOPATOLOGIA

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

EPIDEMIOLOGIA

Incidencia en aumento Multifactorial

USA: 13,2 /100.000 nios/ ao

Australia: 3,6 /100.000 nios/ ao Alto costo
What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

ETIOLOGIA

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

DIAGNOSTICO
Criterios Atlanta 1992: Dolor abdominal tpico Elevacin lipasa / amilasa Hallazgos imagenolgicos abdominales

En pediatra????
What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

DIAGNOSTICO: CLINICA

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

DIAGNOSTICO: BIOQUIMICA

Elevacin > 3 veces VN:

Amilasa: sensibilidad 50 85%

Lipasa: sensibilidad y especificidad 95%

Ambas: aumenta 4% sensibilidad

Pancreatitis aguda CLAUDIA ALARCN O.1, MARA LORETO VILA B.2, VIRGINIA TAJMUCH V Rev Chil Pediatr 2008; 79 (5): 516-521 What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

DIAGNOSTICO: IMAGENOLOGIA

Ecotomografa abdominal

Tomografa axial computarizada

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

SCORE DEBANTO

Ingreso:
Edad < 7 aos Peso <23 Kg Rcto. G. Blancos > 18.500 LDH > 2000 UI/L
Calcemia < 8,3 mg/dl Albmina < 2,6 mg/dl Aumento nitrgeno ureico > 5 mg7dl Secuestro lquido > 75 ml/kg/48 hrs
Pancreatitis aguda CLAUDIA ALARCN O.1, MARA LORETO VILA B.2, VIRGINIA TAJMUCH V Rev Chil Pediatr 2008; 79 (5): 516-521

48 hrs:

SCORE DEBANTO

Pancreatitis aguda CLAUDIA ALARCN O.1, MARA LORETO VILA B.2, VIRGINIA TAJMUCH V Rev Chil Pediatr 2008; 79 (5): 516-521

COMPLICACIONES

PRECOCES

TARDIAS

Falla Multiorgnica Shock

Necrosis Pseudoquiste

RECURRENCIA (15 35%)

What Have We Learned About Acute Pancreatitis in Children? Harrison X. Bai, yMark E. Lowe, and Sohail Z. Husain JPGN 2001;52:262-270

CLASIFICACION ATLANTA 1992

Pancreatitis aguda leve

Pancreatitis aguda grave
Necrosis Colecciones lquidas agudas Pseudoquistes Abscesos pancreticos
Pancreatitis aguda CLAUDIA ALARCN O.1, MARA LORETO VILA B.2, VIRGINIA TAJMUCH V Rev Chil Pediatr 2008; 79 (5): 516-521

PSEUDOQUISTE: DEFINICION

Coleccin de contenido lquido rico en amilasa, envuelta en pseudocpsula fibrotica.

Ocurre 4-6 semanas post pancreatitits aguda

Coleccin lquida aguda: precoz y/o sin cpsula
Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

PSEUDOQUISTE: DEFINICION

Absceso: Pseudoquiste infectado

COLECCIN LIQUIDA INFECTADA

NECROSIS PANCREATICA INFECTADA

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

CLASIFICACION ATLANTA 1993

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

EPIDEMIOLOGIA
Prevalencia:

P. Aguda: P. Crnica:
Alcohlica: Idioptica: Biliar:

6 a 18,5% 20 a 40%
70 a 78% 6 a 16% 6 a 8%

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

PSEUDOQUISTE

Complicaciones:
Ruptura Absceso Ictericia Hemorragia

40%

Resolucin:

20%

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

Factores regresin: Tamao y tiempo

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

FACTORES REGRESION IMPROBABLE

Quistes mltiples Localizacin en cola pancretica Grosor pared mayor 1 cm Falta comunicacin con Wirsung Estenosis ductal proximal Etiologa biliar o traumtica Aumento de tamao en seguimiento.

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

PSEUDOQUISTE: INTERVENCION?
Bradley: Si:
Tamao mayor 6 cm Duracin mayor 6 semanas

Actualidad: No hay consenso Pero

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

PSEUDOQUISTE:

Sintomtico
Dolor Obstruccin vaciamiento gstrico y/o biliar Infeccin y/o sepsis Hemorragia

Pseudoaneurisma Crecimiento progresivo Sospecha malignidad

I N T E R V E N I R

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

DRENAJE INTERNO: Estmago Duodeno Yeyuno

ESCISION

CIRUGIA

DRENAJE EXTERNO
Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

CIRUGIA
MINIMAMENTE INVASIVA
LAPAROSCOPIA ENDOSCOPIA PERCUTANEA

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

DRENAJE LAPAROSCOPICO

Quisto-gastrostomia
Transgstrica (anterior) Lesser Sac (posterior)

Quisto-yeyunostomia

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

DRENAJE LAPAROSCOPICO

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

DRENAJE PERCUTANEO

Externo

Interno

Pancreatitis aguda grave: alternativas teraputicas Fernandez Cruz y cols. Cir Esp. 2006;80:64-71. - vol.80 nm 02 Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

DRENAJE ENDOSCOPICO

Transentrico
Quisto-gastrostoma Quisto-duodenostoma

Transpapilar

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

Pancreatic Pseudocysts Observation, Endoscopic Drainage, or Resection? Markus M. Lerch, Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle Dtsch Arztebl Int 2009; 106(38): 61421

PSEUDOQUISTE PANCREATICO CANCER? SI

NO

TRAT. CA
EVALUAR SINTOMAS Y PROGRESION

ASINTOMATICO

SINTOMATICO O PROGRESIVO

OBSERVACION Y SEGUIMIENTO

INTERVENCION

Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 1447-1460

INTERVENCION

P. CRONICA
INFECCION ABSCESO CIRUGIA ABIERTA PERCUTANEA (2)

P. AGUDA ENDOSCOPICA TRANSENTERICA TIPO 1

ERCP

TIPO 2 Y 3

FRACASO RECURRENCIA

ENDOSCOPICA TRANSPAPILAR

LAPAROSCOPIA: Q-G LESSER SAC Q-G ANTERIOR Q-Y

OPERACIN WHIPPLE
Operative and Nonoperative Management of Pancreatic Pseudocysts. Simon Bergman, MDa, W. Scott Melvin, MDb Surg Clin N Am 87 (2007) 14471460

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