BACKGROUND: Heterotopic pancreas is defined as pancreatic tissue located outside the pancreatic parenchyma that lacks an anatomic or vascular connection to the normal pancreas. Symptomatic gastric heterotopic pancreas is a rare condition that can manifest as acute or chronic pancreatitis. Asymptomatic heterotopic pancreas does not require treatment, while symptomatic lesions should be resected. The modality of final resection of heterotopic pancreas depends on its size and the depth of gastric wall involvement. METHODS AND RESULTS: A 36-year-old woman was admitted for recurrent epigastralgia. Abdominal computed tomography (CT) scan revealed that an abscess had formed in the gastric antrum. After multidisciplinary discussion we decided for conservative treatment with intravenous antibiotics and further detailed endoscopic diagnostic. Esophagogastroduodenoscopy revealed a submucosal mass with a central fistula and intermittent pus secretion in the prepyloric region of the gastric antrum, which was subsequently drained with a double pigtail stent under endoscopic ultrasound (EUS) and fluoroscopy. The possibility of pancreatic fluid collection in the case of heterotopic pancreas was suggested during the EUS examination, and histology subsequently confirmed heterotopic pancreatic tissue. The patient was in good condition and without any abdominal pain. According to a control CT scan after 10 weeks, the fluid collection was completely resolved. Due to the possible recurrence of pancreatitis, resection of heterotopic pancreas was proposed to the patient. Since the lesion involved the muscularis propria of the gastric wall, surgical resection of the mass was indicated. CONCLUSION: Fluid collections after acute pancreatitis in heterotopic pancreas in the gastric antrum can be successfully managed by endoscopy.

• Klíčová slova
• drainage, endoscopy, heterotopic pancreas, pancreatitis, surgery,
• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• endoskopie MeSH
• endosonografie MeSH
• lidé MeSH
• pankreas MeSH
• pankreatitida * chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND/OBJECTIVES: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. METHODS: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. RESULTS: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. CONCLUSIONS: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).

• Klíčová slova
• Acute pancreatitis, Biliary pancreatitis, Global surgery, Guidelines compliance, International audit,
• MeSH
• akutní nemoc MeSH
• cholecystektomie MeSH
• enterální výživa MeSH
• hospitalizace MeSH
• lidé MeSH
• pankreatitida * chirurgie   diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH

Despite several studies, the role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in the case of acute biliary pancreatitis (ABP) remains a subject of discussion.There is a clear indication of early ERCP within 72 hours in patients with ABP andcholedochal obstruction, moreover the ERCP within 24 hours in cases of cholangitis. However, the role of ERCP in patients with ABP without symptoms of cholangitis or concrements obstructing the bile duct is controversial. If ABP is indicated for the ERCP, the earlier the ERCP is performed the less complications it is associated with. The decision to perform ERCP is often based on findings from a biochemical and transabdominal ultrasound examination. The results of these examinations may, but may not, confirm the presence of stones in the choledochus. An effective and safe method approaching the sensitivity of ERCP in the diagnosis of concrements in the choledochus is endoscopic ultrasonography (EUS) and magnetic resonance cho-langiopancreatography (MRCP). The cholecystectomy should be performed to prevent a recurrence of pancreatitis and biliary problems after the successfully treatment of ABP. Key words: acute biliary pancreatitis choledocholithiasis cholangitis endoscopic retrograde cholangiopancreatography.

• Klíčová slova
• acute biliary pancreatitis choledocholithiasis cholangitis endoscopic retrograde cholangiopancreatography,
• MeSH
• akutní nemoc MeSH
• cholangiopankreatografie endoskopická retrográdní * MeSH
• choledocholitiáza * MeSH
• endosonografie MeSH
• lidé MeSH
• pankreatitida * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Surgical treatment of pancreatic diseases has been going through certain changes and developments. This article aims to describe the changes in diagnosis and treatment that have occurred over the years. MATERIAL AND METHODS: Groups of patients from three different periods (1954-1999, 2002-2006 and 2007-2011), all of them having undergone elective follow-up for the diagnosis of acute or chronic pancreatitis (AP, CHP), pancreas and papilla tumours, terminal choledochus, and other less common tumours in this region, are described. Monitoring has focused on the indication criteria, the extent and method of the surgical procedure, perioperative lethality and morbidity, including complications, and also survival rate. RESULTS: In AP patients we recorded a significant drop in indications to surgery (38% vs. 16%), a shift in intervention time from 8.9 to 22.5 days, a decrease in lethality by 24%, or, as the case may be, by 3.5% (yet 7.9% during the first three months). The results show the domination of open abdominal procedures and a rising number of non-interventions. In CHP patients we detected a 30% increase in the number of resection procedures /Whipple/, a slight increase in drainage procedures (by 6%), and a decrease in drainage-resection procedures. The overall drop in the number of procedures in CHP patients probably relates to endoscopic and miniinvasive treatment. In pancreatic tumours we found domination of adenocarcinoma (92.6%), but also an increase in the number of cystic and endocrine tumours (2.6% and 4.8%) as a result of diagnostics and centralisation of care. We also recorded a decrease in exploratory laparotomy cases to 12%. In patients with resectable tumours we performed hemipancreatoduodenectomy in 90%, posterior approach in 2%, and vascular resection in only 4%. Perioperative lethality stagnates around 2.8%. Median survival rate has remained unchanged, as has long-term survival rate. CONCLUSION: Although treatment in general has not recorded any revolutionary and fundamental benefits, its surgical modality still represents the principal treatment and can be considered curative, even in tumours. Pancreatic diseases remain to be seen as a multidisciplinary issue and must be approached and dealt with as such, optimally in large-volume centres.

• MeSH
• chirurgie trávicího traktu trendy   MeSH
• lidé MeSH
• nádory slinivky břišní chirurgie   MeSH
• nemoci slinivky břišní chirurgie   MeSH
• pankreas chirurgie   MeSH
• pankreatitida chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

The Crohn's disease rarely affects duodenum. The symptoms are unspecific and its diagnostic process may be difficult. Patients with complications-stenoses and fistules, are indicated for surgical treatment. According to literature, there is no straightforward agreement on the surgical treatment strategy. In most cases, non-resection procedures are indicated. The authors describe a case of a patient suffering from the Crohn's disease of his duodenum and chronic pancreatitis, which was managed using a radical procedure--hemipancreatoduodenectomy.

• MeSH
• Crohnova nemoc komplikace   chirurgie   MeSH
• duodenum chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci duodena chirurgie   MeSH
• pankreatektomie * MeSH
• pankreatitida komplikace   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: The aim of this study was to compare two surgical procedures in the treatment for chronic pancreatitis (CP): pancreatoduodenectomy resection (classical Whipple - PD procedure, or pylorus-preserving - PPPD) to duodenum-preserving pancreatic head excision with longitudinal pancreatojejunoanastomosis (DPPHE/PJA), to define the advantages of each procedure with regard to postoperative complications, pain relief, and the quality of life. MATERIAL AND METHOD: 104 consecutive patients were included into this study. Duodenopancreatectomy was chosen when the head pancreatic mass was present or pancreatic cancer could not be ruled out (48 patients); otherwise DPPHE/PJA was performed (56 patients). Quality of life was measured prospectively on two occasions, before the procedure and during follow-up (median 39 months after surgery) using the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30). The test was re-evaluated for patients suffering from CP. Pain intensity was quantified using a specially designed pain score. Early postoperative morbidity and mortality were assessed and evaluated in both groups of patients. RESULTS: Total pain score decreased significantly after surgery in both groups of patients. During the follow-up period, the global quality of life improved by 30.4% in the DPPHE/PJA group, and by 23.2% in the PD/PPPD group. Postoperative morbidity and mortality were higher in the resection group, but the differences were not significant. CONCLUSIONS: Both surgical procedures led to significant improvement in the quality of life and pain relief after surgery for CP. The EORTC QLQ-C30 was found to be a valid and readily available test for quality-of-life assessment in patients with CP.

• MeSH
• anastomóza chirurgická MeSH
• bolest prevence a kontrola   MeSH
• chronická nemoc MeSH
• dospělí MeSH
• jejunum chirurgie   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidita MeSH
• pankreas chirurgie   MeSH
• pankreatektomie metody   mortalita   MeSH
• pankreatitida epidemiologie   mortalita   chirurgie   MeSH
• pankreatoduodenektomie * mortalita   MeSH
• pooperační bolest prevence a kontrola   MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Haemosuccus pancreaticus is a rare cause of gastrointestinal bleeding. The blood is passing into the pancreatic duct through the route between an aneurysm of an artery close to the pancreas and pancreatic duct. The blood goes to the gastrointestinal system through Vater's papilla and the patient becomes anemic. The authors describe their own clinical observations. In the presented paper the pathogenesis of the disease as well as difficulties of diagnosis are discussed. The possible ways of treatment are mentioned, too. It is necessary to consider haemosuccus pancreaticus in patients with proved chronic pancreatitis and in patients with ethylic anamnesis. Duodenoscopy, ERCP and especially angiography help to set the diagnosis. For the treatment it is recommended to perform the embolization of the bleeding artery or an operation such as pancreas resection, artery ligation or alternatively a drainage operation.

• MeSH
• arteria lienalis chirurgie   MeSH
• cholangiopankreatografie endoskopická retrográdní MeSH
• chronická nemoc MeSH
• drenáž MeSH
• gastrointestinální krvácení etiologie   chirurgie   MeSH
• lidé MeSH
• ligace MeSH
• pankreatikojejunostomie * MeSH
• pankreatitida komplikace   diagnóza   diagnostické zobrazování   chirurgie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• vývody pankreatu chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Overexpression of p21WAF1/CIP1 was recently described as an early event in the development of pancreatic intraepithelial neoplasia. Since activating K-ras mutations are described in more than 80% of pancreatic cancers and are known to increase intracellular levels of p21WAF1/CIP1 in experimental models, the possible role of activating K-ras mutations in an induction of the p21WAF1/CIP1 expression was investigated in our study. We examined 71 surgical specimens, 29 of chronic pancreatitis and 42 of invasive ductal adenocarcinoma both having a large spectrum of PanIN (pancreatic intraepithelial neoplasia) lesions. Expression of p53 and p21WAF1/CIP1 was examined immunohistochemically and codon 12 K-ras mutational analysis was performed using the very sensitive mutant-enriched PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) analysis. Our study demonstrated the overexpression of p21WAF1/CIP1 as an early event in the development of pancreatic intraepithelial neoplasia in the group of chronic pancreatitis and invasive adenocarcinoma as well. Overexpression of p21WAF1/CIP1 increased progressively from normal ducts through the spectrum of PanIN lesions to invasive carcinomas. The p53 overexpression increased again progressively according to the severity of the lesion and seems to be a later event in the development of pancreatic intraepithelial neoplasia if compared to p21WAF1/CIP1 expression. Our results confirmed also the possible p53 independent p21WAF1/CIP1 expression in some PanIN2, PanIN3 lesions and invasive carcinomas. K-ras mutations were not revealed in samples with only low grade PanIN lesions (PanIN1a and PanIN1b). K-ras mutations were detected in 69,4% adenocarcinomas and in only one case of chronic pancreatitis. Two codon 12 K-ras positive pancreatic carcinomas showed K-ras mutations in the surrounding normal pancreatic tissue. In adenocarcinomas, no statistically significant correlation was found between K-ras mutational status and p21WAF1/CIP1 and p53 expression, respectively. The possible role of activating K-ras mutations in an induction of p21WAF1/CIP1 expression was not confirmed in this study.

• MeSH
• adenokarcinom genetika   chirurgie   MeSH
• chronická nemoc MeSH
• cykliny genetika   MeSH
• geny p53 * MeSH
• geny ras * MeSH
• inhibitor p21 cyklin-dependentní kinasy MeSH
• invazivní růst nádoru MeSH
• lidé MeSH
• mutace genetika   MeSH
• nádory slinivky břišní genetika   patologie   chirurgie   MeSH
• pankreatitida genetika   chirurgie   MeSH
• referenční hodnoty MeSH
• regulace genové exprese u nádorů genetika   MeSH
• vývody pankreatu patologie   fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• CDKN1A protein, human MeSH Prohlížeč
• cykliny MeSH
• inhibitor p21 cyklin-dependentní kinasy MeSH

BACKGROUND AND STUDY AIMS: Invasive treatment for abdominal pain due to chronic pancreatitis may be either surgical or endoscopic, particularly in cases of ductal obstruction. To date, the data published on the effectiveness of these two forms of therapy have been mostly retrospective, and there have been no randomized studies. A prospective, randomized study comparing surgery with endoscopy in patients with painful obstructive chronic pancreatitis was therefore conducted. PATIENTS AND METHODS: Consecutive patients with pancreatic duct obstruction and pain were invited to participate in a randomized trial comparing endotherapy and surgery, the latter consisting of resection and drainage procedures, depending on the patient's individual situation. Patients who did not agree to participation and randomization were also further assessed using the same follow-up protocol. RESULTS: Of 140 eligible patients, only 72 agreed to be randomized. Surgery consisted of resection (80 %) and drainage (20 %) procedures, while endotherapy included sphincterotomy and stenting (52 %) and/or stone removal (23 %). In the entire group, the initial success rates were similar for both groups, but at the 5-year follow-up, complete absence of pain was more frequent after surgery (37 % vs. 14 %), with the rate of partial relief being similar (49 % vs. 51 %). In the randomized subgroup, results were similar (pain absence 34 % after surgery vs. 15 % after endotherapy, relief 52 % after surgery vs. 46 % after endotherapy). The increase in body weight was also greater by 20 - 25 % in the surgical group, while new-onset diabetes developed with similar frequency in both groups (34 - 43 %), again with no differences between the results for the whole group and the randomized subgroup. CONCLUSIONS: Surgery is superior to endotherapy for long-term pain reduction in patients with painful obstructive chronic pancreatitis. Better selection of patients for endotherapy may be helpful in order to maximize results. Due to its low degree of invasiveness, however, endotherapy can be offered as a first-line treatment, with surgery being performed in case of failure and/or recurrence.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• drenáž metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pankreatektomie metody   MeSH
• pankreatitida chirurgie   terapie   MeSH
• prospektivní studie MeSH
• sfinkterotomie endoskopická metody   MeSH
• stenty MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

• MeSH
• chronická nemoc MeSH
• lidé MeSH
• pankreatitida chirurgie   MeSH
• pooperační komplikace MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH