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Ovsyanik D.M., Fomin A.V.
Aspects of pathomorphogenesis and diagnosing of infected pancreatic necrosis (literature review)

Abstract.
Diagnosis, treatment and prevention of infected pancreatic necrosis remain one of the most important tasks of pancreatology. The variety of currently used laboratory and instrumental methods of diagnosis suggests that none of them fully satisfies the needs of clinicians, as it is not always possible to reliably and timely detect the presence of infection of necrotically changed pancreatic tissues and retroperitoneal fat in patients with destructive pancreatitis. The percentage of errors in the differential diagnosis of sterile and infected pancreatic necrosis still remains high - up to 40%.
In this review the current knowledge about pathomorphogenesis of infected pancreatic necrosis has been considered and summarized. The information about the sensitivity and specificity of different methods for its diagnosis has been provided. Trends to improve the quality of diagnosis of infected pancreatic necrosis, based on the study of endothelial dysfunction have been identified. Submitted published data are the basis for clinical studies, the development of new methods for diagnosis of early signs of infected pancreatic necrosis.
Key words: infected pancreatic necrosis, acute pancreatitis, diagnosing.

References

1.    Ermolov AS, Ivanov PA, Blagovestnov DA, Grishin AV, Andreev VG. Diagnostika i lechenie ostrogo pankreatita [Diagnostics and treatment of acute pancreatitis]. Moscow, RF: Vidar-M; 2013. 384 р.
2.    Litvin AA. Infitsirovannyi pankreonekroz [The infected pancreatonecrosis]. Moscow, RF: Integratsiia; 2011. 240 р.
3.    Litvin AA, Khokha VM, Lurie VN. Sovremennye tendentsii v khirurgicheskom lechenii ostrogo nekrotiziruiushchego pankreatita, infitsirovannogo pankreonekroza [Current trends in surgical treatment of the acute necrotizing pancreatitis, the infected pancreatonecrosis]. Novosti khirurgii. 2011;19(5):138-46.
4.    Saveliev VS, Filimonov MI, Gelfand BR, Burnevich SZ. Infitsirovannyi pankreonekroz [The infected pancreatonecrosis]. Infektsii v khirurgii. 2003;1(2):34-9.
5.    Mantke R, Lippert H, Büchler MW, Sarr MG. International Practices in Pancreatic Surgery. Heidelberg: Springer; 2013. 206 p.
6.    Zdravookhranenie v Respublike Belarus' [Health care in Republic of Belarus]: ofits. stat. sb. za 2012 g. Minsk, RB: GU RNMB; 2013. 284 р.
7.    Dellindzher EP. Infektsionnye oslozhneniia pankreatita [Infectious complications of pancreatitis]. Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia. 2003;5(2):108-18.
8.    Forsmark CE. Pancreatitis and its complications. New Jersey: Humana Press Inc; 2005. 349 p.
9.    Galimzianov FV. Pervichnaia diagnostika infitsirovannogo pankreonekroza [Primary diagnostics of the infected pancreatonecrosis]. Khirurgiia. Zhurnal im. N. I. Pirogova. 2006;(6):8-10.
10.    Saganov VP, Gunzynov GD, Khitrikheev VE, Tsybikov EN, Radnaeva LD. Problemy diagnostiki i lecheniia razlichnykh form ostrogo pankreatita [Problems of diagnostics and treatment of various forms of acute pancreatitis] (obzor literatury). Biulleten' Vostochno-Sibirskogo nauchnogo tsentra SO RAMN. 2011;(4,ch2):331-5.
11.    Nedashkovskii EV, red. Ostryi pankreatit [Acute pancreatitis]: ruk. dlia vrachei. Moscow, RF: GEOTAR-Media; 2009. 272 р.
12.    Diebel LN, Dulchavsky SA, Brown WJ. Splachnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1997 Nov;43(5):852-5.
13.    Korovin AIa, Zalesnyi SA, Kulish VA, Lishchenko AN, Balakleets EN, Avakimian SV, Norsiia VV. Immunoterapiia v kompleksnom lechenii nekrotiziruiushchego pankreatita, oslozhnennogo peritonitom [Immunotherapy in complex treatment of the necrotizing pancreatitis complicated by peritonitis]. Kubanskii nauchnyi meditsinskii vestnik. 2011;(4):124-7.
14.    Paskar SV, Kosachev ID, Varzin SA. Effektivnost' metodov rannei diagnostiki i optimizatsiia lechebnoi taktiki pri ostrom destruktivnom pankreatite [Efficiency of methods of early diagnostics and optimization of medical tactics at acute destructive pancreatitis]. Vestnik Sankt-Peterburgskogo universiteta. Ser. 11, Meditsina. 2010;(1):83-91.
15.    Firsova VG, Parshikov VV, Gradusov VP. Ostryi pankreatit: sovremennye aspekty patogeneza i klassifikatsii [Acute pancreatitis: modern aspects of a pathogenesis and classification]. Sovremennye tekhnologii v meditsine. 2011;(2):127-34.
16.    Lobanov SL, Stepanov AV, Lobanov LS. Sovremennye podkhody k lecheniiu ostrogo pankreatita [Modern approaches to treatment of acute pancreatitis]. Chita, RF: IITs ChGMA; 2008. 160 р.
17.    Savelieva VS, red. Destruktivnyi pankreatit. Dokazatel'nye metody diagnostiki i lecheniia [Destructive pancreatitis. Evidential methods of diagnostics and treatment]: metod. rek. Moscow, RF: RASKhI; 2009. 12 р.
18.    Sadakh MV, Fadeeva TV, Vereshchagina SA, Kaporskii VI, Kalinichenko AV. Nekroticheskoe porazhenie tolstoi kishki v usloviiakh infitsirovannogo pankreonekroza: etiologiia, patogenez, mikrobnyi peizazh, lechenie [Necrotic lesion of a colon in the conditions of the infected pancreatonecrosis: etiology, pathogenesis, microbial landscape, treatment]. Biulleten' Vostochno-Sibirskogo nauchnogo tsentra SO RAMN. 2011;(4,ch2):162-8.
19.    Wyncoll DL. The management of severe acute necrotizing pancreatitis: an evidence-based review of the literature. Intensive Care Med. 1999 Feb;25(2):146-56.
20.    Savelieva VS, red. Gelfand BR, red. Abdominal'naia khirurgicheskaia infektsiia: klinika, diagnostika, antimikrobnaia terapiia [Abdominal surgical infection: clinic, diagnostics, antimicrobial therapy]: prakt. ruk. Moscow, RF: Litterra; 2006. 168 р.
21.    Foitzik T, Fernández-del Castillo C, Ferraro MJ, Mithöfer K, Rattner DW, Warshaw AL. Pathogenesis and prevention of early pancreatic infection in experimental acute necrotizing pancreatitis. Ann Surg. 1995 Aug;222(2):179-85.
22.    Fritz S, Hackert T, Hartwig W, Rossmanith F, Strobel O, Schneider L, Will-Schweiger K, Kommerell M, Büchler MW, Werner J. Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg. 2010 Jul;200(1):111-7.
23.    Van Felius ID, Akkermans LM, Bosscha K, Verheem A, Harmsen W, Visser MR, Gooszen HG. Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis. Neurogastroenterol Motil. 2003 Jun;15(3):267-76.
24.    Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009 Mar;96(3):267-73.
25.    Vorobei AV, Litvin AA, Khokha VM. Mezhdunarodnaia klassifikatsiia ostrogo pankreatita (Atlanta, 1992) – sovremennye tendentsii v peresmotre [The international classification of acute pancreatitis (Atlanta, 1992) – current trends in revision]. Novosti khirurgii. 2010;18(1):149-60.
26.    Rattner DW, Legermate DA, Lee MJ, Mueller PR, Warshaw AL. Early surgical debridement of symptomatic necrosis is beneficial irrespective of infection. Am J Surg. 1992 Jan;163(1):105-10.
27.    Abdulianov AV, Farrakhov AZ, Borodin MA. Diagnostika i khirurgicheskoe lechenie bol'nykh destruktivnym pankreatitom [Diagnostics and surgical treatment of patients with destructive pancreatitis]. Prakticheskaia meditsina. 2010;47(8):30-7.
28.    Galimzianov FV, Prudkov MI, Shapovalova OP. Infitsirovannyi pankreatogennyi infil'trat, pankreatogennyi abstsess i pankreatogennaia flegmona, diagnostika i lechenie [The infected pankreatogenny infiltrate, pankreatogenny abscess and pankreatogenny phlegmon, diagnostics and treatment]. Vestnik ural'skoi meditsinskoi akademicheskoi nauki. 2011;(4):34-7.
29.    Rezoliutsiia XVI Mezhdunarodnogo kongressa khirurgov-gepatologov Rossii i stran SNG, Ekaterinburg, Rossiia, 16-18 sentiabria 2009 g. Infitsirovannyi pankreonekroz - diagnostika, khirurgicheskaia taktika [Resolution XVI of the International congress of surgeons-hepatologists of Russia and CIS countries, Yekaterinburg, Russia, on September 16-18, 2009. The infected pancreatonecrosis - diagnostics, surgical tactics]. Annaly khirurgicheskoi gepatologii. 2009;14(4):112-5.
30.    Mikhailusov SV, Moiseenkova EV, Smirnova NA, Bogdanova LS, Vorobyova EA, Eshtrekov MS. Laboratornaia diagnostika infitsirovannogo pankreonekroza [Laboratory diagnostics of the infected pancreatonecrosis]. Klinicheskaia laboratornaia diagnostika. 2010;(11):3-7.
31.    Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993 May;128(5):586-90.
32.    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis - 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11.
33.    Saveliev VS, Filimonov MI, Burnevich SZ, Kulikov VM, Orlov BB, Ignatenko YuN, Kirsanov KV, Morozova LA. Diagnosticheskaia i lechebnaia taktika pri steril'nom i infitsirovannom pankreonekroze [Diagnostic and medical tactics at the sterile and infected pancreatonecrosis]. Rossiiskii meditsinskii zhurnal. 2006;(5):9-14.
34.    Prudkov MI, Galimzianov FV. Evoliutsiia infitsirovannogo pankreonekroza, topicheskaia diagnostika i lechenie oslozhnenii [Evolution of the infected pancreatonecrosis, topical diagnostics and treatment of complications]. Annaly khirurgicheskoi gepatologii. 2012;17(2):42-9.
35.    Bassi С, Corra S, Pederzoli P. Treatment of infected pancreatic necrosis without surgery. International Journal of Pancreatology. 1992 Jun;11(3):209-11.
36.    Saganov VP, Gunzynov GD, Khitrikheev VE, Tsybikov EN, Garmaev BG, Radnaeva LD. Klinicheskaia kartina steril'nogo i infitsirovannogo pankreonekroza [Clinical picture of the sterile and infected pancreatonecrosis]. Biulleten' Vostochno-Sibirskogo nauchnogo tsentra SO RAMN. 2011;(4,ch2):152-5.
37.    Saganov VP, Gunzynov GD, Khitrikheev VE, Tsybikov EN, Garmaev BG, Radnaeva LD. Rol' laboratornykh metodov issledovaniia v diagnostike razlichnykh form steril'nogo pankreonekroza [Role of laboratory methods of research in diagnostics of various forms of a sterile pancreatonecrosis]. Biulleten' Vostochno-Sibirskogo nauchnogo tsentra SO RAMN. 2011;(4,ch2):155-9.
38.    Mamoshin AV, Borsukov AV. Kompleksnoe ispol'zovanie ul'trazvukovoi tomografii v diagnostike ostrogo destruktivnogo pankreatita [Complex use of an ultrasonic tomography in diagnosis of acute destructive pancreatitis]. Endoskopicheskaia khirurgiia. 2006;(3):13-20.
39.    Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas. 2000 Apr;20(3):319-22.
40.    Briukhovetskiу YuA, Mitkov VV, Sokolov AI, Struchkova TIa, Mitkov VV, red. Klinicheskoe rukovodstvo po ul'trazvukovoi diagnostike [Clinical guide to ultrasonic diagnostics]. T. 1. Moscow, RF: Vidar; 1996. р. 166.
41.    Boiko VV, Ivanova YuV, Mushenko EV. Diagnostika i khirurgicheskoe lechenie infitsirovannogo pankreonekroza [Diagnostics and surgical treatment of the infected pancreatonecrosis]. Zdorov'ia Ukraїni. 2012;(4):26-9.
42.    Pavlikova EYu. Diagnostika pankreonekroza i ego posleoperatsionnykh oslozhnenii [Diagnostics of a pancreatonecrosis and its postoperative complications]. Literaturnyi obzor [Elektronnyi resurs]. Vestnik Rossiiskogo nauchnogo tsentra rentgenoradiologii Ministerstva zdravookhraneniia RF. 2010;1(10). Rezhim dostupa: http://vestnik.rncrr.ru/vestnik/v10/papers/pavl_v10.htm. Data dostupa: 10.07.2014.
43.    Chernov VN, Alibekov AZ, Belik BM. Znachenie prokal'tsitoninovogo testa pri vybore taktiki lecheniia bol'nykh s ostrym destruktivnym pankreatitom [Value of prokaltsitoninovy dough at a choice of tactics of treatment of patients with acute destructive pancreatitis]. Vestnik eksperimental'noi i klinicheskoi khirurgii. 2012;5(4):670-2.
44.    Rau B, Steinbach G, Baumgart K, Gansauge F, Grünert A, Beger HG. The clinical value of procalcitonin in the prediction of infected necrosis in acute pancreatitis. Intensive Care Med. Intensive Care Med. 2000 Mar;26(2):159-64.
45.    Saveliev VS, Gelfand BR, Filimonov MI, Burnevich SZ, Sergeeva NA, Brazhnik TB, Saganov VP. Rol' prokal'tsitoninovogo testa v diagnostike i otsenke tiazhesti infitsirovannykh form pankreonekroza [Role of prokaltsitoninovy dough in diagnostics and an assessment of gravity of the infected forms of a pancreatonecrosis]. Annaly khirurgii. 2001;(4):44-9.
46.    Mauda Shadi LA, Litvin AA, Zharikov OG, Senchuk GA. Ispol'zovanie prokal'tsitoninovogo testa dlia diagnostiki infitsirovannogo pankreonekroza [Use of prokaltsitoninovy dough for diagnostics of the infected pancreatonecrosis]. Problemy zdorov'ia i ekologii. 2007;(4):30-34.
47.    Meisner M. PCT, Procalcitonin - a new, innovative infection parameter. Berlin: Brahms Diagnostica; 1996. р. 3-47.
48.    Meisner M. Procalcitonin (PCT). A new, innovative infection parameter. Biochemical and clinical aspects. Stuttgard; New York: Georg Thieme Verlag; 2000. р. 162-175.
49.    Saganov VP, Khitrikheev VE, Gunzynov GD, Ochirov VS. Rol' prokal'tsitonina v differentsial'noi diagnostike steril'nogo i infitsirovannogo pankreonekroza i otsenke stepeni tiazhesti sostoianiia bol'nykh so steril'nym pankreonekrozom [Pro-calcitonin role in differential diagnostics of the sterile and infected pancreatonecrosis and an assessment of severity of a condition of patients with a sterile pancreatonecrosis]. Vestnik Buriatskogo gosudarstvennogo universiteta. 2010;(12):240-6.
50.    Fomin AV, Gidranovich AV. Otsenka tiazhesti sostoianiia bol'nykh ostrym pankreatitom (obzor literatury) [Assessment of gravity of a condition of patients with acute pancreatitis (literature review)]. Vestnik Vitebskogo gosudarstvennogo meditsinskogo universiteta. 2004;3(1):41-50.
51.    Zharikov OG. Prognozirovanie gnoino-septicheskikh oslozhnenii tiazhelogo ostrogo pankreatita [Forecasting is purulent - septic complications of serious acute pancreatitis]. Novosti khirurgii. 2008;16(4):117-25.
52.    Pofahl WE, Walczak SM, Rhone E, Izenberg SD. Use of an artificial neural network to predict length of stay in acute pancreatitis. Am Surg. 1998 Sep;64(9):868-72.
53.    Pat. № 2319150 Rossiiskaia Federatsiia, MPK G 01 N 33/52. Tepliakova OV, Iakimov SV, Meshkova OS, Vinnik YuS, Savchenko AA. Sposob diagnostiki infitsirovannogo pankreonekroza [Way of diagnostics of the infected pancreatonecrosis]; zaiavitel' i patentoobladatel' Krasnoiarskaia gos. med. akademiia Federal'nogo agentstva po zdravookhraneniiu i sotsial'nomu razvitiiu. № 2006137620/15; zaiavl. 24.10.06; opubl. 10.03.08, Biul. № 7 (III ch). 7 р.
54.    Vinnik YuS, Tepliakova OV, Iakimov SV, Savchenko AA, Meshkova OS. Znachenie metoda indutsirovannoi khemiliuminestsentsii v diagnostike infitsirovannogo pankreonekroza [Value of a method of the induced chemoluminescence in diagnostics of the infected pancreatonecrosis]. Sibirskoe meditsinskoe obozrenie. 2007;42(1):17-9.
55.    Sushkov SA, Nebylitsyn YuS, Samsonova IV, Miadelets OD, Kozlovskii VI. Strukturnye i funktsional'nye izmeneniia endoteliia pri eksperimental'nom venoznom tromboze [Structural and functional changes of an endothelium at an experimental venous clottage]. Klіnіchna flebologіia. 2013;6(1):126-35.
56.    Kolbasova EA, Kiseleva NI, Tikhonova LV. Issledovanie tsirkuliruiushchikh endotelial'nykh kletok u patsientok s khirurgicheskoi i estestvennoi menopauzoi [Research of circulating endothelial cells at patients with a surgical and natural menopause]. Mat' i ditia v Kuzbasse. 2013;(1):8-13.
57.    Semenova AS, Morrison VV, Dolishnii VN. Vozmozhnosti uluchsheniia rezul'tatov lecheniia patsientov s abdominal'nym sepsisom na osnove patogeneticheskikh printsipov [Possibilities of improvement of results of treatment of patients with an abdominal sepsis on the basis of the pathogenetic principles]. Fundamental'nye issledovaniia. 2008;(7):23-5.

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