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Khirurgii

SYCHIKOV N.V., BRUKHNOV A.V., SHOSTKO ZH.P., KHILINSKY N.G.

CHRONIC RELAPSING PANCREATITIS RESULTED IN PANCREATONECROSIS MASKED AS ANGINA PECTORIS

Diagnostics of both chronic relapsing and acute pancreatitis in a number of cases may be rather problematic and belated. In many patients pancreatonecrosis is firstly diagnosed at the autopsy.
The description of the 73-year old patient chronic relapsing pancreatitis case is given in the article, resulted in pancreatonecrosis which had not typical clinical picture, masked as angina pectoris with the corresponding changes on ECG and corresponding symptoms. With the diagnosis of progressive angina pectoris the patient was treated both as in and out patient, he used nitrates. Pancreatopathy wasn’t shown by ultra sound examination data, blood amylase and urine investigations. Diagnosis was made only after pancreatonecrosis infection and colon perforation development and peritonitis (at the emergent laparotomy). Left side hemicolectomy with transversectomy, pancreatonecrsectvestrectomy, abdominal drainage and sanation were performed as well as omento- and lumbostomy were formed. After the operation, critical polyorganic insufficiency developed with the 4 systems involvement. During 3 weeks period guided artificial lungs ventilation was performed. Comatose delirious state and sepsis induced hypotension were observed. Several relaparotomies with pancreatonecrosis progression correction and opening intestinal fistulas were carried out. The state had become stable only by the 61st day of staying in the hospital. The patient was discharged on the 81st day. Three months later at the examination it was determined that the patient didn’t need either cardiotropic therapy or nitrates. ECG didn’t reveal any signs of angina pectoris.
It should be concluded that chronic relapsing pancreatitis and pancreatonecrosis both clinically and according to ECG data can be masked as angina pectoris. While diagnosing it is necessary to take into account not only the ultra sound examination data and amylase, but also to apply CT with bolus contrasting, determination of blood lipase.

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