Chapters authored
Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights
Cystic lesions of the pancreas are a common entity with almost a 25% incidence of the general population. These types of lesions are being increasingly diagnosed partly explained due to the technological advances over the past years. The management and treatment varies per cyst type. However, the most threatening cyst lesions are intraductal papillary mucinous neoplasms (IPMNs). These lesions represent nowadays a relatively new clinical entity and in many aspects remain poorly understood. The aim of this chapter is to provide a comprehensive review of the classification, diagnosis, treatment and follow-up strategy.
Part of the book: Challenges in Pancreatic Pathology
Necrotizing Pancreatitis: Step Up Approach
Acute pancreatitis (AP) is a inflamatory condition of the pancreatic gland with or without involvement of peripancreatic tissues and distant organs. The incidence of AP is 20–35 cases per 100,000 inhabitants per year, with an overall mortality of 2–10%. In recent decades the incidence of AP has increased globally. Most cases follow a mild, self-limiting course, but 10–20% of patients develop a severe form with systemic and local life-threatening complications of pancreatic and peripancreatic necrosis come about 20–40% of patient with severe AP and aggravate organ functions. The traditional approach to the treatment of necrotizing pancreatitis with secondary infection of necrotic tissue is open necrosectomy to remove the infected necrotic tissue. But this is associated with high rates of complications, death and pancreatic insufficiency. The benefits of sequential treatment in cases of infected necrosis (“Step an approach”) compared to traditional open necrosectomy, showing less morbidity and lower costs. The sequential treatment is an alternative to open necrosectomy, including percutaneous drainage, endoscopic (transgastric) drainage, and minimally invasive retroperitoneal necrosectomy. With this approach, up to 35% of patients can be treated only with drainage, to avoid necrosectomy and to reduce the percentage of complications. In this chapter we present the step-by-step approach.
Part of the book: Recent Advances in Pancreatitis