European Journal of Molecular & Clinical Medicine

Chronic collection of amylase rich fluid enclosed in a non-epithelialized wall of collagen or granulation tissue, following after, episode of acute pancreatitis (5-15%), chronic pancreatitis (20 to 40%), trauma. Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. Asymptomatic pseudocysts up to 4cms in diameter can be safely observed and monitored without intervention, but larger and symptomatic pseudocysts require intervention.
Method
The materials for this case series was collected from the patients admitted and diagnosed as pseudocyst of pancreas in our surgical units. All 5 cases have been analyzed for this study during period of 6 months from January 2022 to  June  2022.
Results
Out of 5 cases, for 3 cases open surgery was performed, other 1case was ultrasonography assisted drainage was done and other 1 was conservatively managed according to the clinical presentation and investigations. All the cases are kept for regular follow ups with radiological imaging.
Conclusion
Due to progress in sensitivity and more widespread availability of diagnostic imaging techniques, the incidence of pancreatic pseudocysts seems to be increasing steadily. In the above series the different presentations of pseudocyst of pancreas and different techniques of management was elaborated.

Acute pancreatitis is a significant cause of morbidity and mortality and is known to run an unpredictable course. Severe pancreatitis occurs in 20%-30% of all patients with acute pancreatitis and is characterized by a protracted clinical course, multiorgan failure, and pancreatic necrosis. Computed Tomography Severity Index (CTSI) andModified Computed Tomography Severity Index (MCTSI) is used as a scoring system in acute pancreatitis. This study aims to correlate the CTSI and MCTSI grading system with patient outcome in terms of organ failure, mortality and duration of hospital stay.
Materials and Methods: This was a prospective study conducted for a period of two years. 40 Cases diagnosed as acute pancreatitis were included in this study. These patients underwent contrast enhanced computed tomography (CECT) of the abdomen and pelvis. The findings were recorded as per the CT severity index and modified CT severity index.
Results: There was significant correlation between necessity of ICU admission and duration of hospital stay and grade of pancreatitis, positive correlation with duration of ward stay and strong correlation with total duration of hospital stay. Higher CT grade is positively associated with development of local complications and systemic complications.
Conclusion: Grading by modified CT severity index has a significant correlation with necessity of ICU admission and total duration of hospital stay. CT severity index and Modified CT severity index can be used to predict the possibility of developing local and systemic complications, the need for interventions and necessity of hospital stay.

Acute Pancreatitis is an acute inflammatory process of the pancreas and significant cause of morbidity and mortality. Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity.
Aim: To determine the value of computed tomography evaluation in the early diagnosis of acute pancreatitis and to assess the clinical outcome based on Modified CT severity index.
Material and Methods: This observational prospective study was done on 127 patients referred to the Radiodiagnosis department with strong clinical and biochemical suspicion of pancreatitis and those diagnosed by ultrasonography, for a period from March to August 2022. Relevant clinical history and examination was done. A contrast enhanced CT abdomen was performed after checking serum creatinine and severity of pancreatitis was evaluated using MCTSI.
Results: Maximum patients with age group was 31 to 40 years (30%) with male preponerence. Gall stone was the most common etiology (45%) followed by alcoholism (35.4%). Amylase was elevated in 76.3% patients and Lipase in 74%. Pancreatic inflammation was seen in 100% of patients. 60% patients had no evidence of pancreatic necrosis on CT scan while 32% had less than 30% necrosis and only 8% had more than 30% necrosis. 61% patients had one or more extra pancreatic complications.  According to Modified CT Severity Index, 17% patients had mild, 63% had moderate and 20% had severe pancreatitis. Duration of hospital stay ranged from 5 to 20 days with mean duration of 10.9days. 38% patients are considered to have end organ failure. 10% patients required surgical interventions.
Conclusion: MDCT proved to be the imaging modality of choice for the evaluation of the Acute pancreatitis. MCTSI which revealed a strong correlation with clinical outcome and is helpful in assessing disease progression and patient mortality

“Acute pancreatitis (AP) is defined as a sudden onset pancreatic inflammatory process” and is associated with complications such as Multi organ dysfunction syndrome leading to increased hospitalizations and mortality rates.
Aim: This study aims at studying the role of CRP done at admission and at 24 hours as a simple and effective prognostic predictor of Severe Acute Pancreatitis and as an alternative to the complex scoring systems available.
Methods: A hospital based observational study was conducted during October 2020 to September 2022 among 50 AP participants aged between 18- 65 years diagnosed using standard criteria. The study will help to translate the significance of CRP done at admission and at 24 hours as a prognostic predictor after comparisons within two clinical grades of AP - Mild Acute pancreatitis-(MAP) and Severe Acute pancreatitis (SAP).
Results: The mean difference of CRP done on admission and at 24hrs between Mild vs Severe Acute Pancreatitis was statistically significant with a P VALUE <0.05. Upon comparing the AUC for both CRP done on admission and CRP at 24 hours, CRP at 24 hours is found to be not of greater significance in predicting the outcomes of disease and is not a better prognostic marker than CRP done on admission.
Conclusion: In our study, both CRP at admission and CRP at 24 hours were statistically significant in predicting the severity of Acute pancreatitis but the CRP levels done at 24 hours were not found to be superior to CRP done on admission to assess disease severity

Acute pancreatitis is an inflammatory disease of the pancreas and can be caused by several factors such as gallstones, alcohol, trauma, infections, and hereditary factors. The incidence of alcoholic pancreatitis is higher in male; however, more women develop this disorder since gallstones occur with increased frequency in women. Gallstones are the most common cause of acute pancreatitis worldwide. The aim of the study is to find out early indicators of Acute Biliary Pancreatitis. This retrospective study was conducted for a period of 2 years on 650 patients of all age groups. The gallstone is the most common cause of AP. The female to male ratio in this study was 1.8:1. The mean age of male patients was 40.3+11.82 years and that of females was 39.6+9.65 years. Serum bilirubin, ALT and amylase when compared with biliary and non-biliary patients, the difference was found to be statistically significant. The difference between severity and type of pancreatitis was observed to be statistically significant with p < 0.05. The biliary pancreatitis had statistically significant %age of SAP (23%) as compared to non-biliary pancreatitis (13.8%). The Severe Acute Pancreatitis (75%) had statistically significant >1-week hospital stays as compared to moderately SAP (46.9%), followed by mild AP (5.4%). The present study found that there is a significant co-relation between young age, female gender, raised serum bilirubin, ALT & Amylase and these factors are predictors of Acute Biliary Pancreatitis.

Objective: To study the value of computed tomography evaluation in early diagnosis of acute pancreatitis and to evaluate the complications of acute pancreatitis using the Modified computed tomography severity index(MCTSI) and its correlation with clinical outcome
Methods: This observational study was conducted at a tertiary health center over the period of 2 years from 2020-2022.The study sample included 100 patients with clinical/laboratory/ultrasonography diagnoses of acute pancreatitis, who were willing to undergo Contrast-enhanced computed tomography & included in the study. These patients based on their MCTSI (Modified CT Severity Index) score were subjected to either conservative management or surgical/endoscopic intervention. An attempt was made to establish a correlation between the MCTSI score at presentation and possible local/systemic complications as well as clinical outcomes.
Results: The peak incidence was in the 4th decade. The mean age group in our study is
53.6 years with a standard deviation of 12.04.Out of 100 patients, 71 were males and 29 were females. Among 100 patients evaluated Clinically, biochemically, and radiologically were found to have complications in 51 patients.95% of patients recovered with a favorable clinical outcome as compared to 5% of patients who succumbed to organ failure secondary to severe acute pancreatitis.The sensitivity and specificity of the MCTSI score in predicting the clinical outcome of acute pancreatitis in this study was 100%.The p-value of MCTSI in predicting clinical outcomes was <0.057 which was statistically significant. The p-value of MCTSI in predicting complications was <0.00001 which was significant indicating a positive correlation.

Background: Acute pancreatitis, characterised by inflammation, auto-destruction and activation of pancreatic enzyme is a common gastro-intestinal cause of hospital admission. Understanding the etiology, clinical profile and clinical outcomes of these patients in regional setting is key for appropriate management.
Methods: A hospital based observational study was carried out between August 2011 and July 2013 among patients above 18 years of age who presented to the outpatient department with acute pancreatitis. Patients demographic, clinical information, and laboratory findings was obtained at admission. All patients were subjected to ultrasonography and patients with severe disease were subjected to Computed Tomography. The clinical severity and outcomes were recorded. Data was summarised as mean (SD) for continuous variables and proportions for categorical variables.
Results: Among 94 subjects included in the study, about 85% were males and 69% were aged less than 45 years. Abdominal pain (88%) was the most common clinical presentation, followed by vomiting (49%). Alcohol was the most common etiological factor seen in about 60% of the subjects. Ultrasonography revealed bulky pancreas in 38% and gallbladder calculi in 33% of the subjects. Acute kidney Injury was present among 3% of the patients. About 9% had severe disease and mortality was 2.1%. There was marked increase in the levels of pancreatic enzymes, BUN and serum creatinine among patients with severe disease when compared to patients with mild/moderate disease.
Conclusions: Acute pancreatitis is a leading causes of hospitalization due to gastro-intestinal cause. Clinical assessment along with radiological findings correlates well with the disease severity and mortality. Understanding the clinical and etiological profile of patients with acute pancreatitis would be helpful to plan the management strategies for the local setting.

Although measurement of amylase and lipase is useful for diagnosis of pancreatitis, serial
measurements in patients with acute pancreatitis are not useful to predict disease severity,
prognosis, or for altering management. Routine abdominal computed tomography (CT) scan
is not recommended at initial presentation because there is no evidence that CT improves
clinical outcomes and the complete extent of pancreatic and peripancreatic necrosis may only
become clear 72 hours after the onset of acute pancreatitis. This was a prospective
observational study conducted in HIMS, Hassan from July 2020 to July 2021. Modified
Glasgow score showed Mild Acute Pancreatitis in 93 and Severe Acute Pancreatitis in 47
Patients. Using the modified CT severity index, the observers graded severity of the acute
pancreatitis as mild in 66, moderate in 31, or severe in 43 of the 140 patients with CT scans.

Background:Acute pancreatitis is a relatively common but potentially fatal disease seen
in surgical practise. Clinical examination, laboratory investigations, and imaging
techniques are used to make a diagnosis of the disease. Patients usually present with
severe pain in the epigastric region that radiates to the back. Serum levels of amylase
and lipase that are more than three times the normal value usually indicate acute
pancreatic inflammation. When clinical and laboratory investigations fail to diagnose
the disease despite a strong suspicion of acute pancreatitis, radiological investigations
are used to make a diagnosis. Urinary clearance of pancreatic enzymes from the
circulation increases in acute pancreatitis. This is a study that will use urinary amylase
levels to diagnose acute pancreatitis in a non-invasive manner. Objectives: To diagnose
acute pancreatitis using urine amylase levels in conjunction with other specific tests
such as serum lipase and abdominal ultrasound, and to demonstrate that urine amylase
can be used to diagnose acute pancreatitis.
Materials and Methods: It is a case control study with 40 patients diagnosed with acute
pancreatitis and 40 patients admitted with other diagnoses. Patients admitted to Princes
Esra Hospital between November 2019 and May 2021 were chosen as cases and
controls. Serum amylase, serum lipase, and urinary amylase levels were measured in
both the case and control groups. After comparing serum amylase, serum lipase, and
urinary amylase levels in cases and controls, the sensitivity and specificity of these
enzymes were determined.The authors concluded that serum amylase had the highest
sensitivity (100 percent) and serum lipase had the highest specificity (100 percent) after
analysing serum amylase, serum lipase, and urinary amylase results in both cases and
controls (95 percent). Urine amylase's sensitivity and specificity were found to be
98.33% and 95%, respectively. The area under the curve for serum amylase, serum
lipase, and urinary amylase was found to be 0.987, 0.995, and 0.935, respectively, using
ROC curve analysis.
Conclusion: Because serum amylase, serum lipase, and urinary amylase have
comparable sensitivity and specificity, as well as comparable areas under the curve on
ROC analysis for the diagnosis of acute pancreatitis, the authors conclude that urinary
amylase can be used in the diagnosis of acute pancreatitis.

Background: Acute Pancreatitis is a major health problem with significant morbidity and mortality. There is large geographical variability in incidence, disease severity and outcome with data related to prevalence rate lacking in our region. Present study is aimed to observe its demographic variability around the Jorhat Medical College.
Methods: First consecutive 50 cases of acute pancreatitis presented in the Jorhat Medical College during the study period from June 2020 to May 2021 were included in the study; data collected, systematically analyzed and statistically reviewed.
Results: Of the 50 cases, 33 (60%) were male while 17 (34%) were female. The mean age of the study sample is 37.04±13.52 (SD) years, ranging from 15 – 75 years. Majority of the patients are between 15-35 years. In 50% cases, alcohol is the most common aetiology followed by gallstones (36%), idiopathic in 10% cases. Alcohol is the most common aetiology among male and 15-35 years age group while gallstone is most common cause in females and 35-55 years age group. Among 50 cases, 41 (82%) are mild acute pancreatitis and 9 (18%) have severe acute pancreatitis. Majority of severe acute pancreatitis cases are male and alcoholic. Of 50 cases, among Hindus (n= 47) ethnic Assamese are 54%, Tea tribe 20%, Mising 10%, UP 6%, Bengali 4%, while Muslim 4% and Christian 2%. Gallstone is most common cause among ethnic Assamese and alcohol is the common cause in Tea tribe and Mising. Geographical distributions of the cases are as follows: Jorhat district 50% (n=25), Golaghat 32% (n= 16), Majuli 14% (n= 7) and Sivasagar 4% (n=2).
Conclusion: Acute pancreatitis is more common among male than female. Assamese are the most commonly affected ethnic group, gallstone being the most common cause among them. Alcohol is the most common aetiology in Tea tribes and Mising community. Male and alcoholics are more prone to severe acute pancreatitis. The incidence of acute pancreatitis is more in younger population 15-35 years and alcohol is the most common cause in this age group. Most of the cases are from Jorhat district followed by Golaghat, Majuli and Sivasagar.

In general acute pancreatitis is classified in to mild and severe pancreatitis. Mild pancreatitis
is also known as oedematous or interstitial pancreatitis, which is the cause for mild organ
failure and uneventful recovery. Severe pancreatitis also known as necrotizing pancreatitis is
associated with organ failure and leads to other complications like necrosis, infection and
pseudo cyst formation.Fifty cases of acute pancreatitis who presented to the emergency
department as acute abdomen were included in the study. Informed and written consent was
taken from all the participants. When the Modified CT Severity Index was applied, the
average duration of hospital stay in patients categorized as mild pancreatitis was 1.5 days in
moderate pancreatitis 6.9 days and in severe pancreatitis 14.2 days. None of the pat ients
categorized as mild pancreatitis had an adverse or fatal outcome. The majority (90%) of
patients requiring interventional procedure fell in the severe pancreatitis group.

ACS (abdominal compartment syndrome) is a serious condition that affects critically ill people. Because it predominantly affects individuals who are already sick, it may go unnoticed. The aim of study to find a link between IAP and the development of problems in patients with severe acute pancreatitis. We also wanted to see if there was a link between IAP and the development of complications in patients with severe acute pancreatitis (SAP). Patients and methods: This prospective study was conducted on 18 patients with AP hospitalised to the Surgical Intensive Care Unit at Zagazig University's Faculty of Medicine's General Surgery Department (SICU). During the first week after admission, all patients were divided into two groups based on their IAP. Patients with IAP 20 mmHg were assigned to the IAH group, whereas those with IAP 20mmHg were assigned to the normal IAP group. Results: Age, serum Lipase and APACHE were significantly higher among ACS cases and also ACS cases were significantly associated with DM. ACS cases were significantly associated with longer hospital stay also with bleeding, septic shock and mortality.The mean Lipase level was 959.72±103.58 with rang (800-1200). The mean Intra-abdominal pressure of studied patients was 12.94±4.12 and 38.9% of patients had IAH while 2 cases 11.1% had ACS. Conclusion: In patients hospitalised to the ICU with severe acute pancreatitis, IAH and ACS are common findings. IAH could make severe acute pancreatitis worse. Early detection of this possibly treatable aggravating condition could lead to early management and, in turn, a better prognosis. 

To explore the possibilities of different methods
of surgical treatment of severe acute pancreatitis , two groups of surgical
patients were selected depending on the method of surgical treatment,
which were produced by different types
of " open " and laparoscopic operations. To assess the effectiveness of
the applied methods of treatment, in the postoperative period, we used
the following laboratory and physiological parameters: progression
or regression systemic inflammatory response syndrome (SIRS ), neutro
phil-lymphocyte ratio ( NLR), as well as integral scales for assessing
severity Ranson , APACHE - II and SAPS . The results obtained
demonstrate the advantages of laparoscopic surgical methods

Annotation. Systemic inflammatory response syndrome is a protective response of the body aimed at eliminating the agent that caused the inflammatory process (infection, trauma, burns and tissue necrosis, etc.). The severity of the response depends on the amount of damage inflicted. This study was conducted to assess the possibility of using the systemic inflammatory response syndrome as an independent predictor in the development of complications of acute pancreatitis. For this, the following clinical and laboratory parameters were studied: body temperature, pulse, respiratory rate and the number of leukocytes in the blood, which were obtained within the first 24 hours after hospitalization and before the development of organ failure. The relationship between the presence of systemic inflammatory response syndrome and the development of organ failure was investigated.