SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis.

OBJECTIVE: Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. PARTICIPANTS: Spanish and international intensive medicine physicians, radiologists, surgeons, gastroenterologists, emergency care physicians and other physicians involved in the treatment of acute pancreatitis. LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION: The GRADE method has been used for drawing them up. DRAWING UP THE RECOMMENDATIONS: The selection of the committee members was performed by means of a public announcement. The bibliography has been revised from 2004 to the present day and 16 blocks of questions on acute pancreatitis in a ICU have been drawn up. Firstly, all the questions according to groups have been drawn up in order to prepare one document. This document has been debated and agreed upon by computer at the SEMICYUC Congress and lastly at the Consensus Conference which was held with the sole objective of drawing up these recommendations. CONCLUSIONS: Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.

[Thyroglossal duct cyst with anomalous localization]. / Quiste del conducto tirogloso de localización anómala.

The cyst of thyroglossal duct (CTD) are the more frequent congenital mass of the neck, so you must consider them in the differential diagnosis of the neck's tumours. We present one case of CTD with certain clinical peculiarities.

[Cystic pancreatic tumours and pseudo-tumoural lesions]. / Tumores quísticos pancreáticos y lesiones pseudotumorales.

Cystic lesions of the pancreas are infrequent, estimated at only some 1% of all pancreatic tumours and at some 10% of all pancreatic cysts. The pre-operational diagnosis is important for a suitable treatment, with valuable radiological techniques available today such as ultrasound, computerised tomography and magnetic resonance. In spite of this we have to accept that we are facing a group of tumours whose diagnosis is difficult, due to the great variety of cellular types existing within them.

[Computerized axial tomography, ultrasonography and percutaneous drainage in the diagnosis and treatment of pyogenic abscess of the liver]. / La tomografía axial computerizada, la ultrasonografía y el drenaje percutáneo en el diagnóstico y el tratamiento del absceso hepático piógeno.

Pyogenic liver abscesses in 20 adult patients were reviewed to evaluate if computed tomography (CT), ultrasonography (US) and percutaneous catheter drainage have improved prognosis of this disease. The average delay in diagnosis was 16 days. The CT sensitivity was 94% while the US sensitivity was 78%. The response to treatment with open surgery was compared to percutaneous drainage. Eleven patients were surgically drained with complications in 58% of them. Eight were treated with percutaneous drainage and no complication appeared as a result of treatment. One was found at autopsy. Days of hospitalization in surgically drained patients were significantly higher (p less than 0.01) than percutaneous drained patients. Percutaneous catheter drainage is recommended as method of choice for treating patients with pyogenic liver abscesses.

[Pyogenic hepatic abscesses: role of ultrasonography in their diagnosis and treatment]. / Abscesos hepáticos piógenos: valor de la ultrasonografía en su diagnóstico y tratamiento.

We present 26 cases of pyogenic hepatic abscess diagnosed by echography, 14 of which were treated by percutaneous drainage guided by ultrasound. An analysis is made of the clinical and radiological findings, as well as the differential diagnosis of focal hepatic lesions. Due to the lack of clinical specificity in many patients, we recommend fine needle biopsy directed by ultrasound to confirm the suspicion of pyogenic hepatic abscess and isolation of noncausative microorganisms. We think that the treatment of choice in these patients is percutaneous drainage guided by echography.