Diagnóstico y tratamiento del traumatismo de páncreas / Diagnosis and treatment of pancreatic trauma

El traumatismo pancreático es una entidad poco frecuente pero potencialmente mortal, del que es necesario un alto nivel de sospecha clínica. El diagnóstico precoz y la valoración de la integridad del conducto pancreático son relevantes, siendo la lesión ductal el principal predictor de morbimortalidad. La mortalidad global es del 19%, ascendiendo al 30% en presencia de compromiso ductal. El abordaje diagnóstico y terapéutico es multidisciplinario (médico cirujano, radiólogo e intensivista). La analítica de laboratorio muestra elevación de las enzimas pancreáticas, siendo este hallazgo de baja especificidad. En pacientes con hemodinamia estable, la primera aproximación diagnóstica debe ser con una tomografía computarizada multidetector con contraste, recurriendo a la colangiopancreatografía endoscópica retrógrada o a la colangiorresonancia en caso de sospecha de lesión ductal. El propósito de esta revisión es analizar la etiopatogenia y fisiopatología del traumatismo pancreático, presentando su abordaje diagnóstico y terapéutico y sus complicaciones más frecuentes (AU)

Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the pancreatic duct are essential since ductal injury is a crucial predictor of morbimortality. Overall mortality is 19%, which can rise to 30% in cases of ductal injury. The diagnostic and therapeutic approach is multidisciplinary and guided by a surgeon, imaging specialist and ICU physician. Laboratory analysis shows that pancreatic enzymes are frequently elevated, which is a low specificity finding. In hemodynamically stable patients, the posttraumatic condition of the pancreas is firstly evaluated by the multidetector computed tomography. Moreover, in case of suspicion of ductal injury, more sensitive studies such as Endoscopic Retrograde Cholangiopancreatography or cholangioresonance are needed. This narrative review aims to analyze the etiopathogenesis and pathophysiology of pancreatic trauma and discuss its diagnosis and treatment. Also, the most clinically relevant complications will be summarized (AU)

[Diagnosis and treatment of pancreatic trauma]. / Diagnóstico y tratamiento del traumatismo de páncreas.

Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the pancreatic duct are essential since ductal injury is a crucial predictor of morbimortality. Overall mortality is 19%, which can rise to 30% in cases of ductal injury. The diagnostic and therapeutic approach is multidisciplinary and guided by a surgeon, imaging specialist and ICU physician. Laboratory analysis shows that pancreatic enzymes are frequently elevated, which is a low specificity finding. In hemodynamically stable patients, the posttraumatic condition of the pancreas is firstly evaluated by the multidetector computed tomography. Moreover, in case of suspicion of ductal injury, more sensitive studies such as Endoscopic Retrograde Cholangiopancreatography or cholangioresonance are needed. This narrative review aims to analyze the etiopathogenesis and pathophysiology of pancreatic trauma and discuss its diagnosis and treatment. Also, the most clinically relevant complications will be summarized.

Microangiopatía trombótica como complicación de una pancreatitis aguda / Thrombotic microangiopathy as a complication of acute pancreatitis / Microangiopatia trombótica como complicação da pancreatite aguda

La púrpura trombótica trombocitopénica (PTT) es una microangiopatía trombótica poco frecuente, que se caracteriza por anemia hemolítica y plaquetopenia, con una elevada morbimortalidad. Su forma más frecuente es la PTT inmune, también denominada adquirida, provocada por la deficiencia de la enzima disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) secundaria a la presencia en plasma de autoanticuerpos. Presentamos el caso de un paciente con diagnóstico de pancreatitis aguda (PA) complicada con PTT, asociación de presentación excepcional en la práctica clínica.

Summary: Thrombotic thrombocytopenic purpura is rather an unusual thrombotic microangiopathy characterized by hemolytic anemia and plateletopenia which results in high morbimortality rates. The most frequent form of this disease is immune thrombotic thrombocytopenic purpura, also known as acquired thrombotic thrombocytopenic purpura, which is caused by enzime deficiency disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) that is secondary to antibodies in plasma. The study presents the case of a patient with a diagnosis of acute pancreatitis with a rare complication of thrombotic thrombocytopenic purpura which is exceptional in the clinical practice.

A púrpura trombocitopênica trombótica (PTT) é uma microangiopatia trombótica rara, caracterizada por anemia hemolítica e trombocitopenia, com alta morbimortalidade. Sua forma mais comum é a TTP imune, também conhecida como adquirida, que é causada pela deficiência da enzima ADAMTS13 (em inglês A disintegrin-like and metalloprotease with thrombospondin type 1 motif no. 13) secundária à presença de autoanticorpos no plasma. Apresentamos o caso de um paciente com diagnóstico de pancreatite aguda (PA) complicada por PTT, associação com apresentação excepcional na prática clínica.

Crisis hipercalcémica como causa de pancreatitis aguda / Hypercalcemia as a cause of acute pancreatitis. Report of one case

Severe hypercalcemia may cause acute pancreatitis. We report a 75-yearold male presenting with abdominal pain and confusion. The initial laboratory showed elevated amylase levels and a serum calcium of 19.0 mg/dl with highly elevated parathormone levels. An abdominal CT scan disclosed pancreatitis. A neck CT scan showed a parathyroid tumor, which was successfully excised. The pathology of the surgical piece showed a parathyroid adenoma.

[Hypercalcemia as a cause of acute pancreatitis. Report of one case]. / Crisis hipercalcémica como causa de pancreatitis aguda.

Severe hypercalcemia may cause acute pancreatitis. We report a 75-yearold male presenting with abdominal pain and confusion. The initial laboratory showed elevated amylase levels and a serum calcium of 19.0 mg/dl with highly elevated parathormone levels. An abdominal CT scan disclosed pancreatitis. A neck CT scan showed a parathyroid tumor, which was successfully excised. The pathology of the surgical piece showed a parathyroid adenoma.