ELECTRONIC POSTERS (EP02A-EP02F) – PANCREAS EP02A e Electronic Poster: 2A e Pancreatitis Surgical intervention is very important yet the result is devastating. EP02A-003 Method: We reported a case of severe acute pancreatitis GROOVE PANCREATITIS e SERIES OF with massive retroperitoneal necrosis in a 40 years old male 9 CASES with a history of endoscopic retrograde cholangio Y. Bang, S. Patil, P. Rabella and G. V. Rao pancreaticography (ERCP). Surgical Gastroenterology, Asian Institute of Gastroen- Result: After a series of surgical debridement and a close terology, India follow up in intensive care unit, the patient has survived with a intermittent increase in blood amylase and lipase Introduction: Groove pancreatitis also known as para- level, but without any significant clinical symptoms. duodenal pancreatitis is a rare but well-defined type of focal Conclusion: Early recognition and intervention with a pancreatitis seen in duodeno-pancreatic groove. It presents good perioperative critical care is necessary in the man- with recurrent episodes of pancreatitis, gastric outlet agement of severe acute pancreatitis with retroperitoneal obstruction or jaundice. necrosis. Aims and objectives: Study clinicopathological charac- teristics of Groove pancreatitis and evaluate role of various diagnostic modalities and surgery in management of it. Material and methods: 9 cases of Groove Pancreatitis EP02A-005 diagnosed and operated from September 2009 to EARLY VERSUS DELAYED August 2017 are studied. Data including demographic LAPAROSCOPIC CHOLECYSTECTOMY information, presenting symptoms and signs, radiolog- IN ACUTE GALL STONE INDUCED ical investigations, extent of surgery, histology were evaluated. PANCREATITIS Results: 7 patients were male and 2 females. Median age of B. Devkaran presentation was 50 years. Most common presentation was General and Laproscopic Surgery, Indira Gandhi Medical recurrent epigastric pain followed by Gastric outlet College, India obstruction. 1 Patient presented only with Gastric outlet Introduction: Cholecystectomy is mandatory to prevent obstruction without any epigastric pain. Contrast enhanced further biliary events in patients with biliary acute CT was diagnostic in all patients which demonstrated pancreatitis, but timing of cholecystectomy remains thickening of duodeno-pancreatic groove with normal controversial. pancreas. EUS guided FNAC was done in 7 patients which Material and methods: The prospective study included showed characteristics of Pancreatitis. 8 patients underwent 400 patients of acute mild biliary pancreatitis. Whipples pancreaticoduodenectomy and 1 patient with Group A comprised of 200 patients who underwent only gastric outlet obstruction underwent Gastro-jejunos- laparoscopic cholecystectomy in the same admission tomy. Post operative recovery was normal in all patients (within 10 days) and and all patients are symptom free. Group B comprised 200 patients operated after 6 weeks. Discussion: Groove pancreatitis affects the groove which Operative time, blood loss, unclear Calots antomy, con- contains dorso-cranial portion of the pancreatic head, du- version to open cholecystectomy, need for drains, intra- odenum, and CBD. It generally presents with symptoms of operative/postoperative complications, hospital stay after abdominal pain, nausea, postprandial vomiting. CECT is surgery were compared. diagnostic of Groove pancreatitis. Pancreaticoduodenec- Results: The mean operative time was 28.2 minutes in tomy is the surgical treatment of choice for it. In patients Group A and 26.8 minutes in Group B, the mean blood with outlet obstruction without any pain, Gastro- loss was 22.6 ml in Group A and 18 ml in Group B, jejunostomy is acceptable treatment. Calot’s triangle anatomy was unclear in 40 (20%) cases in Group A and 32 (16%) cases in Group B, conversion to open cholecystectomy was done in 24 (12%) cases in EP02A-004 Group A and 16 (8%) cases in Group B.48 (24%) cases in SEVERE ACUTE PANCREATITIS WITH Group A and 24 (12%) in Group B had a need for drain. Mean hospital stay was 3.04 days in Group A and 3.02 RETROPERITONEAL NECROSIS: A days in Group B. 96 (48%) of cases in Group B had CASE REPORT recurrent attacks ranging from 1 to 5 episodes during the A. Nugroho and T. Poniman waiting period for surgery. Digestive Surgery, Fatmawati General Hospital, Conclusion: From the study it is clear that early laparo- Indonesia scopic cholecystectomy is safe, effective feasible in pa- Background: Retroperitoneal necrosis in acute pancreatitis tients of acute mild biliary pancreatitis, preventing recurrent fi is a rare form of disease, but very lethal once it happened. attacks which otherwise cause signi cant morbidity in those undergoing delayed cholecystectomy. HPB 2018, 20 (S2), S505eS684 S506 Electronic Posters (EP02A-EP02F) e Pancreas EP02A-006 Results: Preoperative diagnosis was correct in all the cases except one, when cystic tumor of the pancreatic head was THE EFFECT OF NAFAMOSTAT suspected (1,8%). Patients were presented with abdominal MESILATE INFUSION INTO MAIN pain(100%), weight loss(76%), vomiting(30%) and jaun- PANCREATIC DUCT ON THE dice(18%). CT, MRI and endoUS were the most useful PREVENTION OF POST-ERCP diagnostic modalities. Ten patients were treated conserva- PANCREATITIS IN PORCINE MODEL tively, 35 underwent pancreaticoduodenectomies(PD), pancreatico- and cystoenterostomies(8), Nakao proced- J. -S. Park, S. Jeong and D. H. Lee ures(4), duodenum-preserving pancreatic head (DPPH) Inha University School of Medicine, Republic of Korea resections(5), and 15 pancreas-preserving duodenal resec- Background and aim: Post endoscopic retrograde chol- tions(PPDR). No mortality. Full pain control was achieved angiopancreatography (ERCP) pancreatitis (PEP) is not an after PPRDs in 93%, PDs in 83%, and after PPPH re- uncommon adverse event but may be an avoidable sections and draining procedures in 18% of cases. New complication. For prevention of PEP, various pharmaco- diabetes mellitus(3) and exocrine insufficiency(3) devel- logical or endoscopic attempts were conducted. However, oped after PD, Fig 1. Weight gain after 1 year was much most preventive options were usually ineffective. The aim more significant after PD and PPDR, Fig 2. of this study was to evaluate the effect of intra pancreatic Conclusions: duct injection of Nafamostat Mesilate (NM) for the pre- 1. The diagnosis of DD can be confidently determined vention of PEP in in vivo swine models. preoperatively; Methods: The experiment was conducted on 8 mini pigs. 2. Early diagnosis of DD saves pancreas Animals were randomly allocated to contrast media (CM) 3. Late diagnosis converts DD in PP and leaves patient group (n=4) and NM group (n=4). Pancreatitis was induced only PD; with high pressure of infusing CM into the main pancreatic 4. The efficacy of PPDR proves that DD is an entity of duct by ERCP. After CM injection, NM dissolution fluid duodenal, but not paraduodenal origin. (50 mg/5 ml) was infused in NM group and the same amount of 5% dextrose solution was infused with same manner in CM group, respectively. Twenty four hours after EP02A-009 the endoscopic procedures, pancreatic injuries were eval- uated histologically including inflammation, edema, SPONTANEOUS GASTRIC vacuolization, necrosis and hemorrhage. FISTULATION DURING THE COURSE Results: No technical difficulty or adverse event occurred OF ACUTE NECROTIZING during the procedures. Acute pancreatitis was observed in all PANCREATITIS: A CASE REPORT animals on histologic examinations. Degrees of pancreatitis S. Gunasekaran in the NM group (as assessed using mean histologic acute Khoo Teck Puat Hospital, Singapore pancreatitis scores, 6.5Æ1.29) tended to be mild than in the CM group (8.5Æ1.29), but this difference was not significant Introduction: Acute pancreatitis is a common surgical fi (p=0.114). However, NM group (1.0) scored lower on the condition with signi cant morbidity and mortality. development of necrosis than CM group (1.75, P=0.024). Pancreatic pseudocysts and walled off pancreatic necrosis Conclusion: The intra pancreatic duct injection of NM (WOPN) are late sequele of pancreatitis. Spontaneous fi showed a promising result on prevention of developing perforation or stulation of such collections into a hollow PEP, especially in prevention of necrosis. viscus is a rare complication of pancreatitis. The most commonly reported site is the transverse colon, though fi EP02A-008 such stulation can involve all levels of the alimentary tract. WHICH SURGERY TO CHOOSE FOR Method: We describe a rare case of spontaneous gastric DUODENAL DYSTROPHY, GROOVE OR fistulation of a WOPN with subsequent improvement in the PARADUODENAL PANCREATITIS? patient’s clinical condition and successful conservative EXPERIENCE OF 77 CASES management. V. Egorov and R. Petrov Case report: A 52 year old Chinese male presented on day Surgical Oncology, Bakhrushin Brothers Moscow City 29 after a bout of severe necrotizing alcoholic pancreatitis fi Hospital, Russian Federation with worsening pain and sepsis. Imaging con rmed the presence of an infected walled off pancreatic necrosis Background: The term “paraduodenal pancreatitis“(PP) abutting and inseperable from the posterior gastric wall and was proposed as an umbrella for cystic dystrophy in het- duodenum. The patient was treated initially with percuta- erotopic pancreas (duodenal dystrophy,DD), paraduodenal neous drainage and a step wise approach with an aim for cyst and groove pancreatitis, by reasoning that these condi- VARDS. On day 38 of pancreatitis,