Prevention and Treatment of Intestinal Failure Syndrome in Children with Acute Necrotic Pancreatitis

Abstract

AIM OF STUDY To evaluate the effectiveness of intestinal lavage with glucose-saline solution for acute necrotic pancreatitis in children..MATERIAL AND METHODS A retrospective analysis of the diagnosis and treatment of 48 children aged 3 to 17 years with impaired propulsive function of the intestine against the background of acute necrotic pancreatitis of moderate and severe severity was carried out. Intestinal insufficiency syndrome was diagnosed in 39 cases. In the 1st group (n=13) in I A phase in addition to standard therapy, intestinal lavage was performed during the disease phase, in the 2nd group (n=35) the standard therapy for acute necrotic pancreatitis was performed.RESULTS Median the duration of gastrostasis in group 1 was 4 days (IQR, interquartile range: 2; 5), in group 2-6 days (IQR: 4; 7) (from 2 to 13), p=0.0181. The duration of intestinal paresis in group 1 was 2 days (IQR: 2; 4), in group 2–4 days (IQR: 3; 5), p<0.0053. The median time of onset of independent stool in group 1 was 3 days (IQR: 3; 5), in group 2 — 5.5 days (IQR: 4.3; 6), p<0.0014. Reduction in the level of C-reactive protein by day 3–4: in group 1, the median was 8.2 mg/l (IQR: 1.16; 34.6) (from 0 to 46.9), in group 2 — 31.97 mg/l (IQR: 17.71; 112.4) (from 14 to 285), p=0.028. The risk of developing purulent complications was 4-fold higher in group 2, p=0.0088. The duration of hospitalization in the 1st group was shorter, p=0.0004.CONCLUSION Carrying out intestinal lavage in children with impaired propulsive function of the intestine against the background of acute necrotic pancreatitis significantly more quickly restores the function of the gastrointestinal tract and facilitates an earlier start of enteral feeding.

Keywords

• children
• acute pancreatitis
• acute necrotic pancreatitis
• parapancreatitis
• intestinal insufficiency syndrome
• dynamic intestinal obstruction
• intestinal lavage