GIntroduction: feared by all doctors, acute pancreatitis is one of the most frequent causes of sudden abdominal pain that enters the surgical ward corps and requires urgent hospitalization and hospitalization in intensive care. Objective: to characterize patients with acute pancreatitis in a Havana hospital in 2023. Methods: a cross-sectional descriptive observational study was carried out in the population attended in the emergency surgery service belonging to the 10 de Octubre Clinical-Surgical Teaching Hospital, located in the province of Havana, Cuba, during the year 2023. Results: a predominance of women (n = 4), mestizo complexion (n = 5), the most frequent toxic habit was tobacco consumption by smokers (n = 7), the most frequent etiology was biliary lithiasis (n = 6), 9 patients presented with jaundice. Pain in the right hypochondrium was more frequent (n = 6), according to the Atlanta classification the severe form predominated (n = 6), according to the pathological classification the interstitial edematous form predominated (n = 5), Most of the patients had an uncomplicated course. There were only 2 reoperations and 2 deaths. Conclusions: the incidence of acute pancreatitis in its severe form is predominantly high in females as a complication of gallstones, in addition to associated risk factors and associated local or systemic complications.
Acute abdomen, General surgery, Acute pancreatitis, Intensive therapy
Acute pancreatitis is one of the most frequent causes of sudden abdominal pain in patients who are admitted to the general surgery emergency room and who require admission to intensive care, due to its confusing, non-specific clinical picture and the complications that occur in those affected by this entity, for this reason it is known by surgeons and intensivists as one of the "great abdominal dramas" [1] .
Acute pancreatitis can be defined as an inflammatory reaction of the pancreas caused by the activation of its own enzymes in the glandular parenchyma, resulting from an obstruction of the pancreatic duct. This results in autodigestion of the gland and adjacent tissues, with the presence of edema, necrosis, and hemorrhage [1], [2] .
In recent years, acute pancreatitis has been described to have increased worldwide, with a reported 13.3% increase in cases, especially in developed countries, due to high consumption of fatty foods and alcoholism, and mainly in patients with gallstones. Sixty percent of cases are of biliary cause in women; of the remaining 40%, 30% is due to alcoholism in men, and the remaining 10% is due to other causes such as hypertriglyceridemia, viral or parasitic infections, post-endoscopic retrograde cholangiopancreatography (ERCP), trauma, toxic compounds, metabolic imbalances, and drugs [3], [4] . The worldwide mortality rate from pancreatitis is estimated at 2 to 5% of cases and 5 to 10% in cases of severe acute pancreatitis with multiorgan failure, hemorrhage, sepsis, and parenchymal necrosis [5] .
Studies conducted in Cuba show figures between 0.12 and 1.8% of total admissions due to this cause; it is not among the main causes of death, ranking 25th; however, it is ranked as one of the most serious surgical conditions and requires admission to the intensive care unit . In the case of patients undergoing surgery, mortality increases from 20 to 80% [6], [7] .
The cardinal symptom is sudden onset, high-intensity abdominal pain, usually located in the epigastrium and subsequently radiating to the right and left hypochondria, back, and left subscapular region. This pain is known as "bar pain." The pain becomes more intense over time and is not relieved in any position. However, patients often adopt a Mohammedan prayer position in bed to try to reduce the intensity. This discomfort is also accompanied by frequent vomiting, distension of the upper abdomen, and signs of shock [2], [8], [9] .
Because acute pancreatitis has become a global health problem, due to its confusing and sometimes nonspecific clinical picture, and its complicated treatment with slow progression, it was decided to conduct a study with the objective of characterizing patients with acute pancreatitis in a Havana hospital over a period of one year.
An observational, descriptive and cross-sectional study was carried out in the population treated in the emergency surgery service belonging to the 10 de Octubre Clinical-Surgical Teaching Hospital , located in the province of Havana, Cuba, during the year 2023.
All cases (n = 13) that met the following inclusion criteria were studied: a diagnosis of acute pancreatitis, age over 18 years, informed consent, and a complete individual medical history. The exclusion criterion was a definitive diagnosis other than acute pancreatitis.
The following variables were studied :
Age: 30 - 50 years, 51 - 61 years, 62 - 70 years .
Sex: female (F) or male (M).
Skin complexion: white (B), mixed race (M) or black (N).
Toxic habits: smoker, alcoholic.
Etiology: biliary lithiasis, alcoholic, post-surgical complication, idiopathic.
Jaundice: yes or no.
Location of abdominal pain: right hypochondrium, left hypochondrium, epigastrium, bar.
2012 Atlanta Classification: Mild, Moderately Severe, Severe.
Pathological classification: interstitial edematous, necrotizing, necrohemorrhagic, infected, emphysematous.
Complications: pancreatic pseudocyst, sepsis, septic shock , disseminated intravascular coagulation (DIC), none.
Surgical procedure: non-surgical treatment, toilet and drainage of the omental cavity, percutaneous drainage.
Reinterventions: yes or no.
Discharge status: alive or deceased.
were collected from the medical records using specially designed spreadsheets (Annex 1). Statistical processing was descriptive and performed in Microsoft Excel 2019.
The study design respected the ethical principles of bioethical research of the 13th Declaration of Helsinki [10] and the anonymity of the patients was maintained.
TABLE 1 shows that the highest incidence of acute pancreatitis was in the age range between 51 and 61 years of age (n = 6), with a higher incidence in females (n = 4). The mean age was 52.92 years ± 10.11 years. Mixed skin predominated, with 5 patients having a higher frequency than females (n = 4).
The most common toxic habit was tobacco use among smokers (n = 7), with a greater prevalence among females (n = 5). The most common etiology was gallstones (n = 6), with a predominance among females (n = 4). Jaundice occurred in 9 patients, 5 of whom were female.
| Adriel Herrero Díaz; https://orcid.org/0000-0002-4016-6553 |
|---|
In FIGURE 1 it was observed that the most frequent location of abdominal pain was in the right hypochondrium (n = 6) with a predominance of the female sex (n = 4).
FIGURE 1 : Distribution of patients with respect to the location of abdominal pain
In FIGURE 2 it was observed that according to the Atlanta classification the severe form of the disease was the most frequent (n = 6) with equality between sexes (n = 3).
FIGURE 2 : Distribution of patients according to the Atlanta classification
FIGURE 3 shows that, according to the pathological classification of acute pancreatitis, the most frequent phase was interstitial edematous (n = 5), with a predominance of males (n = 3). However, there was also a high incidence of necrohemorrhagic pancreatitis, accounting for 4 cases.
FIGURE 3 : Distribution of patients according to pathological classification
In FIGURE 4 it was observed that 5 of the patients did not develop any complications, however, the most frequent complication was pancreatic pseudocyst with 3 patients, of which 2 were female.
FIGURE 4 : Distribution of patients according to complications
TABLE 2 shows that the most frequent surgical procedure was toilet paper and drainage of the omental cavity (n = 6), with equal number of patients (n = 3). Three patients underwent reoperation. According to discharge status, only two female patients died.
| Age group (years) | Sex | Total | ||
|---|---|---|---|---|
| F | M | |||
| 30 - 50 | 1 | 4 | 5 | |
| 51 - 61 | 4 | 2 | 6 | |
| 62 - 70 | 2 | 0 | 2 | |
| Total | 7 | 6 | 13 | |
| Maximum value | 67 years old | |||
| Minimum value | 30 years | |||
| Average | 52.92 years | |||
| Standard deviation | 10, 11 years | |||
| Skin complexion | White | 2 | 2 | 4 |
| Mixed race | 4 | 1 | 5 | |
| Black | 2 | 0 | 4 | |
| Toxic habits | Smoker | 5 | 2 | 7 |
| Alcoholic | 2 | 4 | 6 | |
| Etiology | Gallstones | 4 | 2 | 6 |
| Alcoholic | 2 | 3 | 5 | |
| Postsurgical complication | 1 | 0 | 1 | |
| Idiopathic | 0 | 1 | 1 | |
| Jaundice | Yeah | 5 | 4 | 9 |
| No | 2 | 2 | 4 | |
Acute pancreatitis generally has common clinical manifestations, of which a positive diagnosis is made based on diagnostic criteria (2 of 3): abdominal pain characteristic of the entity that begins suddenly in the epigastrium and then radiates to the belt, serum amylase and lipase values elevated 3 times their normal value and signs suggestive of the condition in imaging studies. When a timely and accurate diagnosis is made, treatment and monitoring for complications is immediately initiated [11] .
This treatment is based on three fundamental pillars: suppression of the oral route to achieve gastric and pancreatic rest, adequate hydration to restore hydromineral balance and acid-base balance; and finally, the correct management of intense abdominal pain [11] .
Velázques-Causen et al [12] , in their study, state that the highest incidence of acute pancreatitis was in the male sex, which differs from this study, since the majority of patients were female; however, it agrees with the present study and with the reviewed literature in that the main cause was biliary lithiasis, which is also agreed with the study by Balthazar and Ranson, et al [13] .
The above demonstrates that there is a higher incidence of gallstones that increases over time for both sexes, so it can be deduced that in the future it will displace alcoholism as the main cause of acute pancreatitis in men.
The mean ages in both studies are very close, in the study by Velázques-Causen et al [12] , the mean age was 53.5 years and in the present study 52.92 years, since the incidence of acute pancreatitis increases with age, for this reason the mean between both studies is close, in addition to there being a difference between the total number of cases used in both articles , since in both studies different numbers of patients were used .
García-Revilla et al [14] in their study revealed that the most frequently affected patients were female, of biliary etiology, which coincides with this study; however, according to the Atlanta classification 2012 the most frequent form in their study was mild pancreatitis, in the present study the severe form of the disease predominated; this is due to the conditions of shortages in Cuba of sophisticated technical equipment with greater technology, since in countries with greater technology these means favor timely diagnosis and immediate treatment to improve the quality of life of patients, avoid progression and complications of the disease, and, consequently, avoid deaths.
Their study also shows that no deaths were recorded, which is inconsistent with the study presented here, since there were two deaths, despite the difference in the number of patients studied; this is due to complications and disease progression in these patients.
Hernández-Guadarrama et al [15] , in their study on acute pancreatitis associated with COVID-19, show that the average age of the patients studied was 50 years of age, similar to that found in the present study, since the incidence of acute pancreatitis increases from 40 years of age.
In a study conducted by Estepa-Ramos et al [6] , it was shown that the most frequent toxic habit was alcohol consumption, which does not coincide with the study conducted, since in the latter it was tobacco consumption. In addition, they state that the most frequent complication was shock , in the study conducted it was the pancreatic pseudocyst. Thanks to the early hydration and anti- shock methods used in Cuba, the incidence of shock as a complication of pancreatitis decreases, so the disease follows its natural course.
Local complications of acute pancreatitis, such as pancreatic abscess or pseudocysts, require various procedures for drainage and treatment, either percutaneously, as evidenced in the study, laparoscopically (minimally invasive) or openly (expolatory laparotomy) [15], [16] .
The percutaneous approach is one of the most accepted for the treatment of pancreatic pseudocysts, low in cost and simple in technique; however, it has some disadvantages: the need to maintain a catheter, which will be determined by the evolution of the patient, the performance of daily dressings for the care of the same, the quantification of the extracted liquid in decubitus and the patient pulling the catheter [6] .
Sometimes the use of ultrasound and an imaging specialist is necessary to perform the procedure, which makes it more effective; however, this has a disadvantage, since external equipment and qualified personnel are required [16] .
The incidence of severe acute pancreatitis is predominantly high in women as a complication of gallstone disease. There are also other risk factors and associated local or systemic complications. The most common location of pain was the right hypochondrium, severe pancreatitis predominated, and according to the pathological classification, interstitial edematous pancreatitis had the highest incidence. Most patients had an uneventful course, requiring no reoperations or life-threatening complications.
RBD: conceptualization; formal analysis; research; methodology; project administration; writing – original draft; supervision.
The authors declare that there are no conflicts of interest.
The authors did not receive funding for the development of this article.
Copyright 2024 Royland Bejerano-Durán 1 et al.
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