Page 74 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

synthesis and also in DNA methylation therefore the University of Pécs, Pécs, Hungary; 4. First Department of
selection of the appropriate dosing time is crucial. Medicine, University of Szeged, Szeged, Hungary

103. AN UPHILL BATTLE – OUR DAILY ROUTINE WITH Introduction: Emphysematous pancreatitis (EP) is a rare
PANCREAS NEOPLASM IN A FIVE YEARS PERIOD and life-threatening infection of the pancreas which is
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Netye Z. , Fazekas I. , Bordás L. , Szalai L. , Ilyés S. , Rácz associated with gas-forming bacteria and necrosis. We
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B. , Vágó A. , Crai S. , Zsóri G. , Ottlakán A. , Lichtenstein- present -in Hungarian relation the first- case of fatal EP
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Zábrák J. , Gurzó Z. , Novák J. focusing on the management and late diagnosis.
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1. Department of Gastroenterology, Kálmán Pándy Hospital, Case presentation: A 76 years old multimorbid man was
Békés County Central Hospital, Gyula; 2. Department of admitted to the hospital with a history of abdominal pain in
Surgery, Kálmán Pándy Hospital, Békés County Central the past 6 days and chronic excessive drinking. Pancreatic
Hospital, Gyula; 3. Department of Pathology, Kálmán Pándy enzyme levels levels were elevated (>3 times the upper
Hospital, Békés County Central Hospital, Gyula; 4. limit), but abdominal ultrasound was negative for pancreatic
Endoscopic Laboratory, Kálmán Pándy Hospital, Békés involvement on admission. In the first 48 hours his condition
County Central Hospital, Gyula deteriorated. An abdominal CT scan showed extensive
necrosis and free air in the retroperitoneum on day three.
Introduction: The pancreas neoplasm is the fourth most Acute surgery was performed with the diagnosis of
common cause of death in the advanced countries. In the suspected perforation, which was ruled out and an inflamed
mortality statistics of all the malignant diseases it takes 5%. pancreas was described. The patient developed septic shock
The five-years survival rate does not reach 5%. The clinical and died despite broad-spectrum antibiotics and intensive
symptoms only appear in the advanced stages of the care. Hours before the death microbiological samples of the
disease. Most common symptoms are the jaundice, lavage and blood culture came back positive for Clostridium
abdominal pain and weight loss. perfringens and Enterococcus faecalis.
Objectives: The primary object of the study was the follow- Discussion: This is the case of an elderly, high-risk patient
up of our patients with pancreas neoplasm. with significant comorbidities. The BISAP score (3 points)
Methods: The collected data was based on the WHO’s indicated the need for intensive care shortly after admission,
current ICD codes which was marked at the emission from but transfer only took place after surgery.
our section. The included ICD codes were the following: Conclusion: The three critical points in this case
C2500, C2510, C2590. Also we collected data based on the presentation are the use of BISAP score, the diagnostic
intervention (OENO) codes such as ERCP and PTD. These challenge EP poses and the optimal time for the initiation of
data were taken from the eMedsol database of our hospitals antibiotics. We emphasise that in the case of abdominal gas
healthcare system. TNM staging was defined by the AJCC’s formation and elevated pancreatic enzyme levels,
8th revision. emphysematous pancreatitis should come to mind.
Results: In our study we collected the data between 2015
and 2019 from those patient who were treated in our section. 105. INSUFFICIENT ETIOLOGICAL WORKUP OF COVID-
Totally 78 patients were included, sorted by the foresaid 19-ASSOCIATED ACUTE PANCREATITIS: A
criteria. Majority of the patients were male. The mean age SYSTEMATIC REVIEW
was 69.1 years. According to the TNM staging our patients Ocskay K. , Juhász M. , Kiss S. , Hegyi P. , Párniczky A.
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were in the stage IV. In the examined group of patients, the 1. Institute for Trnaslational Medicine, Medical School,
localization of the tumor was 79% in the pancreas head. At University of Pécs; 2. First Department of Medicine,
80% of the patient there was at least one ERCP, from those University of Szeged; 3. Department of Pediatrics, Heim Pál
we implanted in total 11 SEMS. As a last chance at 20 % of National Institute for Pediatrics
our study group there was a PTD implanted. As this shows
the diagnosis happened at a late stage of the illness. Tumor Introduction: SARS-CoV-2 infection, mostly causing
markers was tested at 74 % of our cases. The median CA respiratory symptoms, is also known to affect the
19-9 level was 773,08 ng/L, the mean was 998,5±948,5 (0,7- gastrointestinal tract. Several case reports hypothesize that
2004ng/L). It did not show any correlation with the staging of SARS-CoV-2 could be an etiological factor in acute
the disease. In 28 cases there was a surgical intervention pancreatitis (AP).
after the diagnosis, and in 15 cases there was a chance for Aims: Our aim was to assess all the available evidence in
oncotherapy. The mean survival time were 211 days from the the literature relating to coronavirus disease 2019 (COVID-
diagnosis. 19) and AP.
Conclusions: Based on localization of the tumor it was Methods: We performed a systematic review of the available
found most times in the head of the pancreas. The CA19-9 literature on the topic. The systematic search was conducted
level is not in correlation with the advanced stage of the on 15 May 2020 on MEDLINE, Embase, CENTRAL, Web of
disease. Most of the patients were diagnosed at the late Science and Scopus with a search key using the terms
stages of the illness, so they only had the chance for “amylase,” “lipase,” “pancr*,” “COVID-19” and synonyms.
palliative treatments or best supportive care. Due to the low quality and poor comparability of the studies,
a meta-analysis was not performed.
104. PANCREATIC GAS FORMATION: Results: Six case reports and two retrospective cohorts
EMPHYSEMATOUS PANCREATITIS MISTAKEN FOR were included, containing data on eleven COVID-19 patients
DUODENAL PERFORATION with AP. Five patients had AP according to the Atlanta
Ocskay K. , Dunás-Varga V. , Jurenka Z. , Gajdán L. , Izbéki classification. Other publications did not provide sufficient
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F. , Kiss E. , Sárkány Á. , Hegyi P. 1,3,4 , Erőss B. information on the diagnostic criteria. Most cases were
1. Institute for Translational Medicine, Medical School, considered SARS-CoV-2-induced, while several established
University of Pécs, Pécs, Hungary; 2. Szent György etiological factors were not investigated. We were able to
University Teaching Hospital of Fejér County, identify other possible causes in most of them.
Székesfehérvár, Hungary; 3. Division of Translational
Medicine, First Department of Medicine, Medical School,
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72 Central European Journal of Gastroenterology and Hepatology
Volume 6, Supplementum 2 / November 2020