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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2019, Vol. 13 Issue (2) : 285-288    https://doi.org/10.1007/s11684-018-0626-z
CASE REPORT |
Total pancreatic necrosis after organophosphate intoxication
Rui Hou1, Hongmin Zhang2, Huan Chen2, Yuankai Zhou2, Yun Long2, Dawei Liu2()
1. Department of Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Beijing 100730, China
2. Department of Critical Care Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Beijing 100730, China
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Abstract

Cases of acute pancreatitis induced by organophosphate intoxication are encountered occasionally in clinics, but very few of them develop into severe pancreas necrosis and irreversible pancreatic function impairment. Here, we report a 47-year-old female organophosphate poisoning case after ingestion of massive insecticides; she was considered to have total necrosis and function failure of the pancreas via serum amylase test, glucose level test, and CT imaging. The patient exhibited no relief under the regular medicine treatment, which included sandostatin, antibiotics, intravenous atropine, and pralidoxime methiodide. She received percutaneous catheterization and drainage of pancreatic zone to expel hazardous necrotic waste, also by which the pathogenic evidence was obtained and the antibiotics were adjusted subsequently. The patient recovered gradually, was discharged after 2 weeks, and was prescribed with oral pancreatin capsules before meals and hypodermic insulin at meals and bedtime to compensate the impaired pancreatic function.

Keywords organophosphate intoxication      severe acute pancreatitis      pancreas necrosis      percutaneous catheterization      sandostatin      insulin     
Corresponding Authors: Dawei Liu   
Just Accepted Date: 24 April 2018   Online First Date: 21 May 2018    Issue Date: 28 March 2019
 Cite this article:   
Rui Hou,Hongmin Zhang,Huan Chen, et al. Total pancreatic necrosis after organophosphate intoxication[J]. Front. Med., 2019, 13(2): 285-288.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-018-0626-z
http://academic.hep.com.cn/fmd/EN/Y2019/V13/I2/285
Authors Age/sex Necrosis Treatment Hospital stay Outcome
Panieri et al. [3]
1997
39/M Severe Medicine, surgery (abscess evacuation and hemostasis) 48 days Deceased
Panieri et al. [3]
1997
26/M Severe Medicine, surgery (necrosectomy) 75 days Cured, pancreatic insufficiency
Hamaguchi et al. [6] 2006 69/F Mild Medicine 42 days Cured, formation of pseudocyst
Roeyenet al. [4]
2008
Young/M Medium Medicine, distal pancreatectomy Cured, pancreatic insufficiency
Yoshida et al. [1]
2015
62/F No Medicine, hemodiafiltration 32 days Cured
Tab.1  Documented cases of severe acute pancreatitis induced by organophosphate poisoning
Fig.1  Plot of blood WBC, amylase, cholinesterase, glucose, and major medications by time. Δ, Cease of intravenous atropine and PAM, and the launch of enteral nutrition (June 30th −July 1st); *, CT-guided percutaneous catheterization and drainage of pancreatic zone (July 7th).
Fig.2  Abdominal CT images of the patients.
Blood routine Coagulation
WBC
Neutrophil, %
19.86 × 109/L
84.3%
PT
APTT
17.0 s
37.5 s
Hb
Hct
PLT
138 g/L
43.9%
286 × 109/L
Fbg
d-dimer
TT
3.38 g/L
14.92 mg/L
26.1 s
Biochemistry Arterial blood gas
ALT 39 U/L pH 7.32
DB/TB
Cr
Urea
GLU
4.2/15.2 mmol/L
500 mmol/L
29.01 mmol/L
34.3 mmol/L
PaO2
PaCO2
SaO2
SvO2
78.1 mmHg
38.9 mmHg
88.9%
74.2%
cTnI 2.050 mg/L cLac 3.8 mmol/L
Amy
Lip
ChE
2069 U/L
15996 U/L
1.8 kU/L
K+
Na+
BE
5.1 mmol/L
128 mmol/L
-5.2 mmol/L
Tab.2  Laboratory tests results on admission
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https://doi.org/10.1186/s40560-015-0088-1
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