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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

邮发代号 80-967

2019 Impact Factor: 3.421

Frontiers of Medicine  2019, Vol. 13 Issue (2): 285-288   https://doi.org/10.1007/s11684-018-0626-z
  本期目录
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.

Key wordsorganophosphate intoxication    severe acute pancreatitis    pancreas necrosis    percutaneous catheterization    sandostatin    insulin
收稿日期: 2017-07-29      出版日期: 2019-03-28
Corresponding Author(s): Dawei Liu   
 引用本文:   
. [J]. Frontiers of Medicine, 2019, 13(2): 285-288.
Rui Hou, Hongmin Zhang, Huan Chen, Yuankai Zhou, Yun Long, Dawei Liu. Total pancreatic necrosis after organophosphate intoxication. Front. Med., 2019, 13(2): 285-288.
 链接本文:  
https://academic.hep.com.cn/fmd/CN/10.1007/s11684-018-0626-z
https://academic.hep.com.cn/fmd/CN/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  
Fig.1  
Fig.2  
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  
1 SYoshida, H Okada, SNakano, KShirai, TYuhara, HKojima, TDoi, H Kato, KSuzuki, KMorishita, EMurakami, HUshikoshi, IToyoda, SOgura. Much caution does no harm! Organophosphate poisoning often causes pancreatitis. J Intensive Care 2015; 3(1): 21–25
https://doi.org/10.1186/s40560-015-0088-1
2 MGoud, B Nayal, KDeepa, OSDevi, RNDevaki, MAnitha. A case of acute pancreatitis with occupational exposure to organophosphorus compound. Toxicol Int 2012; 19(2): 223–224
https://doi.org/10.4103/0971-6580.97226
3 EPanieri, JE Krige, PCBornman, DMLinton. Severe necrotizing pancreatitis caused by organophosphate poisoning. J Clin Gastroenterol 1997; 25(2): 463–465
https://doi.org/10.1097/00004836-199709000-00015
4 GRoeyen, T Chapelle, PJorens, BOde Beeck, DYsebaert. Necrotizing pancreatitis due to poisoning with organophosphate pesticides. Acta Gastroenterol Belg 2008; 71(1): 27–29
5 Venugopal L, Dharma Rao V, Srinivas Rao M, Mallikarjuna Y. Toxic pancreatitis with an intra-abdominal abscess which was caused by organophosphate poisoning (OP). J Clin Diagn Res 2013; 7(2): 366–368
https://doi.org/10.7860/JCDR/2013/4608.2771 pmid: 23543622
6 MHamaguchi, A Namera, NTsuda, TUejima, KMaruyama, TKanai, ISakata. Severe acute pancreatitis caused by organophosphate poisoning. Chudoku Kenkyu 2006; 19(4): 395–399
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