necrosectomy, and 16 patients required surgery of which 15 were being managed with PCD. Overall Sepsis reversal with PCD was seen in 55.3% patients. Curative efficacy of PCD was 46.4%. Patients referred within one week of PCD placement had better survival (20.8% vs. 54.8%, P=0.011), higher sepsis reversal with PCD (75% vs. 42%, P=0.014) and lower surgical mortality (16.6% vs. 77.7%) as compared to patients referred after one week of PCD insertion. Conclusions: In the step-up era, there has been change in referral pattern in acute pancreatitis with patients being referred in the later part of the disease process. In this study, early referral to the surgical unit with respect to PCD placement has shown better outcomes.

Summary. Aim. To evaluate the features of acute alimentary pancreatitis and the risk of complications in patients with a combination of PRSS1 and SPINKI1 gene mutations. Materials and methods. 70 patients with acute alimentary pancreatitis were examined. The mean age was 45.4±13.87 years. The study group included 48 (68.57 %) men and 22 (31.43 %) women. In 34 (48.57 %) patients there was a severe course of acute pancreatitis, in 25 (35.72 %) – moderate severity, in 11 (15.71 %) – mild. Complicated disease was diagnosed in 59 (84.29 %) patients, 11 (15.71 %) – uncomplicated. The severity of the course and the presence of complications were evaluated using the Atlanta Classification, 2012. The polymorphism of the PRSS1 and SPINKI1 genes was determined by all subjects. Statistica 13 was used for statistical analysis. Results and discussion. The combined effect of the PRSS1 and SPINKI1 gene mutation is associated with a higher risk of severe alimentary pancreatitis. The presence of a combined mutational status increases the chances of developing peritonitis, pleurisy, pancreatic accumulation, pseudocysts and pancreatogenic diabetes mellitus. In addition, these patients have proven significantly higher chances of formation of purulent peritonitis, phlegmon, suppuration of pseudocysts, development of systemic complications – systemic inflammatory response syndrome and multiple organ failure syndrome. Conclusions. The reliable connection between the presence of a combination of mutations of the studied genes and the development of severe course of acute alimentary pancreatitis and the formation of complications have been proved.

Мета. Вивчити вплив плазмаферезу (ПФ) на лабораторні показники інтоксикації та запального процесу у пацієнтів з гострим некротичним панкреатитом (ГНП). Матеріали і методи. До дослідження залучено 73 пацієнти з ГНП. Контрольну групу склали 27 пацієнтів, які отримували інтенсивну медикаментозну терапію. До основної групи включили 46 пацієнтів, яким стандартну інтенсивну терапію доповнили ПФ. Крім рутинних, вивчали показники інтоксикації та маркери запалення. Результати. У пацієнтів основної групи показники інтоксикації та запалення вже після першого сеансу ПФ були достовірно нижчими за аналогічні показники у пацієнтів контрольної групи. Щодо частини пацієнтів, у яких зазначені показники наближалися до аналогічних показників у здорових людей, було прийнято рішення обмежитися лише одним сеансом ПФ. Решті пацієнтів провели два, а окремим - навіть три сеанси ПФ. Після повторних сеансів ПФ показники інтоксикації та запалення у пацієнтів основної групи достовірно відрізнялися не лише від аналогічних показників у пацієнтів контрольної групи, а й від показників у пацієнтів, яким було проведено лише один сеанс екстракорпоральної детоксикації. Висновки. ПФ зменшує клінічні прояви панкреатиту, а також знижує лабораторні показники інтоксикації та запального процесу.

Background: Spontaneous rupture of liver tumors, such as hepatocellular adenoma (HCA) and carcinoma (HCC), is rare but might lead to a potentially life-threating situation, as unspecific symptoms can be misleading. However, immediate interventional or surgical intervention is required to stop the bleeding. Methods: A female 53-year old patient was admitted to the hospital with unspecific epigastric pain for the past three days. Successful emergency angiographic embolization was accomplished with gelatin foam powder in the hemodynamically stable patient. Subsequent magnetic imaging (MRI) revealed the most likely diagnosis of an HCA, which had ruptured and a two additional adenomas witch less than 3cm in diameter in segments 4 and 6. We performed a single-incision laparoscopy to evacuate the hematoma and to address the ruptured liver tumor. Anatomical left lateral sectionectomy was performed. The resected liver lobe was removed via the umbilical single-port incision Results: The postoperative course was uneventful and the patient could be discharged on postoperative day 5. Conclusion: With the high probability of a benign lesion to be resected at the site of rupture and the additional lesions without an immediate indication for surgical removal, it was safe to perform the resection laparoscopically instead of a major open resection. In our opinion, benefits of routine laparoscopic liver surgery should also be taken into account in emergency settings.

Purpose of the study. To evaluate changes of bands nuclear neutrophils level and their dynamics parameters during treatment in patients with acute alimentary pancreatitis based on repeated measurements and taking into account the severity of the course. Materials and methods. Seventy patients with acute alimentary pancreatitis were examined, who treated in Surgical Department of Vinnitsa Regional M. I. Pirogov Clinical Hospital. Average age was 45,4 ± 13,87 years. Severe pancreatitis was found in 34 (48,57%) people, in 25 (35,72%) – moderate, 11 (15,71%) persons had mild forms. The severity of the disease was assessed using the Atlanta classification (2012). To achieve aim of study the repeated measurements of the stabs neutrophils levels were performed for all patients. Statistical analysis was performed using STATISTICA 13. Results. The significant difference between the stabs neutrophils values identified in patients with acute alimentary pancreatitis was proved, taking into account the severity of the course, both during the primary measured (p = 0,04), during treatment (p = 0,004), and after its completion (p < 0,00001). The significant increase of stabs neutrophils level associated with increasing severity of acute pancreatitis, as in the primary treatment of patients (τ = 0,23, p = 0,005), with determination during treatment (τ = 0,31, p = 0,0001) and after its termination (τ = 0,49, p ≤ 0,00001) was determined. When comparing the indexes of stabs neutrophils determined by repeated measurements, a rapid and continuous decrease of their values was found, as a whole in the group – by 3,76 times, and in the groups with a mild course of the inflammatory process – 6,75 times, the average degree of severity – in 5,11 times and severe forms – 3,05 times. Conclusions. High informativeness of evaluation stabs neutrophils level and their dynamic during repeated measurements in patients with acute alimentary pancreatitis taking into account the severity of the course has been proved. Keywords: acute alimentary pancreatitis, stabs neutrophils level, inflammatory process, damage to the pancreas, acute pancreatitis of alimentary genesis.