“The pancreas is a strange organ.” The record holder was operated twenty-six times

A sick pancreas is like a time bomb. It takes a good surgeon who, like a sapper, can disarm it. However, a potential outbreak can be prevented already at the stage of internal medicine by referring the patient to a gastroenterologist. This one should take further steps immediately.

The pancreas is a specific organ. It is hidden behind the stomach, less than 40 cm long, small in diameter. Its location is not favorable for surgeons and it is difficult to operate
The pancreas produces insulin, glucagon, somatostatin, vasoactive intestinal peptide, i.e. hormones responsible for the entire sugar metabolism, which drives the body by providing it with energy
– A lot depends on this poor pancreas and when it starts to fail, everything starts to fall apart – explains Dr. Marcin Tchórzewski, a surgeon and proctologist from the Solec Hospital in Warsaw
The doctor explains that the pancreas is an insidious organ that can get sick without showing symptoms for a long time. – For 80 percent all pancreatitis is caused by urolithiasis and alcohol – says Dr. Tchórzewski
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Małgorzata Szcześniak, MedTvoiLokony: The woman comes to the internist and says this: my stomach hurts, I don’t know where, but the pain radiates to my back. The antispasmodics are not helping. And he hears: the lady will take diastolic drugs and go to the nearest emergency room. Baba goes to the next SOR, it’s Saturday. The doctor on duty says: There is no radiologist today, but we can test your blood. The examination shows an elevated CRP, around 100. Baba goes home, eats bread with butter, her eyes turn yellow, you do not need to test bilirubin to find jaundice. Baba faints. Fortunately, there is someone in the house calling for an ambulance. And this is how a woman ends up in the ICU with multiple organ failure. The kidneys, lungs and intestines stop working very quickly. Fortunately, the woman’s heart is healthy. What’s next?

Dr Marcin Tchórzewski: Black scenario – it could be the pancreas. The pancreas is a strange organ, it weighs as much as a good apple. It is hidden behind the stomach, less than 40 cm long, small in diameter. It is fragile … And not fully understood for hundreds of years – so far the pancreas is a mystery to us. A small organ you can’t live without! It produces substances that we are unable to function without.

Yet some do!

Yes, but only if we know about the disease and are lucky. We can support the chronically diseased pancreas. But the pancreas is so sneaky that it doesn’t alert you when trouble starts. It only warns you in the event of acute inflammation – then it makes itself felt suddenly and quickly. But in this case, the problems associated with it are already serious, which is why it is an organ that we are all a little afraid of.

There are various myths around a small pancreas, therefore the patient, when he finds out about the disease, is most often depressed, often gives up, does not fight, and sometimes even becomes depressed.

Coming back to the organ itself and what it produces. The pancreas generally has two parts: the exocrine part, which is responsible for the general digestive mechanisms, by producing digestive enzymes, enables and supports the digestion of proteins, carbohydrates and fats, and a slightly different endocrine part, which produces insulin, glucagon, somatostatin, vasoactive intestinal peptide, i.e. hormones, which are necessary for the functioning of the body. It is the whole sugar economy that drives us to life by providing energy. A lot depends on this poor pancreas and when it starts to fail, everything starts to fall apart. On the one hand, we have digestive problems, and on the other hand, we have sugar balance in our body. The pancreas is a small organ that can stress a lot and lead to death.

But back to our story, or rather horror. Baba lands in the ICU.

Contrary to appearances, the patient lands in the ICU not so often. Pancreatitis, as we are talking about now, rarely has such an acute course. However, if this happens, unfortunately the condition of this pancreas is really bad and a tough fight begins. A diseased pancreas causes a number of disorders that generally lead to the uncontrolled activation of enzymes and self-digestion of the pancreas and surrounding tissues.

The blood vessels or the walls of the digestive tract may become irritated. This self-digesting process produces a very strong local and often generalized inflammatory response that can be so severe that it gets out of control. Mastering it is extremely difficult or even impossible. The sooner we diagnose the disease, the better – usually a thorough interview, examination of the patient and laboratory tests are enough to make the diagnosis. However, there is no definite and unequivocal treatment. So there is not a single specific medicine, not a single scheme by which we treat this pancreas. Treatment is largely based on correcting the disorders that arise.

Creative medicine?

None of that, pancreatitis is a dynamic process that we respond to. We treat mild forms with a short fasting, hydration and painkillers. The severe form requires intensive care and is designed to fight infection, blood condensation and often developing shock. It is not so that we administer a specific drug, as is the case, for example, in the case of a bacterial infection, where we identify a microorganism that reacts to antibiotics from a given group. Treatment of the pancreas in the initial stage consists in supplementing the deficiencies, preventing the development of shock, and then fighting against complications, e.g. kidney or pulmonary complications.

When does the medical team: anesthesiologist and surgeon make the decision about surgery?

As a surgeon, I always look for possible surgical intervention. However, we must remember that many forms of pancreatitis are treated conservatively for as long as possible. Surgical treatment is reserved for the most severe cases, for complicated cases. Surgical intervention is intended for the treatment of complications, in which we deal with necrosis of an organ that has already become infected, bleeding, and perforation. There is a general rule, we postpone surgical intervention as long as possible. We enter the knife only when serious necrotic and purulent changes appear or when urgent intervention is required due to life-threatening complications. The longer the body can handle it, the better. Too early surgery, e.g. in the phase of unlimited inflammation, often ends badly.

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The decision was made. We cut. What is the operation?

The operation consists mainly in the elimination of the foci of infected necrosis. We remove dead tissues and abscesses and drain infected areas. It sounds simple, it is often insanely difficult. Sometimes we also “cut” due to acute complications such as bleeding or perforation of the gastrointestinal tract.

The patient often lies for several or several months with a few tubes in the abdomen …

Unfortunately yes. The procedure involves the removal of dead tissues and the maximum cleaning of the entire area of purulent lesions. The pancreas is a very delicate organ. During inflammation, it breaks down, so we remove as much as possible and as the situation allows. We rinse the entire area, very copiously, to flush the pus accumulated around the organ, and drain it. We leave as many drains as needed to clean the entire infected area on an ongoing basis.

You talk about it all as if it were a piece of cake, but not every surgeon can clean the retroperitoneal space. The Lord can do it.

The location of the pancreas is not the most surgeon-friendly. It is located retroperitoneally in the vicinity of large venous and arterial vessels, in the vicinity of important organs, there is always a risk of their damage. Hence, problems sometimes arise, so we must remember that the more aggressive the surgical procedure, the greater the risk of complications that may turn out to be tragic. We need to feel how much we can afford and how much we know the anatomy of this area, the specificity of the disease, so that we can safely do what we should, which is to clean the area.

What was your record holder?

I remember a young patient who was operated on 26 times due to acute pancreatitis.

And he survived.

He survived. The treatments consisted of gradual cleansing, evacuation of dead pancreatic tissues and adjacent spaces, and drainage. Treatments in acute pancreatitis are usually not resection procedures, during which we cut something out, and then we have to fix it, sew, etc.

Who has the best chance of survival?

Difficult question because there is no clear answer to it. An apparently young patient, without any burdens, no alcohol history, non-smoker – bypassing the risk factors – should theoretically have a better chance, but there is no rule. It turns out that young patients, who have not been hurt so far, can literally die within a few days.

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The first three days are said to be the worst?

It is so believed that if the patient survives the first period, his chances of survival increase. Three days may be an exaggeration, but these first days are certainly the most critical.

Of course, all this mess is caused by gallstones in the gallbladder or alcohol.

Yes. For 80 percent all pancreatitis is caused by urolithiasis and alcohol … The remaining cases are injuries, complications of endoscopic procedures, certain medications, hyperlipidemias and congenital factors.

Do you have to remove every urolithiasis?

Not! We would have to operate on 50 percent. society.

That is 50 percent. society would have to be operated and 50 operated?

With urolithiasis, a lot of people have stones, often asymptomatically. Sometimes they are discovered during routine checkups. However, he is classified for surgery when it causes discomfort.

So to get pancreatitis you have to be unlucky?

Yes, as with everything. In life, we have either bad luck or luck. However, it should be remembered that pancreatitis is not an extremely common disease. It affects a small number of people. Pancreatitis and pancreatitis are completely different things if we look at the frequency of these diseases. However, surgery on all Poles is unrealistic and unjustified. I think the question was more about what to do to avoid getting sick. Obesity increases the risk of developing gallstones and makes the course of the inflammation more severe. I would pay more attention to dietary issues – avoiding alcohol and eating such meals that are supposed to prevent this urolithiasis from developing and progressing.

Can you dissolve these stones with your diet?

There is absolutely no such possibility. Of course, there are methods such as the use of strong pharmacological agents that dissolve these stones, but these are rarely used methods reserved for people who do not qualify or agree to surgery. The therapy can last from several months to several years. It is therefore a solution for people in whom the procedure is absolutely contraindicated.

I will not ask you what is worse, urolithiasis or alcoholism. I know very well that it is difficult to break bad habits and often an alcoholic rescued in the ICU returns to the addiction, and doctors who saved him with dedication for months have their hands dropped.

Unfortunately. But it is also not that one insubordinate patient always goes through several acute pancreatitis. Often, inflammation turns into chronic inflammation, and this is a completely separate disease entity in terms of its course, symptoms and further management.

They appear on the skin when the pancreas is unwell

What are the complications?

It all depends on the extent to which the organ has been damaged. The pancreas has great compensatory abilities – if we have 10 percent left. organ, we can function almost normally with it. We just need to supply the enzymes necessary to digest proteins, fats and carbohydrates. And with diabetes, insulin is necessary.

How to take care of health with a sick pancreas?

Diet, diet and more diet!

But the pancreatic and diabetic diets are mutually exclusive …

It needs to be individualized and adjusted to the antidiabetic drugs or insulin you are taking. And if there are problems with the pancreas in the presence of gallstone disease, it is necessary to get rid of the gallstone disease.

Were there any situations where you failed to perform the operation?

Yes. Such situations happen because the pancreas is an extremely perverse and difficult organ. There are severe bleeding, damage to neighboring organs. These treatments are very difficult and unpredictable.

Surgeons are known as barbarians. Once, in the hospital corridor, I heard one of the doctors saying to a boy: Cut a bit here, cut a bit here. It was about his leg, and the boy was 20 years old.

There is a saying that there is no pain in a patient that a surgeon cannot bear. Yes, on the one hand, it can be described as barbarism, on the other, seriously – we are in a sense craftsmen, professionals and we cannot be guided by emotions, because it always disturbs the real assessment of the situation.

I saw you going for surgery. The patient’s family and friends sat outside the operating room. They threw you slogans: “God with you”. “Good luck!”. And the gentleman walked upright and unmoved. Then I felt that I would very much not like to be in your shoes. And I understood why Zbigniew Religa was drinking.

Unperturbed or concentrated. Therefore, a surgeon should never operate on a loved one, as he could make absurd decisions.

Should he be a man of iron? Barbarian?

The latter is a pretty thick word. I’d rather be called the man of gold.

“The pancreas is a strange organ.” The record holder was operated twenty-six times

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