A case of acute necrotizing pancreatitis: Practical and ethical challenges of a North-South partnership.
A case of acute necrotizing pancreatitis: Practical and ethical challenges of a North-South partnership.
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DOI：
10.1016/j.ijscr.2013.10.009
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发表时间：
2013
影响因子：
0.6
通讯作者：
Charles, Anthony G
中科院分区：
文献类型：
--
作者：
Samuel, Jonathan C;Ludzu, Enock K;Cairns, Bruce A;Varela, Carlos;Charles, Anthony G
2008年，北卡罗来纳州大学外科系和马拉维利隆圭的Kamuzu中心医院建立了服务、培训和研究伙伴关系。我们报告一例复发性胰腺炎导致胰腺坏死治疗在KCH。一名42岁男性因第四次腹痛、恶心和呕吐就诊于KCH。他有心动过速，警惕，反跳痛，腹部超声检查显示有游离液体。他接受了剖腹手术，脂肪皂化和胰腺坏死。一个大的排水管被放置，他被给予抗生素，他康复了。他的血脂正常，没有胆结石，也没有饮酒。鼓励他在南非寻求内镜逆行胰胆管造影或计算机断层扫描的进一步评价，但这过于昂贵。这个案例说明了访问发展中国家的外科医生经常面临的限制。我们认为在发达国家管理坏死性胰腺炎的标准资源和治疗算法（如血清脂肪酶和经皮干预）不可用。来访的外科医生和实习生必须熟悉当地的资源限制，并意识到这种限制对病人护理的影响。为了支持培训和促进医疗保健的进步，本地外科医生和学员应了解最佳的治疗策略，无论他们的特定资源限制。南北伙伴关系是一种极好的手段，可以维护我们对人类的专业义务，促进卫生保健作为一项权利，并塑造发展中国家卫生保健的未来。
The Departments of Surgery at the University of North Carolina (UNC) and Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, formed a partnership of service, training, and research in 2008. We report a case of recurrent pancreatitis leading to pancreatic necrosis treated at KCH. A 42 year-old male presented to KCH with his fourth episode of abdominal pain, nausea and vomiting. He had tachycardia, guarding, rebound tenderness, and free fluid on abdominal ultrasonography. He underwent laparotomy and had fat saponification with pancreatic necrosis. A large drain was placed, he was given antibiotics, and he recovered. He had normal lipids, no gallstones, and did not consume alcohol. He was encouraged to seek further evaluation with endoscopic retrograde cholangiopancreatography or computed tomography in South Africa, however this was prohibitively expensive. This case illustrates the limitations that are often faced by surgeons visiting developing countries. What we consider standard resources and treatment algorithms in managing necrotizing pancreatitis in developed countries (such as serum lipase and percutaneous interventions) were not available. Visiting surgeons and trainees must be both familiar with local resource limitations and aware of the implications of such limitations on patient care. To support training and promote advances in health care, local surgeons and trainees should understand optimal treatment strategies regardless of their particular resource limitations. North–South partnerships are an excellent means to uphold our professional obligation to humanity, promote health care as a right, and shape the future of health care in developing countries.