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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 17 cases of gallstones in children observed over a period of 10 years in the area of Marseilles is described and the literature reviewed. The majority of children were girls over 10 years old. Symptoms were constantly present and the disease revealed nine times by acute "mechanical" cholecystitis, compared to 16 infectious cholecystitis followed during the same period, three times by an accident of migration (cholangitis in a 14 years old girl, bile ascitis in two infants). A cholecystography should be performed in acute recurrent abdominal pain of unknown origin in children, gallstones appearing to be radiotransparent in six patients. Among causes of gallstone formation, the authors dig out only 6 hemolytic anemias, related to hemoglobinopathies in three patients, and they emphasize the frequency of idiopathic cholelithiasis which should lead to a more complete investigation of the enterohepatic cycle and chemical constitution of bile in such patients.
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PMID:[A clinical survey on 17 cases of cholelithiasis in childhood (author's transl)]. 22 Jul 27

The reported complication rate from T-tube infusion of sodium cholate for dissolution of retained biliary stones is low. Among 84 patients reported in the English-language literature, and 10 additional cases of our own, there have been no deaths, an incidence of liver enzyme elevation in 7%, fever in 5%, cholangitis in 2%, and pancreatitis in 2%. Recently, we have infused 100mM sodium cholate at 30 cc/hr into patients through transhepatic biliary stents in an effort to rid the intrahepatic biliary tree of retained stones and biliary sludge. Appropriate precautions were taken to prevent increased biliary pressures by the insetion of a 30 cm manometer into the perfusion system. During four transhepatic infusions in three patients, all experienced nausea and vomiting, and two of the three patients developed diarrhea and abdominal pain. Liver enzymes became elevated during all four infusions, and two of the three patients became septic and died shortly after their infusions. Experimental work in animals suggests that intrahepatic sodium cholate infusion results in injury to the ductal epithelium and predisposes patients to bactermia and sepsis. Even though T-tube infusion of sodium cholate into the common bile duct is well tolerated, direct infusion into the intrahepatic biliary tree through a transhepatic tube is not and carries a high risk of sepsis and death.
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PMID:Sodium cholate dissolution of retained biliary stones: mortality rate following intrahepatic infusion. 43 6

In comparison to common radiologic methods hepato-biliary sequential scintigraphy proves superior in the investigation of the choledocho-(hepatico-)jejunostomy Roux-en-Y. The functional behavior of the jejunal-(Roux-en-Y-) loop is demonstrated. After biliary-intestinal anastomoses, 15 healthy patients showed normal dynamic studies with unimpeded bile passage. Hypotonic loops with intrahepatic bile stasis responsible for cholangitis were seen in 2 patients. A strangulation phenomenon on the level of the mesocolon hiatus responsible for upper abdominal pain is demonstrated in one case.
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PMID:[The functionally defective Roux Y-loop in biliodigestive anastomoses]. 59 51

Acute obstructive suppurative cholangitis is a potentially lethal complication of biliary tract obstruction, caused by passage of septic material into the circulation originating from pus under tension in the biliary ducts. Of the three cases presented herein, decompression occurred spontaneously in the second one, and was achieved surgically in the other two. The diagnosis is based in Charcot's triad of: Abdominal Pain, Fever and Jaundice, with or without history of biliary disease. Progression leads to septicemia, shock and death. Treatment is surgical and it should be carried out as soon as the diagnosis is made. Effective decompression of the biliary tract is obtained by cannalization of the choledoccus with a T-Tube. Delayed treatment increases mortality, thus the importance of early recognition.
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PMID:[Acute obstructive suppurative cholangitis]. 61 39

Clinical features and validity of a duodenofiberscopic examination for the diagnosis of carcinoma of the papilla of Vater were evaluated on 13 cases preoperatively diagnosed endoscopically. Followings are the conclusions derived. 1) Average age was 59.8 years. Incidence was equal among men and women. 2) As initial symptoms, general fatigue and easy fatigability or symptoms of cholangitis should be emphasized. 3) Other important symptoms include jaundice, fever with chills and weight loss. Abdominal pain, when present, was noted as one of symptoms of cholangitis in most cases. 4) Important laboratory findings include elevated serum bilirubin and alkaline phosphatase, elevated erythrocyte sedimentation rate, positive occult blood in stool. 5) Carcinomas of the papilla of Vater were divided into 3 types (type I, II and III) according to endoscopical and pathological findings. Clinical features and laboratory findings were discussed in relation to the type of lesions. Characteristic endoscopic findings of each type of the lesions were described. Validity of aspiration cytology, pancreatocholangiography and biopsy under duodeno-fiberscopic observation was also discussed. As a result, duodenofiberscopy was considered to be the most useful method for the diagnosis of carcinoma of the papilla of Vater because it provides us with an opportunity to perform simultaneously an endoscopic observation, aspiration cytology, pancreatocholangiography and biopsy.
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PMID:Diagnosis of carcinoma of the papilla of Vater by duodenofiberscopy: simultaneous attempt on endoscopic observation, aspiration cytology, retrograde pancreatocholangiography and biopsy. 78 67

Choledochal cyst was diagnosed before operation in 14 out of 16 infants and children by means of a combination of diagnostic tests. Ultrasonic echogram showed a cystic mass in all 11 patients examined. The characteristic displacement of the duodenum was noted in 9 of 14 patients by contrast studies of the upper gastrointestinal tract, and hepatobiliary scintiscanning confirmed choledochal cyst in 7 of 8 patients (88%). A cyst was shown by oral or intravenous cholangiography in 3 of 4 patients. Onset of symptoms occurred from 7 days of age to 9-5 years; in 10 patients onset occurred under 12 months of age, in 3 from 13 to 24 months, and in the remaining 3 from 2 to 9-5 years. The first symptoms were jaundice, vomiting, acholic stools, and poor sucking. Obstructive jaundice and acholic stools were found in more than 80% of the patients, and abdominal mass in 60%. Vomiting occurred in 50% of the patients, one-third of whom showed failure to thrive, and 70% of patients over the age of 1-5 years had abdominal pain. About half of the patients had a mild to moderate degree of fever. In all patients primary excision of the cyst was followed by hepaticojejunostomy in Roux-en-Y fashion. The postoperative course was uneventful in 14 patients; 2 patients died, one from ascending cholangitis and one from hepatic failure.
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PMID:Choledochal cyst in infancy and childhood. Analysis of 16 cases. 83 63

Long strictures of the intrapancreatic portion of the common bile duct were found in 6 patients with chronic pancreatitis. These strictures were responsible for painless obstructive jaundice, recurrent cholangitis, secondary biliary cirrhosis, and chronic abdominal pain difficult to distinguish from that caused by pancreatitis. Endoscopic retrograde cholangiopancreatography and intraoperative cholangiography were invaluable in making the diagnosis and in planning surgical correction. Decompression of the biliary tree by anastomosis of the gallbladder or common duct to the small intestine completely relieved symptoms and allowed liver function to improve significantly. Common duct stricture as a complication of chronic pancreatitis should be considered in the differential diagnosis of extrahepatic biliary obstruction and whenever surgical treatment of chronic pancreatitis is contemplated.
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PMID:Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. 94 56

Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.
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PMID:The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. 127 37

In AIDS patients an acalculous cholecystitis may be responsible for abdominal pain subsiding after cholecystectomy. But the indications for cholecystectomy are not clear: cholecystitis is usually associated with diffuse cholangitis and this might cause the symptoms. Since 1985, 8 AIDS patients have undergone cholecystectomy for acute cholecystitis. Ultrasonography revealed a 5 to 12 mm thickening of the gallbladder wall in all of them and gallbladder stones in two; four patients had cholangitis. The decision to operate was based on persistent pain associated with fever, poor general condition and muscular rigidity at palpation. Four patients had septic shock at the time of surgery; one died in the immediate postoperative period. In all other patients pain and septic syndrome subsided. Two patients died of AIDS complications 20 days after surgery; the remaining five died of AIDS 6, 9, 10, 12 and 14 months respectively after surgery; in two of them cholestasis had reappeared due to cholangitis. To summarize, in the 8 AIDS patients studied cholecystectomy was performed for clinical deterioration. Gallbladder pathology was responsible for the abdominal pain and the febrile general condition which was relieved by cholecystectomy.
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PMID:[Hepatobiliary manifestations in AIDS in adults. Place of cholecystectomy]. 129

Choledochal cyst remains a rare pathology in western countries. Over the past 15 years, 18 children were diagnosed with choledochal cyst at Hospital Sainte-Justine. There were 14 girls and 4 boys with an average age of 7.4 years ranging from newborn to 15 years. Abdominal pain, jaundice and abdominal mass were present in 70%, 54% and 7% respectively. Only one patient, a 15 years old girl had all three symptoms. Abdominal ultrasonography was diagnostic in all cases and in two cases, a cystic dilatation was found in the antenatal ultrasonography. Transvesicular cholangiography was performed successfully in 11 patients and showed a detailed anatomy of the biliary tract preoperatively. Sixty-seven percent of the cysts were type I while 33% were type IV. A common channel was found in 43% of the cases. Sixteen patients underwent cyst excision followed by Roux en Y hepatico-jejunostomy, one patient with associated biliary atresia had a porto-enterostomy and one patient had a cysto-duodenostomy. The last patient had recurrent episodes of cholangitis and required reoperation while the others are doing well and free of infection. With the liberal use of ultrasonography, the diagnosis of choledochal cyst is being done earlier improving the long term prognosis. Transvesicular cholangiography is a very useful addition in the preoperative investigation of these patients. Roux en Y hepatico-jejunostomy was associated with minimal morbidity and mortality and gave excellent result.
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PMID:[Cysts of the choledochus in children: experience of the Sainte-Justine hospital]. 129 61


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