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

Recent advances in technology and techniques have opened the gates widely to a wide range of applications of minimally invasive surgery in patients with inflammatory and neoplastic diseases of the pancreas. Laparoscopic cholecystectomy is the gold standard treatment for prevention of further attacks of acute biliary pancreatitis. Bile duct calculi detected at intraoperative cholangiography in patients with mild attacks of pancreatitis may be safely managed with laparoscopic bile duct exploration. Laparoscopic internal drainage of large, persistent and symptomatic pancreatic pseudocysts is safely applicable to most patients, achieves adequate drainage and facilitates debridement, and brings recognised benefits over open surgery and endoscopic approaches. Laparoscopic pancreatic necrosectomy for infected necrosis is feasible in some patients but the benefits of this approach in this high-risk group of patients remain to be shown. Staging laparoscopy and laparoscopic ultrasound avoids unnecessary laparotomy in approximately one-fifth of patients with pancreatic cancer, but their routine application in patients with ampullary and duodenal cancers is not warranted. The majority of patients with periampullary cancer have locally advanced or metastatic disease at presentation and their management is entirely palliative. Laparoscopic surgery therefore has its place in the relief of biliary and gastric outlet obstruction, and has its advantages over endoscopic biliary and duodenal stenting in patients with predicted better prognosis, though these advantages ought to be confirmed in randomised controlled trials. Thoracoscopic splanchnicectomy is beneficial in the short-to-medium term for the palliation of intractable opiate-dependent abdominal pain of locally advanced pancreatic cancer and that of chronic pancreatitis with demonstrable improvements in quality of life. Laparoscopic enucleation of neuroendocrine tumours of the pancreas, and distal or subtotal pancreatectomy with or without preservation of the splenic vessels and spleen for neuroendocrine and cystic tumours, and in some patients with chronic pancreatitis is feasible and safe. In experienced hands, this minimally invasive approach reduces postoperative hospital stay and expedites recovery. However, the incidence of pancreatic fistula following distal resection is not any less than that of open surgery. Although the previous limited experience with laparoscopic pancreaticoduodenectomy was discouraging, the recent experience with the hand-assisted approach is quite favourable and is likely to expand.
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PMID:Pancreatic surgery in the laparoscopic era. 1461 98

Tropical chronic pancreatitis (TCP) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. The classical triad of TCP consists of abdominal pain, steatorrhoea, and diabetes. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes (FCPD) which is thus a later stage of TCP. Some of the distinctive features of TCP are younger age at onset, presence of large intraductal calculi, more aggressive course of the disease, and a high susceptibility to pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis of TCP and in non-calcific cases ductal dilation on endoscopic retrograde cholangiopancreatography, computed tomography, or ultrasound helps to identify the disease. Diabetes is usually quite severe and of the insulin requiring type, but ketosis is rare. Microvascular complications of diabetes occur as frequently as in type 2 diabetes but macrovascular complications are uncommon. Pancreatic enzyme supplements are used for relief of abdominal pain and reducing the symptoms related to steatorrhoea. Early diagnosis and better control of the endocrine and exocrine dysfunction could help to ensure better survival and improve the prognosis and quality of life of TCP patients.
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PMID:Tropical chronic pancreatitis. 1465 69

Groove pancreatitis is a special form of chronic pancreatitis in which scarring is found mainly in the groove between the pancreatic head, duodenum, and common bile duct. Preoperative differentiation between groove pancreatitis and pancreatic cancer is difficult. Here we report one case of segmental groove pancreatitis diagnosed by clinical and radiological features. The patient was a 46-year old man with severe abdominal pain, weight loss, and a long history of alcohol abuse. Computed tomography revealed swelling of the pancreatic head and a heterogeneously enhanced low-density lesion in the groove. MR images revealed a mass in the groove that had a low signal on T1-weighted images and a low signal relative to the pancreatic head on T2-weighted images. T1-weighted images on dynamic study showed the medial wall thickening of descending duodenum, several small cysts in the groove and thickened duodenal wall. The patient has been under conservative treatment for 2 months and his severe abdominal pain has improved.
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PMID:Segmental groove pancreatitis: report of one case. 1471 32

Small pancreatic cancers, intractable diseases, offer the possibility of cure. Can this be true? Through the National Pancreatic Cancer Registry, the Japan Pancreas Society (JPS) has collected 822 cases of invasive cancer with tumors <2 cm in diameter (TS1 pancreatic cancer). Papillary adenocarcinoma and the well-differentiated type of tubular adenocarcinoma are more frequent in TS1 pancreatic cancer than the larger tumors, suggesting that further genetic and phenotypic changes occur during their progression. Patients with TS1 pancreatic cancer presented with abdominal pain, jaundice, and exacerbation of diabetes, while 17.3% of them had no symptoms. Further imaging diagnosis should be employed to detect TS1 pancreatic cancer, but conventional US and ERCP play an important role in the diagnostic process. In this study, of 822 patients with TS1 pancreatic cancer, only 216 patients (26.3%) had T1 tumors because of invasion to adjacent tissue. There were 306 patients (37.2%) with lymph node metastasis, of whom 63 (7.7%) had N3 metastasis that is counted as a distant metastasis. As a result, only 136 patients (16.5%) had stage I disease with a median survival time of 78.2 months and a 5-year survival rate of 58.1%. Small pancreatic cancer does not necessarily mean early pancreatic cancer, and surgery alone is not sufficient to cure this disease.
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PMID:Clinicopathological aspects of small pancreatic cancer. 1508 63

Cancer of the pancreas is the tenth most frequent cancer in Europe, accounting for some 3% of cancer in both sex. Smoking has been clearly established as a major risk factor affecting the carcinogenesis of pancreatic carcinoma. Diet has also been associated with pancreatic cancer, although no conclusive data are yet available. Different genetic alterations have been observed in pancreatic neoplasms. Typical symptoms of pancreatic cancer are: jaundice, abdominal pain and weight loss. The prognosis of pancreatic carcinoma depends mainly on radical surgery and the presence of negative resection margins, as well as on the biological tumour stage, which also influences the treatment strategy. The treatment of pancreatic cancer is undertaken with two aims. Radical surgery is indicated for patients with early stage of disease, mainly stage I and partially II. In all other cases, the aim of treatment is the palliation of different very distressing symptoms related to this neoplasm.
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PMID:Cancer of pancreas. 1515 63

Chronic pancreatitis is characterized by periodic episodes of inflammation and loss of exocrine and endocrine function of the pancreas. Hereditary pancreatitis is an autosomal dominant disorder with an 80% penetrance, is associated with recurrent episodes of pancreatitis starting in early childhood and correlated to an increased risk of pancreatic cancer. The pathogenesis of chronic and hereditary pancreatitis is not yet fully understood. Patients suffering from chronic pancreatitis present with belt-like abdominal pain, weight loss, and often diabetes mellitus. The diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography and exocrine and endocrine function tests. Therapy is restricted to symptom control. Approximately 30-60% of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones which require either interventional or surgical treatment.
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PMID:[Chronic pancreatitis. Diagnosis and treatment]. 1520 51

Splenosis, the autotransplantation of splenic tissue, has been designed to preserve organ functions after splenectomy. We present the first case of laparoscopic resection of a pancreatic splenosis, in a patient who had undergone a splenectomy 31 years before, complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) scan showed an enhancing hypervascular 3-cm solid mass in the body of the pancreas, mimicking a pancreatic cancer or a neuroendocrine tumor. A diagnostic laparoscopy was planned, and a 3-cm peripancreatic nodule with a long pedicle was visualized, with many nodules close to the tail of the pancreas and in the greater omentum. They were all resected, and the specimens obtained were immediately sent for frozen-section examination, which confirmed the diagnosis of heterotopic splenic tissue. Splenosis should be included in the differential diagnosis of the pancreatic masses in patients with previous splenic surgery. A hypervascular mass on CT scan should be regarded as an adenocarcinoma of the pancreas until proven otherwise. The possibility of a neuroendocrine tumor mandates an octreotide scan and gastrointestinal hormones dosage. In the unlikely event that all tests may produce equivocal results, a diagnostic laparoscopy is mandatory, in order to obtain an accurate histopathologic diagnosis.
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PMID:A rare diagnosis for a pancreatic mass: splenosis. 1553 Dec 47

Tropical pancreatitis is a special type of chronic pancreatitis that is seen mainly in tropical countries. The prevalence of tropical pancreatitis is about 126/100,000 population in southern India. It occurs usually in young people, involves the main pancreatic duct and results in large ductal calculi. The etiology is not known, but genetic mutations such as the SPINK1 gene mutation and environmental factors are likely causes. Clinically, >90% of patients present with abdominal pain. About 25% of patients develop diabetes which generally requires insulin for its control but is ketosis-resistant. Painless diabetes is another clinical presentation in some patients. Most patients develop malnutrition during the course of the disease. Steatorrhea is less common. Patients with tropical pancreatitis may develop pancreatic cancer as a long-term complication. The diagnosis can be established by plain radiography of the abdomen, ultrasonography, computerized tomography scan of the abdomen or endoscopic retrograde cholangiopancreatography. Management is directed towards relief from pain and control of diabetes and steatorrhea. Pain relief can be obtained by analgesics and enzyme supplementation with preparations rich in proteases. Endotherapy coupled with stone fragmentation by extracorporeal shock wave lithotripsy is an effective therapy for those who fail to respond to medical therapy. Surgical decompression of the main pancreatic duct by lateral pancreato-jejunostomy is reserved for patients with severe pain non-responsive to other forms of therapy.
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PMID:Tropical pancreatitis. 1575 8

A 63-year-old man presented to the emergency department with sudden-onset abdominal pain. Chest radiography demonstrated pneumoperitoneum. At surgery, the source was found to be a ruptured hepatic abscess. Cultures grew Clostridium perfringens, and biopsies confirmed metastasis of a previously resected pancreatic cancer. We document this rare cause of pneumoperitoneum and briefly review the literature on liver abscess as it relates to metastatic cancer.
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PMID:Liver metastasis presenting as pneumoperitoneum. 1575 62

Chronic pancreatitis is mostly caused by heavy alcohol consumption and is characterized by the onset of symptoms in the fourth and fifth decade. Beginning in patients older than 65 years of age is rare. Leading symptom is recurrent or persisting abdominal pain which is missed only in approximately 5% of the cases. Chronic pancreatitis is classified as idiopathic if there is no anamnesis of alcohol abuse or some rare specific causes. The Idiopathic Chronic Senile Pancreatitis (ICSP) is a subset of the non-alcoholic pancreatitis and is characterized by advanced age at the time of first manifestation. Although life expectancy especially in chronic alcoholic pancreatitis is reduced, there are many patients who reach older age. The natural history in all forms of chronic pancreatitis shows a decrease in pain and the manifestation of exocrine and endocrine insufficiency as late complications. Especially in the elderly loss of weight may occur with steatorrhea and pancreatic diabetes mellitus as the dominating clinical problem of chronic pancreatitis. If pain persists treatment is symptomatically with analgesics. The possibility of causal surgery or the indication for endoscopic treatment of painful chronic pancreatitis should be proven in every single case. Standard pancreatin treatment consisting of large amounts of enzymes will abolish maldigestion. Pancreatic diabetes requires often insulin, there is a tendency to hypoglycaemia. In contrast to chronic pancreatitis cancer of the pancreas is a typical and frequent disease of the elderly. The prognosis is bad and one year life expectancy is just about 11%. One of the reasons is, that the diagnosis is found lately because early symptoms are missing. Specific symptoms like pain, weight loss or jaundice occur lately. In suspicion of pancreatic cancer a lot of methods of morphological diagnostic are available such as CT, MRCP, ultrasound, ERCP and PET, in addition the specific tumor markers CA 19-9 and CEA. After diagnostic is completed, curative resection is possible in only a low percentage of all cases. Old age is no contraindication for surgery, prognosis and the risk of surgery don't differ to other age groups. In most cases palliative therapy is the only possible option because of an advanced tumor stage. Sufficient pain therapy, endoscopic stenting in case of obstructive jaundice or gastroenterostomy in case of duodenal are useful interventions.
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PMID:[Chronic pancreatis and pancreatic carcinoma in the elderly]. 1598 40


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