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

Morbid obesity is a recognized risk factor for gastrointestinal cancer. Little is known about pancreatic cancer developing after gastric bypass surgery or about surgery for this type of tumor following bariatric surgery. This report describes a case of pancreatic head cancer identified 3 months after laparoscopic sleeve gastrectomy for morbid obesity. During routine follow-up, mild abdominal pain and elevated pancreatic enzymes prompted computed tomography, which revealed mild edematous pancreatitis. Hyperbilirubinemia developed, and magnetic resonance imaging showed a pancreatic head tumor. CA19-9 was elevated. After a pylorus-preserving pancreatic head resection, the postoperative course was uneventful. The patient received adjuvant chemotherapy. Unfortunately, at the time of writing (9 months postoperatively), a local recurrence and hepatic metastases were diagnosed. Patients treated with bariatric surgery who develop new symptoms or report constant mild symptoms should be evaluated using endoscopy and radiomorphological imaging. Interdisciplinary obesity treatment can then offer significant benefits for the patient, particularly in the case of pancreatic cancer, which is still difficult to diagnose. In addition, there is a need for epidemiological studies of patients who undergo bariatric surgery and subsequently develop cancer.
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PMID:Morbid obesity and subsequent pancreatic cancer: pylorus-preserving pancreatoduodenectomy after laparoscopic sleeve gastrectomy. 1881 48

Imaging studies play a crucial role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best-validated modality for imaging patients with pancreatic adenocarcinoma. To maximize the diagnostic efficacy of CT, use of a pancreas protocol is mandatory. The sensitivity of CT for diagnosis of pancreatic adenocarcinoma (89%-97%) and its positive predictive value for predicting unresectability (89%-100%) are high. The positive predictive value of CT for predicting resectability (45%-79%) is low because the diagnostic criteria for diagnosing vascular invasion by tumor favors specificity over sensitivity to avoid denying surgery to patients with potentially resectable tumor. Furthermore, the sensitivity of CT for small hepatic and peritoneal metastases is limited. Magnetic resonance imaging has not been shown to perform better than CT for the diagnosis and staging of pancreatic adenocarcinoma, but can be helpful as an adjunct to CT, particularly for evaluation of small hepatic lesions that cannot be fully characterized by CT. Ultrasound is often the first study obtained in patients with obstructive jaundice or unexplained abdominal pain, but its utility for diagnosis and staging of patients with pancreatic adenocarcinoma is limited. Positron emission tomography/CT combines the functional information provided by positron emission tomography with the anatomic information provided by CT and is a promising modality for imaging of patients with pancreatic adenocarcinoma, but its utility has not been established. Endoscopic ultrasound is generally considered superior to CT for the diagnosis and local staging of pancreatic cancer, but is limited by availability and inability to assess for distant metastases.
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PMID:Staging of pancreatic adenocarcinoma by imaging studies. 1894 28

At present, most surgeons will not resect the pancreas if there is involvement of celiac axis. We present the case of a 67 yo male with pancreatic body and tail cancer invading the celiac axis treated by extended pancreatectomy, splenectomy, partial resection of proximal portion of jejunum and transverse colon, and left adrenalectomy with en bloc resection of celiac axis. The pulsation in the proper hepatic artery was felt intraoperatively after occlusion of the celiac axis. There were no severe complications. The patient returned home after 32 days stay in the hospital. Severe abdominal pain unresponsive to pain medicines was cured by the procedure and did not return. The patient died of distant disease eleven months after surgery. The case demonstrates that a procedure that may offer cure of locally advanced pancreas cancer may also completely resolve abdominal pain.
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PMID:Extended pancreatectomy with en bloc resection of the celiac axis for locally advanced cancer of pancreatic body and tail. 1926 May 16

Perineural invasion, the growth of tumor cells along nerves, is a key feature of pancreatic cancer. The cardinal symptom of pancreatic cancer, abdominal pain often radiating to the back, as well as the high frequency of local tumor recurrence following resection are both attributed to the unique ability of pancreatic tumor cells to invade the neuronal system. The molecular mechanisms underlying the neuroaffinity of pancreatic tumors are not completely understood. In this study, we developed a novel method to monitor ex vivo perineural invasion into surgically resected rat vagal nerves by different human pancreatic tumor cell lines. Genome-wide transcriptional analyses were employed to identify the consensus set of genes differentially regulated in all highly nerve-invasive (nerve invasion passage 3) versus less invasive (nerve invasion passage 0) pancreatic tumor cells. The critical involvement of kinesin family member 14 (KIF14) and Rho-GDP dissociation inhibitor beta (ARHGDIbeta) in perineural invasion was confirmed on RNA and protein levels in human pancreatic tumor specimens. We found significant up-regulation of KIF14 and ARHGDIbeta mRNA levels in patients with pancreatic cancer, and both proteins were differentially expressed in tumor cells invading the perineural niche of pancreatic cancer patients as detected by immunohistochemistry. Moreover, functional knockdown of KIF14 and ARHGDIbeta using small interfering RNA resulted in altered basal and/or perineural invasion of pancreatic tumor cells. Our work provides novel insights into the molecular determinants of perineural invasion in pancreatic cancer. The established nerve invasion model and the consensus signature of perineural invasion could be instrumental in the identification of novel therapeutic targets of pancreatic cancer as exemplified by KIF14 and ARHGDIbeta.
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PMID:Consensus transcriptome signature of perineural invasion in pancreatic carcinoma. 1950 38

Autoimmune pancreatitis (AIP) is a chronic inflammatory disease of the pancreas that is increasingly encountered worldwide. It has generated considerable interest, in part because the inflammatory process usually responds dramatically to corticosteroid therapy. The most common presentation mimics that of pancreatic cancer; thus, a correct diagnosis of AIP can avoid major surgery. However, the diagnosis is challenging, because its incidence is far lower than that of the diseases it mimics and there is no single diagnostic clinical feature or test that can identify the full spectrum of AIP. Therefore, we are increasingly encountering patients misdiagnosed as having AIP. The misdiagnosis typically occurs in three scenarios: (i) treatment of pancreatic or biliary malignancy with corticosteroids and/or immunomodulators, (ii) treatment of chronic abdominal pain with corticosteroids and/or immunomodulators, or (iii) performance of operative resection for autoimmune disease. Our purpose is to highlight this growing clinical problem and to reinforce the use of published guidelines for the diagnosis and management of AIP.
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PMID:Misdiagnosis of autoimmune pancreatitis: a caution to clinicians. 1957 65

A 56-year-old man was hospitalized with a history of diffuse abdominal pain. Cutaneous examination revealed an erythematous to violaceous, infiltrative nodule of the umbilicus. Histologic examination demonstrated poorly differentiated adenocarcinoma. Abdominal tomography showed advanced pancreatic cancer with metastatic involvement of the liver and the diagnosis of pancreatic adenocarcinoma with umbilical metastasis -- Sister Mary Joseph's nodule.
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PMID:Case for diagnosis: umbilical metastasis of pancreatic carcinoma (Sister Mary Joseph's Nodule). 1966 47

A 63 year old patient underwent uneventful laparoscopic cholecystectomy in 1994. The patient had a long history of biliary colic after fatty meals. The chief presenting symptom was pain localized in the epigastrium radiating to the back and later distributing to the whole abdomen. The patient also had a history of constipation, but no other symptoms were noted. An ultrasonogram of the liver, gall bladder and pancreas was reported to show calculi in the gall bladder but otherwise normal findings. The laparascopic cholecystectomy was uneventful with discharge the following day. The symptoms however did not disappear, changing in character, locating at the center of the abdomen. The patient began to lose appetite with bouts of diarrhea. The symptoms gradually increased and the patient was admitted to the hospital. Upon arrival the patient was found to have diffuse abdominal pain with a painful swelling of the umbilical trocar site. Incarcerated hernia was suspected, but proved to be a mass at exploration. Pathologic examination disclosed a metastatic adenocarcinoma. A similar but smaller mass was also discovered in the epigastric trocar site. CT scan showed a pancreatic carcinoma of the corpus with infiltration. The patient deteriorated rapidly and died four months after the diagnosis of pancreatic cancer.
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PMID:[Subcutaneous metastasis after laparoscopic cholecystectomy in a patient with unsuspected adenocarcinoma of the pancreas.]. 1967 21

Thoracoscopic splanchnicectomy has been used for the management of upper abdominal pain syndromes as an alternative to celiac plexus block for conditions such as chronic pancreatitis or supramesocolic malignant neoplasms, including unresectable pancreatic cancer. This procedure is similar to the percutaneous block with a higher degree of precision and avoids the side effects associated with the local diffusion of neurolytic solutions. Thoracoscopic splanchnicectomy appears to be a better treatment in such cases as the procedure is done under direct vision and less dependent on anatomical variations.
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PMID:Thoracoscopic splanchnicectomy as a palliative procedure for pain relief in carcinoma pancreas. 1972 77

Most of the malignant neoplasms of the pancreas demonstrate features that are consistent with adenocarcinoma. According to the WHO classification, primary clear cell carcinoma of the pancreas is rare and it is classified as a "miscellaneous" carcinoma. In addition, there is not an adequate systematic overview that can demonstrate its true existence as a definable entity. We report here on an unusual case of primary pancreatic clear cell carcinoma, which is the first such reported case in Korea. A 66 year old woman presented with abdominal pain and significant weight loss over the previous three weeks. On the abdominal computed tomography (CT), we detected an abdominal mass involving the pancreas tail and liver, and clear cell carcinoma with rhabdoid feature was seen on the histologic evaluation. The tumor cells showed well defined cell membranes, clear cytoplasm and prominent cell boundaries. The immunohistochemical stains showed positive reactions to antibodies against pan-cytokeratin, cytokeratin 7, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). On the other hand, there was a negative reaction for cytokeratin 20, chromogranin, synaptophysin, smooth muscle actin and HMB-45. She was diagnosed with a primary pancreatic clear cell carcinoma with hepatic metastasis and she received palliative gemcitabine chemotherapy. The patient died one month later of pancreatic cancer progression.
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PMID:Clear cell carcinoma of the pancreas--a case report and review of the literature. 1980 68

In patients with pancreatic cancer, the most frequent symptoms are abdominal pain, weight loss and jaundice. Upper gastrointestinal bleeding produced by gastric varices is a rare entity in these patients and requires the presence of splenic vein thrombosis (SVT) to be excluded. We describe the case of a young man who presented to the emergency department with hematemesis. Diagnostic tests revealed primary pancreatic lymphoma (PPL), which provoked splenic vein thrombosis, collateral circulation and the formation of isolated bleeding gastric varices. To date, we have found no reports in the literature of PPL with this form of presentation. Finally, we review the literature, with emphasis on the importance of excluding splenic vein thrombosis in patients with isolated gastric varices, and discuss certain features of the diagnosis and treatment of PPL.
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PMID:[Bleeding from gastric varices as the initial manifestation of primary pancreatic lymphoma]. 1992 39


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