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

sWe describe the management of a cystic duct remnant calculus in a 45-year-old male patient who had undergone a laparoscopic cholecystectomy and re-presented with abdominal pain and jaundice. Magnetic resonance cholangiopancreatography was utilized to confirm the diagnosis of an impacted calculus within the remnant cystic duct along with several small retained common bile duct stones. Four sequential endoscopic procedures successfully removed all retained common bile duct calculi to alleviate the biliary obstruction; however, we were unable to treat the cystic duct remnant calculus endoscopically. The patient finally underwent successful laparoscopic excision of a 2.5-cm cystic duct remnant containing its impacted calculus. It remains unclear if cystic duct remnant calculi may become more prevalent as a cause of postcholecystectomy syndrome in future due to the large numbers of laparoscopic cholecystectomies performed in the past 2 decades.
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PMID:Postcholecystectomy syndrome in the laparoscopic era. 1700 73

Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved.
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PMID:Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. 1725 97

Biliary cystadenoma is a rare epithelial cystic neoplasm representing only 5% of intrahepatic cystic lesions of biliary origin. Commonly, the lesions are solitary cystic structures with multiple thin-walled septa predominantly arising from the right hepatic duct. Although the lesions are generally intrahepatic, extrahepatic tumors have been reported. Biliary cystadenomas range in diameter from 1.5 to 35 cm. The tumor usually affects middle-aged women. Clinical symptoms are related to the mass effect and comprise episodes of jaundice due to biliary obstruction and intermittent upper abdominal pain. Laboratory parameters are nonspecific. As the tumor is considered a premalignant lesion, complete surgical resection is the treatment of choice. We report a case of typical biliary cystadenoma of the left hepatic duct.
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PMID:Biliary cystadenoma of the left intrahepatic duct (2007: 2b). 1735 42

The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia is directed at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical.
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PMID:[Hemobilia]. 1763 61

Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However in the last decade, it has been recognized that there is a distinct form of autosomal dominant PCLD that arises without concomitant ADPKD. Early knowledge of the pathogenesis was gained from the study of hepatic cysts in patients with ADPKD. Bile duct overgrowth after embryogenesis results in cystic hepatic dilatations that are known as biliary microhamartomas or von Meyenburg complexes. Further dilatation arises from cellular proliferation and fluid secretion into these cysts. There is a variable, broad spectrum of manifestations of PCLD. Although PCLD is most often asymptomatic, massive hepatomegaly can lead to disabling symptoms of abdominal pain, early satiety, persistent nausea, dyspnea, ascites, biliary obstruction, and lower body edema. Complications of PCLD include cyst rupture and cyst infection. Also, there are associated medical problems, especially intracranial aneurysms and valvular heart disease, which clinicians need to be aware of and evaluate in patients with PCLD. In asymptomatic patients, no treatment is indicated for PCLD. In the symptomatic patient, surgical therapy is the mainstay of treatment tailored to the extent of disease for each patient. Management options include cyst aspiration and sclerosis, open or laparoscopic fenestration, liver resection with fenestration, and liver transplantation. The surgical literature discussing treatment of PCLD, including techniques, outcomes, and complication rates, are summarized in this review.
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PMID:Surgical management of polycystic liver disease. 1787 69

Chronic pancreatitis (CP) is characterized by progressive, chronic inflammation of the pancreas, resulting in loss of exocrine and endocrine function and chronic abdominal pain. In most cases, CP is induced by long-term alcoholism. The second most frequent diagnosis is idiopathic CP, in the absence of known causes of CP. However, the identification of genetic and immunological causes continuously reduces the number of cases classified as idiopathic pancreatitis. Common symptoms of CP comprise abdominal pain radiating to the back, diarrhea, steatorrhea and the development of diabetes. The diagnosis is mainly based on clinical features, typical morphological findings such as pancreatic calcifications, duct stenoses and dilatations, as well as pathologic pancreatic function tests. Treatment of CP includes watch and wait strategies in asymptomatic patients, symptomatic treatment of the clinical features such as pain, exocrine and endocrine insufficiency, as well as interventional or surgical therapy of complications such as pseudocysts, pancreatic duct stenosis, stones or biliary obstruction.
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PMID:[Diagnostics and therapy of chronic pancreatitis]. 1843 29

Autoimmune pancreatitis is characterized by a lympho-plasmacytic infiltrate centred around the pancreatic ducts along with venulitis; it can produce a mass-like fibroinflammatory lesion and often simulates pancreatic malignancy or chronic pancreatitis of other types. This may lead to unnecessary surgical interventions. Patients, who are usually over 40 years of age, show 1) mild unspecific abdominal pain, 2) increased serum immunoglobulins (specifically IgG4) and autoantibodies, and 3) diffuse or focal enlargement of the pancreas with pancreatic strictures and sometimes jaundice due to biliary obstruction (detectable by US, CT, MRI, ERCP and/or endoscopic ultrasound (EUS)). The diagnosis can be strongly supported by EUS- or US-guided biopsies showing typical histological changes and specific indirect immunohistochemistry with the patient's serum or a steroid trial showing often a dramatic decrease of pathological findings within weeks.
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PMID:[Autoimmune pancreatitis: new concepts of an often overlooked disease]. 1854 13

Obstruction of the cystic duct after Biliary Shock Waves Lithotripsy in an uncommon complication. It occurs when a small fragment is hemming in the neck of the gallbladder. Usually, cholecystectomy is the indicated treatment, we challenged this concept and attempted early ESWL to treat this complication. In our clinic, 150 patients were treated with a Lithostar-Plus device between March 1, 1989 to April 30, 1990. Of these, 12 presented acute uncontrolled biliary colic, 28 presented mild abdominal pain and the rest, remained pain free. Of the 12, one presented biliary obstruction and cholecystectomy was performed in other hospital; one refused to be retreated and other presented sonographic gallbladder thickness and hence underwent surgery. Nine patients were re-treated and in all, fragments nested in the gallbladder neck were successfully pulverised and obstruction cleared. To date all patients are free of stones. In summary, we propose early re-treatment with ESWL as a non-surgical alternative approach for treating this complication.
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PMID:[Extracorporeal shock waves lithotripsy during acute obstruction of the cystic duct]. 1925 40

Sclerosing peritonitis describes the development of a peel or rind of fibrosis that spreads over the peritoneal surface and can lead to recalcitrant ascites, bowel obstruction, and sepsis. It is well described as a complication of peritoneal dialysis, especially with episodes of bacterial peritonitis. It is also a complication of end-stage liver disease with ascites and liver transplantation. This article describes 3 cases of sclerosing peritonitis present at the time of liver transplantation or soon after. All 3 patients had massive refractory ascites with episodes of spontaneous bacterial peritonitis prior to transplantation. Two patients had evidence of a fibrous peel at the time of transplantation. Postoperatively, all 3 patients continued to have refractory ascites and episodes of peritonitis, along with partial small bowel obstructions, abdominal pain, and malnutrition. Two patients also had constriction of the graft, including biliary obstruction and inferior vena cava and outflow obstruction, which has not been previously described. All 3 patients eventually died from complications related to the sclerosing peritonitis.
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PMID:Sclerosing peritonitis and mortality after liver transplantation. 1932 14

Disseminated histoplasmosis is an AIDS-defining illness which usually involves the liver and gastrointestinal tract, most commonly the small bowel. Abdominal pain, diarrhea, GI bleeding, hepatosplenomegaly and small bowel obstruction are well described presentations. Still gastrointestinal histoplasmosis often results in either vague symptomatology or no symptoms. Pancreaticobiliary disease related to disseminated histoplasmosis is not well characterized. We report the case of a young female with advanced HIV infection and biliary obstruction and a periampullary duodenal ulcer due to disseminated histoplasmosis.
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PMID:Disseminated histoplasmosis presenting with biliary obstruction and duodenal ulcer. 1963 48


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