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

We have evaluated the association between gallstones and abdominal symptoms, comparing two different study designs. We asked questions on abdominal pain, dyspeptic symptoms, and food intolerance in (1) surgery patients referred for conditions unrelated to gallstones, screened by ultrasound (screening study, n = 892, 63 with gallstones); and in (2) symptomatic patients referred for gallbladder ultrasound (clinical study, n = 336, 71 with gallstones). Gallstones were associated with mid upper abdominal pain in the screening study, and with mid upper abdominal pain, biliary pain, and colic (each independently) in the clinical study. When these symptoms were absent (and only dyspeptic symptoms or food intolerance was present), gallstones were not more common than expected from the general population prevalence (estimated from the screening study). When upper abdominal pain symptoms are accounted for, other symptoms (dyspeptic; food intolerance; pain related to food intake) have no additional diagnostic value. The results are discussed, contrasting different types of studies.
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PMID:Abdominal symptoms and food intolerance related to gallstones. 1063 27

Among 698 patients subjected to endoscopic retrograde cholangiopancreatography, an anomalous union of the pancreaticobiliary ductal system (AUPBD) was found in 6 patients (0.9%). One of these 6 patients had an associated congenital choledochal cyst, and 4 did not. Two of these 4 patients, however, had advanced gallbladder cancer. The remaining 2 patients had no associated carcinoma of the biliary tract. A clinicopathological study was performed on these 2 patients and 26 such cases have been reported in the literature. The diagnosis of AUPBD was made by direct cholangiography. Regarding the type of union, the Pancreatic-Biliary type was present in 15 of 18 (83.3%) of these patients. Fifteen of 28 patients (53.6%) had right upper abdominal pain. Thickness of the gallbladder wall was visualized in 26 of the 28 (92.9%) patients. Gallstones were present in 4 (14.3%). AUPBD should always be kept in mind when a patient with abdominal pain is diagnosed as having gallbladder wall thickness without gallstones. ERCP should be performed in these patients in order to detect AUPBD without dilation of the bile duct. This may allow early detection of carcinoma of the biliary tract.
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PMID:Anomalous union of the pancreaticobiliary ductal system without dilation of the common bile duct or tumor: case reports and literature review. 1022 79

We report on a case of an atypically located gallstone ileus as a rare complication of cholecystolithiasis. A 61-year old lady with a history of diabetes type II and nephrolitiasis presented with abdominal pain lasting for 8 days and with vomiting and diarrhoea. Physical examination revealed a palpable tumour and pain in the left lower abdomen. An extensive elevation of blood sugar, CRP and leukocytosis was found. Initially X-ray of the abdomen and sonography showed signs of a subileus. Additionally a 5 x 2 cm mass with dorsal shadowing was detected by ultrasound. Gallbladder and the biliary system were normal. The sonographic suspicion of a gallstone ileus was confirmed by a subsequent CT scan. Under operation the gallstone was found in the distal Jejunum. A gallstone ileus must be included in the differential diagnosis of a tumour in the left lower abdomen. A tumour with dorsal shadowing and signs of a subileus may be the only sonographic findings of a gallstone ileus.
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PMID:[Atypical gallstone ileus: radiologic and sonographic findings]. 1040 80

We studied cholelithiasis that occurred after gastrectomy in 52 patients (35 males and 17 females) encountered at our department between January, 1978 and December, 1998. Gastrectomy had been performed for gastric or duodenal ulcer in 35, gastric cancer in 14, gastroptosis in 2, and gastric trauma in 1 of these patients. Reconstruction after gastrectomy was performed by the Billroth II method (B-II method) in 31 patients, Billroth I method (B-I method) in 17, Roux-en-Y method (Roux-Y method) in 3, and esophagogastrostomy in 1. The period between gastrectomy and discovery of gallstones was 1-5 years in 9, 5-10 years in 10, and 10 years or longer in 33, or more than 60% of the patients. Gallstones were present in the gallbladder alone in 33, bile duct alone in 9, gallbladder and bile duct in 10; the percentage of bile duct stones was high. The type of stones was bilirubin-calcium stones in 21, black stones in 12, pure cholesterol stones in 1, combined stones in 4, mixed stones in 12, and others in 2; pigment stones accounted for 63.5%. Gallstones were symptomatic in 78.8% of the patients, and abdominal pain was the most frequent symptom. Bile was positive on bacterial culture in 68.4%, and Gram-negative bacilli were the most frequently isolated. Lymph node dissection, vagotomy, cholestasis, and biliary tract infection are considered to be related to cholelithiasis after gastrectomy.
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PMID:Study of cholelithiasis after gastrectomy. 1094 47

A case of double cystic duct with cholecystolithiasis detected by preoperative endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography which was treated successfully by laparoscopic surgery is reported. The patient was a 74-year-old woman who complained of abdominal pain in the right upper quadrant. On admission, ultrasonography revealed hyperechoic areas accompanied by obscure acoustic shadows in the gallbladder. Preoperative endoscopic retrograde cholangiopancreatography showed 2 cystic ducts; 1 branched from the common bile duct and the other from the right hepatic duct. After a diagnosis of double cystic ducts, we chose laparoscopic cholecystectomy. Intraoperative cholangiography via 1 of the cystic ducts revealed the presence of the other. We were able to perform laparoscopic cholecystectomy without any complications and the postoperative course was uneventful. This case suggests that preoperative endoscopic retrograde cholangiopancreatography and intraoperative cholangiography is required to avoid complications during laparoscopic cholecystectomy.
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PMID:Double cystic duct detected by endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy: a case report. 1110 Mar 29

A patient with symptomatic cholecystolithiasis underwent laparoscopic cholecystectomy after confirmation of the diagnosis by sonography. Intraoperative cholangiography was normal and the operation was completed laparoscopically. Due to the postoperative persistence of right upper abdominal pain, another sonogram and then an endoscopic retrograde cholangiogram (ERCP) were performed. To our surprise, an accessory gallbladder with a remaining gallstone was revealed. The accessory cystic duct was shown as arising directly from the right hepatic duct. The patient underwent a second laparoscopic cholecystectomy, but due to hemorrhaging the operation had to be converted to an open procedure. The two gallbladders and their corresponding cystic ducts and arteries were entirely separate. To our knowledge, this is the first publication of a duplicate gallbladder where the cystic duct arose directly from the right hepatic duct.
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PMID:Accessory gallbladder originating from the right hepatic duct. 1135 78

Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma.
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PMID:Periampullary choledochoduodenal fistula in ampullary carcinoma. 1145 77

We recently encountered a rare case of late-onset biliary leakage after laparoscopic cholecystectomy using laparoscopic coagulating shears (LCS). The patient was a 49-year-old Japanese man who had undergone a laparoscopic cholecystectomy at Hamamatsu Medical Center after a diagnosis of cholecystolithiasis associated with localized adenomyomatosis. The cystic duct and the cystic artery were closed using LCS instead of metal endoclips. The postoperative course was uneventful, and the patient was discharged on the 4th operative day. However, on the 7th day after the surgery, the patient developed severe upper abdominal pain and was readmitted to our center with the diagnosis of a late biliary leakage, which was confirmed by an endoscopic retrograde cholangiogram. We then treated the leak successfully with endoscopic nasobiliary drainage.
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PMID:Late-onset biliary leakage after laparoscopic cholecystectomy using laparoscopic coagulating shears. Report of a case. 1172 14

Acute pancreatitis is rarely considered in the diagnosis of paediatric abdominal pain and can be misdiagnosed. Gallstones are uncommon in children and are a rare cause of pancreatitis. Trauma, infections and idiopathic causes are the commonest aetiological factors. Three cases of gallstone-induced acute pancreatitis with jaundice in children are reported which resolved with conservative treatment. The gallstones were managed by laparoscopic cholecystectomy with or without endoscopic retrograde cholangiopancreatography (ERCP). The three children had presented previously to a doctor with symptoms of gallstone disease but the diagnosis was missed. It is concluded that acute pancreatitis should be considered in children presenting as an emergency with abdominal pain. Children with recurrent attacks of upper abdominal pain should be investigated for gallstone disease so that the diagnosis is made before the development of potentially serious complications such as acute pancreatitis and jaundice.
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PMID:Acute gallstone pancreatitis in childhood. 1177 36

Diagnostic ability of endoscopic sphincter of oddi manometry for 112 patients with biliopancreatic diseases (including 12 patients of normal) was evaluated. The presence of abnormal high pressure was recognized in 50% of suspected sphincter of oddi dysfunction (SOD). 56% of cholecystolithiasis, 67% of cholecystocholedocholithiasis and 50% of pancreatic stones. Many patients with abdominal pain of suspected SOD or stones of biliopancreatic ducts were considered to have possibility of the complication of papillary stenosis. It was thought that endoscopic sphincter of oddi manometry was a useful method of confirming the presence of SOD.
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PMID:[Evaluation of endoscopic sphincter of Oddi manometry in patients with biliopancreatic diseases]. 1501 39


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