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

Pancreas divisum is the most common anatomical variant of pancreatic ductal anatomy. It has been suggested that obstruction at the accessory papilla in subjects with pancreas divisum can be assessed by measurement of ductal diameter by ultrasonic examination after a maximal secretory stimulus with i.v. secretin. We have prospectively assessed this test in 44 individuals; nine healthy controls, nine patients with abdominal pain and normal pancreatic anatomy, 17 patients with pancreas divisum and abdominal pain but no other evidence of pancreatitis, and nine patients with pancreas divisum and either chronic or recurrent acute pancreatitis. We have found no correlation between ductal anatomy and response to i.v. secretin. Secretin provocation tests do not indicate which patients have accessory papillary stenosis and do not add support to the hypothesis of obstruction leading to pancreatitis in patients with pancreas divisum.
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PMID:Pancreatic duct dilatation after secretin stimulation in patients with pancreas divisum. 266 Jan 34

Two patients with chronic abdominal pain and fasting hypergastrinemia had increases in serum gastrin of 440 and 300 pg/ml after injection of 2 U/kg Secretin-KABI. Both subsequently proved to have pentagastrin-fast achlorhydria. Intragastric instillation of 0.1 N HCl suppressed serum gastrin concentration by greater than 60%. In both, the pancreas was normal by sonography or computed tomography (CT) scan and at laparotomy in one. Both are currently asymptomatic 12 and 18 months later. We conclude that achlorhydria may be associated after injection of Secretin-KABI with a false-positive rise in fasting serum gastrin concentration of greater than 200 pg/ml and that gastric analysis for hypochlorhydria should be performed before secretin provocation testing.
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PMID:False-positive secretin-KABI provocation test associated with achlorhydria. 341 78

When all is said and done, the case for an association between pancreas divisum and accessory papilla stenosis is empirical. In our experience, there are more persons with long-standing, persistent or increasing symptoms who respond favorably to accessory papilla sphincteroplasty than chance or placebo effect can reasonably explain. These same patients tend to have what is thought to be pathologically increased resistance to excretion of pancreatic secretions via the accessory papilla (positive secretin-ultrasound test), which is corrected by the accessory papilla sphincteroplasty (conversion to negative secretin-ultrasound test). At operation the orifice in the accessory papilla is tiny. Secretin-induced flow is only a trickle in these patients, but when the limiting membranous web is cut, pancreatic secretions gush forth. Symptoms present before the operation are perceived as absent as soon as the pain of operation has subsided enough to allow assessment. Symptoms recur if the papillary orifice scars down and restenoses. Problems remain. Accurate selection of candidates for accessory papilla sphincteroplasty is not yet possible because of the lack of a highly reliable test for accessory papilla stenosis. The secretin-ultrasound test helps in this regard but still has a 10%-20% false positive rate and a 30%-35% false negative rate. The operation demands fine, precise, meticulous technique to avoid failure and the creation of even bigger problems with iatrogenic pancreatic duct obstruction. The final caveat is this: pancreas divisum as an anatomic form is common; pancreas divisum as a cause of pancreatic symptoms is very uncommon. Accessory papilla sphincteroplasty is no more a panacea for abdominal pain than sphincteroplasty of the major papilla has been. Nonetheless past failures do not negate the successes. With appropriate attention to patient selection and surgical technique, success can be the rule.
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PMID:Pancreas divisum: a case for surgical treatment. 348 79

In 104 patients with longstanding abdominal pain of unknown origin endoscopic pancreatography was carried through after a thorough noninvasive exploration (Secretin-CCK-test included). Pancreatography revealed in 18% slight but distinct-pathological changes at the pancreatic duct system compatible with chronic pancreatitis. As the frequency of the pathological pancreatographic findings showed no correlation with duration of pain history but a significant correlation with age it is suggested that the duct changes encountered represent rather age-dependent irrelevant fibrosis of the pancreas tan clinically relevant chronic pancreatitis. Slight pathological duct changes are by themselves no proof of chronic pancreatitis because there is no possibility to discriminate between chronic pancreatitis and age-dependent fibrosis on the ground of pancreatography. ERP therefore is of little or no value in patients with otherwise insubstantial suspicion of chronic pancreatitis.
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PMID:[Frequency and significance of inflammatory pancreatic duct changes in patients with upper abdominal pain of unknown origin]. 712 18

Pancreas divisum is found in 5% of the population. It is linked to three clinical entities; recurrent epigastric pain, and acute and chronic pancreatitis. The relation between chronic pancreatitis and pancreas divisum is, however, uncertain. Pancreas divisum is controversial as a cause of acute pancreatitis and abdominal pain. However, this association probably exists as surgical sphincteroplasty of the minor papilla alleviate symptoms in a high proportion of patients. We have treated two patients surgically. Patient 1 was hospitalized 11 times because of recurrent acute pancreatitis. Two and a half years after sphincteroplasty he has had no further attacks of abdominal pain. Patient 2 had had recurrent epigastric pain, mostly related to meals, since early childhood. Secretin stimulation initially showed normal pancreatic duct dilatation and emptying. After sphincteroplasty, and reoperation for stricture, she can eat normally without pain one year after the last operation. We conclude that in selected patients surgical treatment of symptomatic pancreas divisum is beneficial. Sphincteroplasty should be considered as treatment in patients with pancreas divisum and recurrent acute pancreatitis or pain, as long as other causes are excluded.
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PMID:[Surgical treatment of symptomatic pancreas divisum]. 777 Aug 33

In a small number of patients with pancreas divisum (with stenotic minor papilla) a relative obstruction to pancreatic exocrine secretory flow results in pancreatitis. We report a 2-year-old boy presenting with recurrent bouts of abdominal pain. The diagnosis of acute pancreatitis was made based on blood biochemistry results. Ultrasound, computed tomography and magnetic resonance imaging showed several abdominal pseudocysts, peritoneal exsudate and confirmed pancreatitis but initially failed to reveal the aetiology. Ascites and cysts contained pancreatic enzymes. After weeks of combined conservative and surgical treatment, a magnetic resonance cholangiopancreaticography with secretin, showed a pancreas divisum with a cyst between the ducts of Santorini and Wirsung. Based on these findings, two endoscopic papillotomies (minor and major papilla) were performed. Three years follow-up was uneventful. In a child with recurrent pancreatitis or pancreatitis with chronic recurrent abdominal pain it is crucial to search aggressively for congenital abnormalities, including pancreas divisum. Secretin-enhanced magnetic resonance cholangiopancreaticography or diffusion-weighted magnetic resonance imaging is a valuable diagnostic tool for visualizing pancreatic duct anatomy.
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PMID:A two-year old boy with recurrent bouts of acute abdominal pain. 2129 65