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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have prospectively studied all cholecystectomies performed in one year in our clinic in two groups: 190 cases performed laparoscopically and 98 open. We used standardized records and the EPI 5 program on an IBM compatible computer. There were no significant differences between groups regarding weight, sex and proportion of cases with acute cholecystitis. There were however major differences regarding age, type of habitat, ASA score and association with acute pancreatitis, obstructive jaundice and angiocholitis. Conversion of laparoscopic cholecystectomy to open procedure was imposed in 17 cases (not included in statistical analysis) due to technical difficulties (12 cases), haemorrhagic accidents (6 cases), injury of the common bile duct (1 case), stones lost in the abdominal cavity (3 cases), local peritonitis (5 cases). Laparoscopic cholecystectomy lasted a mean of 74 minutes. We encountered 3 specific complications: one CBD injury recognized intraoperatively and managed by Kehr's procedure (one CBD injury in the open cholecystectomy group), one small bowel perforation and one of biloma. Mortality averaged 0.5% in the LC group (one case of late postoperative stroke considered not related to the procedure) and 1% in the open cholecystectomy group. The hospital admission period was significantly reduced in the LC group (5 days vs. 12 days). LC appears as a safe procedure with a low complication rate. Conversion to open procedure is not a complication. Our study recommend LC as the method of choice in the treatment of gallbladder lithiasis.
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PMID:[The value of laparoscopic cholecystectomy in the treatment of gallbladder pathologies]. 945 51

ERCP and sphincterotomy (EPT) are well accepted as the procedure of choice for diagnostic and therapeutic purposes of extrahepatic biliary obstructions. In case of obstructive jaundice and biliary sepsis urgent sphincterotomy is the method of choice, also during acute pancreatitis. The question has been debated whether endoscopic sphincterotomy improves the prognosis of acute (e.g. biliary) pancreatitis itself. With regard to biliary problems different causes of pancreatitis should be distinguished: If the cause of pancreatitis is not obstructive like biliary pancreatitis but metabolic or toxic like alcoholic pancreatitis, no sphincterotomy is indicated. With regard to biliary pancreatitis three prospective randomised trials have been published. All agree to an urgent endoscopic treatment of biliary complications like obstructive jaundice or biliary sepsis during acute pancreatitis. Two of these studies did not find any benefit of interventional endoscopy concerning local or systemic complications of pancreatitis but observed a benefit concerning biliary complications. In one study including patients with biliary problems the complication rate but not mortality rate has been diminished by endoscopy in a subgroup of patients. It is concluded that urgency of ERCP in patients with acute pancreatitis depends on biliary symptoms. Sphincterotomy cannot be generally recommended for acute pancreatitis but only for biliary complications.
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PMID:Endoscopic sphincterotomy for acute pancreatitis: arguments against. 983 18

The standard treatment of acute pancreatitis is primarily supportive, including a well standardized conservative therapy and additionally specific interventions in complicated disease. The role of early endoscopic retrograde cholangiopancreatography in acute pancreatitis has been discussed for about 20 years. The etiology of pancreatitis plays an important role in making the decision for early interventional treatment. The results of clinical trials about early interventional treatment of acute biliary pancreatitis demonstrate that the outcome of patients without signs of biliary stone impaction or acute cholangitis is burdened by more severe complications than in patients treated conservatively. Urgent endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy and stone extraction within 72 hours of admission reduces the frequency of major complications only in patients with acute biliary pancreatitis with obstructive jaundice or biliary sepsis.
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PMID:[How to proceed? ERCP in acute pancreatitis?]. 1006 2

Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.
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PMID:Obstructive jaundice and acute cholangitis due to papillary stenosis. 1033 25

The views upon the value of general antiprotease capacity of the blood in evaluation of endotoxicosis in purulent-inflammatory processes of the abdominal cavity are presented. One hundred and thirty one patient with diffuse peritonitis, acute pancreatitis and obstructive jaundice was examined. A role of bacterial proteases in exhaustion of the inhibitors at the example of Pseudomonas aeruginosa strain has been established. Use of protease inhibitors (contrykal etc.) only for strict indications is substantiated.
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PMID:[The clinico-diagnostic significance of the general antiprotease capacity of the blood in assessing endotoxicosis in suppurative-inflammatory diseases of the abdominal cavity organs]. 1091 55

When assessing the indications for interventional endoscopy, obstructive and non-obstructive causes of acute pancreatitis should be distinguished. In non-obstructive (e.g. alcoholic) pancreatitis, no data are available proving any benefit for endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. In obstructive (e.g. biliary) pancreatitis, the pathogenetic role of gallstones is controversial. The vast majority of gallstones initiating biliary pancreatitis pass spontaneously through the papilla of Vater into the duodenum without causing cholangitis or obstructive jaundice. Three prospective randomized published studies have attempted to answer the question of whether urgent removal of the stone improves the prognosis of patients suffering from acute pancreatitis. From these studies it can be concluded that the use of ERCP in acute biliary pancreatitis should depend on biliary symptoms: in cases of obstructive jaundice or cholangitis, bile duct stones should be removed as soon as possible; in patients without biliary complications, emergency ERCP is neither beneficial nor cost-effective; if retained stones (without biliary complications) are suspected, they can be removed electively.
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PMID:Role of ERCP and endoscopic sphincterotomy in acute pancreatitis. 1103 Jun 10

Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and high mortality. We have prospectively analyzed patients with liver disease and ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Other than hepatorenal syndrome patients, out of 221 cases, 66 developed ARF secondary to various liver disease like cirrhosis (n = 29, mortality 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.05), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), drugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemia. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatinine p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, oliguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortality 5, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), acute pancreatitis (n = 12, mortality 4, risk factors-higher bilirubin p < 0.001, higher SGPT p < 0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), CuSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors higher creatinine p < 0.05 and SGPT p < 0.01), ARF following delivery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bilirubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n= 14 mortality 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or peritoneal dialysis. ARF associated with liver disease is having high mortality (42.5%). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, with promote dialytic support are necessary to reduce mortality and morbidity.
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PMID:Acute renal failure associated with liver disease in India: etiology and outcome. 1104 Dec 94

We present a patient with duodenal papillary carcinoma who repeatedly developed acute pancreatitis preoperatively. The patient was a 65-year-old male. In February 1997, the patient consulted a local hospital due to vomiting, high fever, and jaundice. With the diagnosis of obstructive jaundice, percutaneous transhepatic biliary drainage (PTBD) was performed, revealing a distal bile duct obstruction. Because duodenal papillary carcinoma was diagnosed based on endoscopic findings, the patient was admitted to Kurume University Hospital. Hypotonic duodenography (HDG) disclosed a protruding lesion with an irregular surface in the descending part of the duodenum, resulting in a diagnosis of positive duodenal invasion (du1). Because computed tomography (CT) demonstrated a protruding lesion on the medial side of the second portion of the duodenum, positive pancreatic invasion (panc2) was diagnosed. On March 18 and April 22, sudden abdominal pain, leukocytosis, and an increase in serum amylase were noted. CT revealed that the pancreas was diffusely enlarged, showing an ill-defined boundary between the pancreas and adipose tissue and fluid collection. On CT, the lesion was evaluated as Grade 3 and moderate. For treatment, pancreatic enzyme inhibitors and antibiotics were intravenously injected. Peritoneal perfusion was concomitantly performed during the second treatment. Because symptoms remitted thereafter, a pylorus preserving pancreatoduodenectomy (PpPD) was carried out. The postoperative histologic examination revealed negative pancreatic invasion. Concerning the etiology of acute pancreatitis, not pancreatic invasion, but impaction of the liberated tumor mass in the common canal was considered responsible for the repeated pancreatitis because the tumor showed a cauliflower-like shape.
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PMID:A case of duodenal papillary carcinoma complicated by repeated acute pancreatitis. 1105 25

Results of treatment of some surgical diseases of the hepatopancreatoduodenal zone organs using transcutaneous intervention under the ultrasonic investigation control were analyzed. There were confirmed their high efficacy in the treatment of focal purulent diseases, hepatic cyst, possibility of application as primary surgical manipulation in treatment of destructive forms of an acute pancreatitis and in external drainage of biliary ducts for obstructive jaundice. Perspective trends of the method usage were determined.
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PMID:[Transcutaneous interventions under the ultrasonographic investigation control of organs of hepato-pancreatic-biliary zone]. 1183 23

An obstruction of the afferent loop after Billroth-II-resection is an extremely rare late complication of this procedure. We report on a 76-year-old female patient with a history of Billroth-II-resection 11 years ago who was admitted due to acute pancreatitis and obstructive jaundice. Abdominal sonography lead to the suspicion of a dilated afferent loop, which could be proven by means of magnetic resonance imaging. A tumorous lesion as cause of the obstructive jaundice was not detectable. Intraoperatively a volvulus of the small intestine and strangling adhesions near the Braun's anastomosis were seen, causing the obstruction of the afferent loop. Following reposition of the small intestine and adhesiolysis the patient gained a quick relief of symptoms and the jaundice disappeared completely.
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PMID:[Obstructive jaundice and acute pancreatitis due to an obstruction of the afferent loop after billroth-II-resection]. 1185 2


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