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

The purpose of this review is to evaluate our current knowledge of the embryologic etiology of pancreaticobiliary maljunction (PBM), its diagnosis, clinical aspects, and treatment, and to clarify the mechanisms of PBM involvement in carcinogenesis. Although the embryologic etiology of PBM still awaits clarification, an arrest of the migration of the common duct of the biliary and pancreatic ducts inwards in the duodenal wall has hitherto been speculated to result in a long common channel in PBM. However, we propose the hypothesis that the etiology of PBM is caused by a disturbance in the embryonic connections (misarrangement) of the choledochopancreatic duct system in the extremely early embryo. That is, PBM is an anomaly caused by a misarrangement whereby the terminal bile duct joins with a branch of the ventral pancreatic duct system, including the main pancreatic duct. PBM is frequently associated with congenital bile duct cyst (CCBD). However, these two anomalies are thought to have different embryonic etiologies. The diagnostic criteria for PBM are the radiological and anatomical detection of the extramural location of the junction of the pancreatic and biliary ducts in the duodenal wall. However, in PBM patients with a short common duct (less than 1 cm in length), detection of the extramural location is difficult. The clinical features of PBM are intermittent abdominal pain, with or without elevation of pancreatic enzyme levels; and obstructive jaundice, with or without acute pancreatitis, while the clinical features of PBM patients with CCBD are primary bile duct stone and acute cholangitis. The optimum approach for the treatment of PBM is the prevention of the reciprocal reflux of bile and pancreatic juice in the pancreas and the bile duct system. To achieve these aims, the surgical approach is most effective, and complete biliary diversion procedures with bile duct resection (for example, choledochoduodenostomy or choledochojejunostomy of the Roux-en-Y type) are most useful. Recently, it has been recognized that the development of biliary ductal carcinoma is associated with PBM. That is, the development of gallbladder cancer occurs frequently in PBM patients without CCBD, and bile duct cancer originating from the cyst wall also occurs in PBM patients with CCBD. It is speculated that the pathogenesis of the bile duct or gallbladder cancer in PBM patients involves the reciprocal reflux of bile and pancreatic juice. Investigations of epithelial cell proliferation in the gallbladder of PBM patients, and of K- ras mutations and p53 suppressor gene mutations, loss of heterozygosity of p53, and overexpression of the p53 gene product in gallbladder cancer and noncancerous lesions in PBM patients have been carried out in various laboratories around the world. The results support the conclusion that PBM is a high risk factor for the development of bile duct carcinoma.
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PMID:Recent advances in pancreaticobiliary maljunction. 1202 97

Obstructive jaundice is consequence of several diseases of biliary ducts which cause biliary stasis. Constant finding is jaundice on skin and visible mucosal areas, acholic stool and dark urine. Obstruction could be permanent or intermittent. It could have rapid course with severe symptoms: biliary colics, signs of acute biliary ducts inflammation, acute pancreatitis or with atypical upper abdominal disorders. Asymptomatic biliary obstruction implies malignant disease. After initial clinical evaluation (history of disease, physical examination, biochemical analyses, ultrasound orientation) treatment of choice in diagnostic and management of biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP) proceeded with endoscopic sphincterotomy of sphincter Oddi. Further procedures depend on cause of obstruction.
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PMID:[Endoscopic therapy of biliary obstruction]. 1205 18

We report the first case of obstructive jaundice and acute pancreatitis caused by herniation of the small bowel through the foramen of Winslow in a 45-year-old man. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed dilated small-bowel loops positioned in the gastrohepatic space, dilatation of the gallbladder and both intrahepatic bile ducts, and mild swelling of the pancreas. A small-bowel series revealed a cluster of small-bowel loops in the mid-upper abdomen, with displacement of the stomach to the left. At laparotomy, there was an internal herniation of jejunal loop through the defect of gastrocolic ligament into the lesser sac and finally passing through the foramen of Winslow. The common bile duct was compressed externally by the herniated bowel and the pancreas was mildly swollen. To the best of our knowledge, these complications of internal hernia have not been reported previously.
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PMID:Internal hernia presenting as obstructive jaundice and acute pancreatitis. 1260 75

Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.
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PMID:Surgical Treatment of Acute Pancreatitis. 1295 42

A duodenal duplication cyst is an uncommon congenital anomaly that is usually encountered during infancy or in early childhood. Duodenal duplication cysts generally appear on the first or second portion of the duodenum and may cause duodenal obstruction, hemorrhage or pancreatitis. Here, we report a case of a duodenal duplication cyst on the second and third portion of the duodenum in an old aged man with obstructive jaundice and acute pancreatitis, which was treated successfully by a surgical excision.
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PMID:Duodenal duplicated cyst manifested by acute pancreatitis and obstructive jaundice in an elderly man. 1530 56

A case of repeated obstructive jaundice and acute pancreatitis caused by mucus plug produced by metastatic liver tumor is reported. A 74-year-old woman, who had a past history of curative resection of mucinous rectal cancer, showed repeated obstructive jaundice and acute pancreatitis during the follow-up period. Neither computed tomographic scan nor abdominal ultrasound could detect the recurrent lesion, however, cholangioscopy detected mucin and tumor projection into the left hepatic duct. Since the biopsy specimen of the tumor revealed adenocarcinoma, left hepatectomy was performed. The tumor was mucinous adenocarcinoma having the same histology as the primary rectal cancer, with partly mucosal replacement and formation of intraluminal mucus plaque. This case indicates that repeated obstructive jaundice and acute pancreatitis should be considered one of the manifestations of liver metastasis of mucinous cancer.
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PMID:Repeated obstructive jaundice and acute pancreatitis caused by metastatic liver tumor: an unusual case. 1578 35

The individual surgical policy in the treatment of patients over 60 years of age with destructive cholecystitis was developed. Urgent radical surgical procedures using total intravenous anesthesia with endotracheal intubation and ALV were performed in patients with a low surgical and anesthetic risk and without concomitant acute pancreatitis and obstructive jaundice. Cholecystostomy and delayed cholecystectomy were performed in patients with these concomitant pathologies. Palliative operations were performed in patients with high surgical and anesthetic risk. Patients with disseminated peritonitis underwent cholecystectomy through laparotomy using total intravenous anesthesia with epidural blockade. Choice of method of cholecystectomy and anesthetic management depended on nature of concomitant diseases and complications. Proposed individual surgical policy permitted to decrease postoperative lethality to 0.8%.
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PMID:[Surgical approach for destructive cholecystitis in elderly and old patients]. 1604 21

Biliary pancreatitis accounts for 30 - 60% of all cases of acute pancreatitis. During the last ten years a number of randomized trials was implemented which evaluated the role of acute endoscopic retrograde cholangiopancreatography and papillosphincterotomy in the treatment of biliary pancreatitis. From analysis of different trials ensues that an urgent endoscopic operation is indicated unequivocally in patients with the acute form of biliary pancreatitis, furthermore in patients with concurrent cholangoitis or the presence of obstructive jaundice. The author assumes that, based on detailed analysis of the results, urgent endoscopic retrograde cholangiopancreatography can be recommended also in patients with the mild form of the disease provided the operation will be made within 12 hours after admission to hospital and that the operation will be implemented by an experienced endoscopist.
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PMID:[Acute biliary pancreatitis--endoscopic therapy yes or no?]. 1673 22

Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting (fish-mouth sign) and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.
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PMID:Pancreatitis complicating mucin-hypersecreting common bile duct adenoma. 1693 85

Intraduodenal diverticulum (IDD) is a rare congenital anomaly, arising at or near the papilla of Vater. Double common bile duct (DCBD) is another rare congenital anomaly of the biliary system. Recognition of these abnormalities is essential to prevent the development of lesions in the biliary system, as well as to avoid unnecessary surgical intervention. Although both conditions are often asymptomatic, severe clinical conditions may develop. Intraduodenal diverticulum should always be considered as a possible cause of pancreatitis of unknown etiology. We report a rare case of IDD with DCBD in a patient with Lemmel's syndrome, which consists of obstructive jaundice, acute pancreatitis, and suppurative cholangitis. The patient was treated successfully with a Roux-en-Y hepaticojejunostomy.
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PMID:Intraduodenal diverticulum associated with a double common bile duct causing recurrent pancreatitis and cholangitis: report of a case. 1738 66


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