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

The development of laparoscopic cholecystectomy is only justified if it can ensure the good results obtained by laparotomy. The purpose of this work is to study all complications which occurred in a homogeneous group of patients. From May 1988 to January 1993, we operated on 2006 patients by laparoscopy (724 men and 1282 women) with a mean age of 50.6 years. Signs of stones in the common bile duct were noted in 4.1% and acute cholecystitis was detected in 12.5%. A conversion to normal laparotomy was necessary in 2.1% of patients. All complications were systematically investigated restrospectively in any patient hospitalised for more than five days. Residual stones in the common bile duct were not taken into consideration when they were not complications obviously related to the operation. We observed five intraoperative complications (4 hemorrhages, 1 ileum puncture) and 40 postoperative complications (25 non biliary and 15 biliary). The 25 non biliary complications consisted of: 1 death by pulmonary embolism, 9 hemorrhages, 4 cases of acute pancreatitis, 4 subphrenic abscesses, 2 colon punctures, 2 parietal complications, 1 ulcer perforation, 1 myocardial infarction and 1 phlebitis. The 15 biliary complications consisted of: 3 lateral punctures of the common bile duct, 9 fistulas of the cystic duct (4 with a residual stone in the common bile duct and 5 without), 2 punctures of an abnormal right hepatic duct, one of which was treated by "Roux en Y loop" intestinal diversion, and a late stenosis of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Complications of celioscopic cholecystectomy in 2006 patients]. 773 88

The article generalizes experience (1986-1991) in the treatment of 246 patients with choledocholithiasis with the performance of endoscopic papillosphincterotomy. Most patients (61%) were over 60 years of age, many had serious concomitant diseases. Among patients with occlusion of the bile ducts, 53.6% had obstructive purulent cholangitis, 53.6% had acute biliary pancreatitis, and 30.9% had acute cholecystitis. Typical as well as atypical cannulation EPST was applied. To exclude an X-ray load on the patient and doctor, the orifices of the terminal part of the common bile duct and of the main pancreatic duct were identified in most patients by an elaborated method of cannulation with aspiration control without preliminary contrast X-ray examination. After EPST the concrements were removed completely in 194 and partly in 52 patients. Complications occurred in 35 patients (bleeding in 5, acute pancreatitis in 8, acute cholangitis in 6, acute cholecystitis in 8, perforation of the duodenum in 1, and wedging of Dormia's basket in 8 patients. Eight patients died after EPST from unresolved purulent cholangitis and multiple cholangitic abscesses of the liver. The long-term results were studied in follow-up periods of 12 months to 7 years. Recurrent cholelithiasis was encountered in 2 patients. On the basis of the accumulated experience we believe EPST to be the method of choice in the management of: residual and recurrent choledocholithiasis, patients with cholecystocholedocholithiasis and operation risk factors, patients with acute biliary pancreatitis and acute obstructive cholangitis.
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PMID:[Endoscopic removal of calculi from the choledochus. Are there debatable questions in this problem?]. 789 39

Transient electrocardiographic changes in patients with acute cholecystitis, pancreatitis, and pneumonia have been reported in the past. These changes usually are in the form of T-wave inversion, ST-segment depression, and rarely ST-segment elevation in the absence of coronary artery disease. To the authors' knowledge, this is the first report documenting both left ventricular segmental wall motion abnormality and electrocardiographic changes of myocardial injury in the presence of acute pancreatitis.
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PMID:Electrocardiographic and segmental wall motion abnormalities in pancreatitis mimicking myocardial infarction. 772 Feb 88

In about 95% of patients with acute cholecystitis the cystic duct is obstructed by a gall stone. The imprisoned bile salts have a toxic action on the gall bladder wall. Acute cholecystitis is liable to be confused with other causes of sudden pain and tenderness in the right hypochondrium. Below the diaphragm, acute retrocecal appendicitis, intestinal obstruction, a perforated peptic ulcer or acute pancreatitis may be confusing factors; however, the gall bladder remains shrunken, fibrotic, full of stones and nonfunctioning. Recurrent acute cholecystitis may follow, but there may be surprisingly long clinically silent periods. The treatment of choice is elective cholecystectomy. General measures include bed rest, intravenous fluids, a light diet and relief of pain with pethidine and buscopan. Antibiotics are given to treat septicemia and prevent peritonitis and empyema. During the first 24 h., 30% of the gall bladder cultures are positive. This rises to 80% after 72 h. Common infecting organisms are Escherichia coli, Streptococcus faecalis and Klebsiella, often in combination. Anaerobes are present, if sought, and are usually found with aerobes. They include Bacteroides and Clostridia. Antibiotic(s) should have a spectrum to cover the colonic type micro-organisms which are usually found with infection of the biliary tree. The choice depends upon the clinical picture. A broad-spectrum penicillin or a cephalosporin is usually adequate for the stable patient with pain and mild fever. The severely septicemic patient is better treated with a combination of ureidopenicillin (mezlocillin or piperacillin) and metronidazole.
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PMID:[Acute cholecystitis--conservative therapy]. 809 Oct 58

Tc-99m DISIDA cholescintigraphy is a highly sensitive and specific method of evaluating cystic duct obstruction in acute cholecystitis. It has also been argued that cholescintigraphy has high sensitivity in the differential diagnosis of gallstone pancreatitis due to cystic duct obstruction following gallstone migration. The purpose of this study was to evaluate the clinical availability of cholescintigraphy in acute pancreatitis. Tc-99m DISIDA cholescintigraphy performed in 18 patients with documented acute pancreatitis, including 11 gallstone and 7 nonbiliary, were reviewed. Abnormal scans were obtained in 82% (9/11) of acute gallstone pancreatitis, while only 29% (2/7) of acute nonbiliary pancreatitis had abnormal scan. These results demonstrated a significant difference with Fisher's exact test (p < 0.05). An abnormal cholescintigraphy had a sensitivity of 82%, a specificity of 71% and an accuracy of 78% in detecting gallstone pancreatitis. Ten cases of acute gallstone pancreatitis coincided with cholecystitis (2 cases of acute and chronic, and 8 cases of chronic). Both cases of acute nonbiliary pancreatitis with abnormal scan had total parenteral nutrition over 5 days. In conclusion, abnormal cholescintigraphy in acute pancreatitis indicates gallstone origin and may coincide with cholecystitis; while, a normal cholescintigraphy largely excludes such diagnoses.
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PMID:[Tc-99m cholescintigraphy in acute pancreatitis]. 817 83

Data of 5000 consecutive patients with biliary lithiasis operated on between 1970 and 1990 were recorded prospectively. There were 476 emergency procedures and 125 reoperations. Concomitant abdominal operations were performed in 504 patients. The mean(s.d.) age was 54.7(14.2) years. Cholecystectomy was performed in 4872 patients (97.4 per cent) and intraoperative cholangiography in 4400 (88.0 per cent). There were 612 operations for acute cholecystitis, 579 for common bile duct stones, 50 for acute pancreatitis and 29 reoperations following injury to the bile duct. Complications occurred in 527 patients (10.5 per cent). There was one injury (0.02 per cent) to the hepatic duct. The complication rate was 7.0 per cent following elective cholecystectomy and 17.4 per cent after emergency surgery. The mortality rate was zero after elective procedures and 0.8 per cent after emergency surgery; the mortality rate after concomitant abdominal operations (1.0 per cent) was unrelated to the biliary procedure. The mean(s.d.) hospital stay was 12.8(5.2) days.
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PMID:Prospective study of open cholecystectomy for calculous biliary disease. 831 84

Acute cholecystitis, acute cholangitis, and acute pancreatitis represent the most common biliary tract emergencies. Most are due to gallstones in the gallbladder and bile ducts. Acute cholecystitis is treated by surgery in most cases. Laparoscopic cholecystectomy combined with endoscopic sphincterotomy may become more common in the future for treatment of acute cholecystitis as well as in cases of acute cholangitis and pancreatitis if the bile ducts are cleared of gallstones. Although the role of either surgery or endoscopic treatment may be more clearly defined in some biliary tract emergencies, in other situations either modality may be appropriate or they may compliment each other. Most biliary emergencies should be managed by gastroenterologists, surgeons, and radiologists working together in a harmonious fashion.
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PMID:Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis. 837 14

To understand the surgical approach to acute abdominal pain, the internist must be familiar with common presentations of most abdominal emergencies; these emergencies include acute appendicitis, acute gall bladder disease (biliary colic, acute cholecystitis, and acute pancreatitis), ischemic bowel disease and ischemic colitis, abdominal aortic aneurysm, and intestinal obstruction. Nothing compares to experience; this article reviews the salient points that deserve consideration.
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PMID:An internist's approach to acute abdominal pain. 837 23

This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n = 6), small bowel (n = 4), duodenum (n = 2), stomach (n = 1), and esophagus (n = 1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.
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PMID:Gastrointestinal surgical emergencies following kidney transplantation. 849 65

Over a one year period (June 1992-June 1993), 260 patients (208 females and 52 males) with mean age of 37 years (range 13-80), underwent laparoscopic cholecystectomy (LC) for symptomatic gallstones. Thirty patients were admitted as emergency (20 acute cholecystitis, 10 acute pancreatitis). The procedure was performed successfully in 232 cases (89%). In 28 patients (18 electives, 10 emergencies), the procedure was converted to open for a variety of reasons, difficult anatomy being the commonest. Our mean operative time was 99.9 minutes (range 30-290 minutes). There were 3 major complications (2 common bile duct injuries and one abdominal aortic injury) and 4 minor complications (2 wound infections, one prolonged ileus and one chest infection). There was one death due to sickle cell crisis on the fifth post-operative day. The mean hospital stay was 2.3 days and 6.5 days for LC and converted cases, respectively. Our results suggest that laparoscopic cholecystectomy can be offered and conducted safely and effectively in the great majority of patients presenting acutely or electively with cholelithiasis, and that the results we achieved during the first year of our experience with LC is comparable to those reported from Europe and North America.
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PMID:Laparoscopic cholecystectomy: the Dammam Central Hospital experience. 853 Feb 20


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