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

Two series from greater Stockholm consisting of 726 (1960 to 1968) and 1,000 (1977 to 1978) patients over age 70 years with acute abdominal complaints are presented. Almost two thirds were women. Acute cholecystitis dominated both series, but its incidence decreased from 40.8 to 26 percent in the later series. The incidence of malignant disease increased from 3 to 13.2 percent. About one third of the patients were operated on; 50 percent had postoperative complications. Some frequently occurring aberrations of the usual symptoms and signs in acute appendicitis, ileus, and perforated gastric duodenal ulcer are discussed. The overall therapeutic results improved, as judged by postoperative mortality (series I, 23.1; series II, 16 percent) and mortality associated with individual diseases (except for acute pancreatitis). However, total mortality only decreased from 14 to 11.3 percent due to the large number of malignant diseases in series II, which were associated with a mortality of 37.9 percent. In series II the median duration of stay was 10.5 days and 75 percent of the patients were discharged home.
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PMID:Acute abdominal disease in the elderly: experience from two series in Stockholm. 709 11

The occurrence of a postoperative complication represents an additional stress factor for patients and leads in many cases rapidly to a malnutrition status. Thus a nutritional support is required as soon as the foreseeable duration of starvation has a longer duration than one week. Considering its lower risk of septic complications and lower cost, enteral feeding should be initiated as soon as possible. Appraisal of caloric needs with standard formulas often leads to inappropriate nutritional management. Therefore the requirements should be assessed by indirect calorimetry if available. Nutritional support is a part of the management of a postoperative septic patient. It must be initiated when initial phase of haemodynamic instability is amended. Branched chain amino acids, medium chain triglycerides and other specific nutrients have failed to demonstrate a real clinical beneficial effect. In case of acute respiratory failure, nutritional support must be cautious with regard to caloric load, as carbohydrates may increase CO2 production and lipids may worsen hypoxaemia. In case of postoperative acute renal failure, nutritional management is facilitated by continuous haemofiltration techniques allowing an unlimited nutrient intake. Solutions containing only essential amino acids are not recommended. During severe acute pancreatitis, enteral feeding is indicated when ileus does not permit the use of the intestinal tract. Jejunal access must be preferred to stomach or duodenum. Lipid emulsions can be used safely if serum triglyceride concentrations remain below 4 g.L-1 during infusion and below 2 g.L-1 between infusions.
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PMID:[Effect of postoperative complications on nutritional status: therapeutic consequences]. 748 37

Pancreatic infection from gut-derived bacteria has emerged as the major cause of death in necrotizing pancreatitis. Bacterial overgrowth of indigenous enteric organisms as a consequence of guts stasis (ileus) represents a potential initial event in this process. The present study was designed to examine the interrelationships between intestinal transit, enteric bacteriology, and the translocation of bacteria from the gut lumen to mesenteric lymph nodes and splanchnic viscera during experimentally induced acute pancreatitis. Male rats underwent pancreaticobiliary duct ligation (PBDL) or sham surgery and were sacrificed after 24, 48, or 96 hr. Severity of pancreatitis was assessed with histology, tissue water content, and amylase and lipase levels. Intestinal transit was measured with fluorescent tracers. Blood, mesenteric lymph nodes (MLNs), splanchnic organs, and gut luminal contents were subjected to bacteriologic analysis. PBDL was followed by biochemical and histologic evidence of progressive pancreatic injury at each time interval. Enteric bacteria within the gut and in adjacent MLNs increased as intestinal transit decreased after PBDL-induced pancreatic inflammation. Surprisingly, all parameters returned to control levels by 96 hr in spite of progression of pancreatic inflammation.
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PMID:Intestinal transit and bacterial translocation in obstructive pancreatitis. 764 83

We report a patient with alcohol-induced necrotizing pancreatitis who developed a severe ileus followed by incarceration of a portion of the transverse colon within a ventral hernia. Laparotomy 9 days after the onset of symptoms revealed infarction of the transverse colon and infection of the pancreas. This is the first report of a case of acute pancreatitis that led to a strangulated ventral hernia of the colon. We believe that the enteric organisms that infected the pancreas originated in the incarcerated transverse colon.
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PMID:Strangulation of the colon complicating acute pancreatitis. 766 Nov 80

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

The diagnosis of acute pancreatitis is based on clinical examination and basic laboratory tests. The main role of sonography in acute pancreatitis is to evaluate gallstones and small fluid collections. However, sonography is frequently difficult due to intestinal ileus related to pancreatitis. CT is indicated early in the clinical course of acute severe pancreatitis when the diagnosis is uncertain or when complications such as abscess, hemorrhage, or necrosis, are suspected. In addition, CT may be used to assess the prognosis and follow-up of patients.
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PMID:[Acute pancreatitis]. 879 75

Intra-or extrapancreatic pseudocyst is a common local complication in pancreatitis. Pathological involvement of the colon secondary to acute and chronic pancreatitis is a rare complication of major clinical interest. Contiguity with the tail of the pancreas and certain anatomical relationships, particularly at the level of the peritoneal reflections, explain the involvement of, particularly, the left flexure of the colon and the adjacent part of the transverse colon. We report a patient, presenting with ileus resulting from pressure of a giant pseudocyst secondary to acute pancreatitis, to share the diagnostic and chronologic follow-up computed tomography (CT) scanning findings of this rare complication.
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PMID:Ileus secondary to pancreatic pseudocyst. 942 54

This was a prospective analysis of the first 162 patients who underwent biliary and nonbiliary minimally invasive (video laparoscopic) procedures in the Royal Commission Medical Centre (RCMC) over two periods separated by a one year interval (September 1993-September 1994)-(October 1995-February 1996). One hundred and fifty patients had video laparoscopic cholecystectomy (VLC). Thirty four males and 116 females with a mean age of 39.7 years (range 16-80). Forty two patients (28%) were admitted as emergency (37 acute cholecystitis, 5 acute pancreatitis). The indication for VLC was symptomatic gall stones. The VLC was accomplished successfully in 144 patients (96%). Six patients (2 electives and 4 emergency) required a conversion for various reasons, unfavourable anatomy being the commonest. Ten patients with preoperative evidence of a dilated common bile duct, with or without stones had an ERCP done in another hospital 200 km away. The median operative time was 100 minutes (range 30-270 minutes) There were three major complications (one CBD injury, one bleeding from gall bladder bed and one post operative acute pancreatitis) and 6 minor complications (urethral bleeding, atelectasis post-operative pyrexia, umbilical port cellulitis, prolonged ileus and acute anxiety state). The median hospital stay was 72 hours for successful VLC. Twenty five per cent of the patients did not require any narcotic analgesic. Twelve patients (7.4%) had one or another non-biliary video laparoscopic procedure. Our results suggest that VLC can be offered and performed safely in the majority of patients presenting with acute and/or chronic cholecystitis and that the results we achieved in a district hospital are comparable to other series. We conclude that VLC will continue to be demanded by patients and non-biliary video laparoscopic procedures which were slow to develop in our hospital will continue to need special training, interest and expertise before it can be adopted as a routine.
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PMID:Minimal invasive surgery: a district hospital experience. 974 97

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedematous and necrotizing pancreatitis. Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data. Persisting or progressive systemic or local organ complications occurring despite ICU-treatment are indicators for surgical management. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, surgical acute abdomen and persisting or progressing ileus should be treated surgically. The surgical technique is based on careful necrosectomy or debridement in combination with continuous or repeated surgical evacuation of necrotic tissue, bacteria and biologically active compounds. Necrosectomy and postoperative continuous local lavage resulted in a hospital mortality of 17% in necrotizing pancreatitis, conservative management of necrotizing pancreatitis in a hospital mortality of 6.3%. In 1442 patients treated in a 14-year period the overall hospital mortality was 4.4%.
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PMID:Surgical treatment of acute pancreatitis. 982 61

A 37-yr-old man underwent an open drainage operation for severe acute pancreatitis and received respiratory ventilation support for 4 mo because of respiratory failure based on disseminated intravascular coagulation (DIC) and septic shock. Under intensive care, he sometimes had bloody diarrhea for about 6 wk. Colonoscopic findings suggested that the bleeding had derived from the small intestine. The patient then gradually recovered from acute pancreatitis and was discharged from the hospital. Thereafter, he suffered relapses of ileus and his symptoms progressively worsened. The patient underwent a second operation about 2 yr after the onset of acute pancreatitis. At celiotomy, multiple stenoses of the distal ileum measuring about 60 cm in length were found and the segment was resected. The resected specimen demonstrated six separate circumferential strictures and shallow ulcerations. Histologically, multiple ulcerations were restricted to the mucosa and were accompanied by marked submucosal edema and fibrosis. The mucosa between the ulcers revealed chronic regenerative changes: intimal thickening of small mesenteric arteries causing luminal narrowing and organized thrombosis in small mesenteric veins. Therefore, these were considered to be a series of segmental ischemic lesions. Note that delayed ischemic stricture of the small intestine may occur as a chronic complication of acute pancreatitis.
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PMID:Ischemic stricture of the small intestine associated with acute pancreatitis. 987 59


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