Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 93-year-old woman admitted because of epigastralgia. Cholelithiasis, obstructive jaundice, acute suppurative cholangitis and acute pancreatitis were diagnosed on blood chemistry and ultrasonography on admission. We performed emergency PTCD. A calculus 4 cm in diameter was detected at the papilla of Vater and marked dilatation of the common bile duct and pancreatic duct. ESWL was performed because of her age and because endoscopical operation seemed to be difficult. After lithotripsy, PTC and endoscopy demonstrated a diverticulum at the peripapillary portion of the duodenum. Based on analysis of PTC result before and after ESWL, we diagnosed this case as Lemmel's syndrome (obstructive jaundice, acute suppurative cholangitis and acute pancreatitis) caused by a large diverticular enterolith at the peripapillary portion of the duodenum. ESWL treatment of aged patient with an enterolith is safe.
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PMID:[A case of Lemmel's syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum]. 886 45

Endoscopic manometry was performed to evaluate the motor activity of the sphincter of Oddi (OS) in six patients with Lemmel's syndrome, four of whom had acute cholangitis and two of whom had acute pancreatitis. As controls, 24 patients undergoing cholecystectomy without juxtapapillary duodenal diverticula (JPD) for cholelithiasis or cholesterol polyps in the gallbladder were also studied. The OS basal pressure and contraction pressure values were 12.4 +/- 5.1 mmHg and 103.4 +/- 24.3 mmHg, respectively, in the patients with Lemmel's syndrome, and 19.5 +/- 5.1 mmHg and 136.8 +/- 28.2 mmHg, respectively, in the control patients. These differences between the groups were statistically significant; however, the wave frequency was not significantly different between the groups. The mean percentages of antegrade, simultaneous, and retrograde sequences were 37.5% +/- 11.3%, 19.9% +/- 8.7%, and 43.4% +/- 11.7%, respectively, in the patients with Lemmel's syndrome, and 66.5% +/- 11.0%, 20.2% +/- 4.7%, and 14.3% +/- 9.2%, respectively, in the controls. The differences between the groups were significant (P < 0.01) for the antegrade and retrograde sequences. These findings indicate that dysfunction of the OS in patients with Lemmel's syndrome could be important in the development of hepatocholangiopancreatic disease caused by duodenobiliary and duodenopancreatic reflux.
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PMID:Endoscopic manometry of the sphincter of Oddi in patients with Lemmel's syndrome. 954 5

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

Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum in the absence of choledocholithiasis or tumour. Periampular duodenal diverticula are usually incidental findings, but they can be complicated. We present two cases. The first is a 79-year-old woman with hypertension and chronic kidney disease who starts with epigastric pain. Blood tests show cholestasis and a rise in bilirubin and pancreatic enzymes. Abdominal computed tomography with contrast confirms biliary dilation, parapapillary duodenal diverticulum and acute pancreatitis. Follow-up is decided. The second case is an 80-year-old man, without previous illness, with abdominal pain, fever and jaundice. Magnetic resonance cholangiopancreatography shows a 4 cm duodenal diverticulum displacing bile and pancreatic duct. ERCP is performed with the placement of a plastic biliary stent. The etiopathogenic theories of Lemmel syndrome are chronic ampullar inflammation, Oddi sphincter dysfunction due to the diverticulum or direct compression by diverticular content. The diagnosis of Lemmel syndrome is a challenge. It can be diagnosed by imaging tests, although the gold standard for diagnosis and treatment is ERCP.
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PMID:Lemmel syndrome: an uncommon complication of periampular duodenal diverticulum. 3326 3