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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a 6-year period at the University Hospital in London, Ont., 101 patients underwent heart transplantation and 5 heart-lung transplantation. The authors review the general surgical problems identified from the charts of 13 of these patients. In the early postoperative period (within 30 days), laparotomy was required for pancreatitis (one), perforated peptic ulcer (two), cholecystectomy (one), pancreatic cyst (one) and appendicitis (one). In addition, a spontaneous colocutaneous fistula and spontaneous pneumoperitoneum occurred; both were managed conservatively. Later, three patients required cholecystectomy; one underwent a below-knee and a Symes amputation for dry gangrene and one surgical correction of a lymphocele. The incidence of surgical problems (13%) indicates an increased susceptibility in this group of patients. Four of the 13 patients died. Pancreatitis is a well-recognized complication of cardiac surgery; it is frequently associated with a normal or only slightly elevated serum amylase level, making a definitive diagnosis without laparotomy almost impossible. Persistence of abdominal signs should signal the need for exploratory surgery. During the early postoperative period and in the absence of multiorgan failure, immediate operation for an acute abdomen is usually successful. Despite the additional risk, cardiac transplantation does not preclude later surgery, but immunosuppression must be continued and carefully monitored.
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PMID:Management of general surgical problems after cardiac transplantation. 329 32

Twenty-nine children with acute pancreatitis were managed during the period 1971 to 1983. Aetiology included trauma (5), mumps (5), drug therapy (4), biliary disease (1), and cystic fibrosis (1); 13 cases were classified as idiopathic. Diagnosis could be difficult, and unnecessary laparotomies were performed in 7 instances for suspected appendicitis. One patient, however, had a well-justified laparotomy revealing coexisting severe appendicitis and pancreatitis. Morbidity included relapses (7), pseudocysts (3), obstructive duodenal hematoma (1), and miscellaneous problems (4). Improvements in management included endoscopic retrograde cholangio-pancreatography (ERCP) to exclude anatomical anomalies in relapsing cases, ultrasonography for the diagnosis of pseudocysts and for follow-up measurements in two such cases successfully managed conservatively, and increasing use of total parenteral nutrition in cases with protracted disease or serious complications.
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PMID:Acute pancreatitis in children. 388 28

In many respects abdominal pain in pregnancy is managed just as in a nonpregnant patient, but the diagnostic criteria, methods of diagnosis, therapy, and consequences of mismanagement differ. This article discusses appendicitis, cholecystitis, urolithiasis, pancreatitis, and intestinal obstruction--conditions that often manifest a similar clinical picture. The article presents epidemiologic data, distinguishing characteristics, modifications of the workup, and treatment appropriate to pregnancy and perinatal complications of each condition.
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PMID:Abdominal pain in pregnancy. 395 84

An audit of 150 consecutive cases of abdominal pain presenting to an urban teaching practice between October 1983 and May 1984 was performed. The median duration of pain prior to presentation was two days. Females predominated in all age groups.Eighty-nine per cent of these patients were managed entirely in the practice and of these, 52 per cent were managed with reassurance and advice alone, while 48 per cent also received a prescription. Only 15 per cent of patients were investigated in any way by the practice. Of the 17 patients (11 per cent) referred, nine were referred as emergencies and eight were admitted that day. However, there were only three true surgical emergencies in the entire series (one appendicitis, one intussusception and one fulminating pancreatitis).
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PMID:Audit of abdominal pain in general practice. 402 Jul 46

The aim of this report was to present an interesting surgically treated patient having a rare type III choledochal cyst with peculiar clinical course. Anatomically the cyst was a diverticulum of ampulla Vater. It contained stones and was lined by duodenal mucosa. At admission the patient had an actual, severe pancreatitis simulating appendicitis. Two laparotomies were done before the final successful cystoduodenostomy. Ultrasonography was the most illustrative and reliable preoperative diagnostic method.
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PMID:Congenital choledochal cyst opening into the intraduodenal part of the common bile duct and complicated by cystolithiasis and acute pancreatitis. 642 25

Changes in the pattern of disease managed by general surgeons in New Zealand, were assessed for the period 1940-80, using the public hospital admission and cancer incidence data of a representative selection of diseases. During the forty-year period, there was an increase in the incidence of four of the five cancers studied, and an increase in admission rate for non-specific abdominal pain, head injury (indicated by skull fracture), peripheral arterial disease (indicated by aortic aneurysm), gall-stone disease and pancreatitis, large bowel disorders and breast diseases. There was a decline in admission rate for appendicitis, stomach disorders and goitre.
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PMID:Changes in the pattern of disease managed by general surgeons in New Zealand, 1940-80. 659 23

Among 81 hospitalized patients with enteritis due to Campylobacter fetus ssp. jejuni, abdominal pain was found to be an outstanding symptom, being observed in half the patients on admission. In 16 patients pain was the main reason for admission and in 5 prompted laparotomy. In 4 cases appendicitis was suspected, but in only 2 was slight inflammation seen; in 1 of these, however, the inflammation could not be verified by microscopic examination. One patient was operated on because of intestinal occlusion, presumably due to Campylobacter enteritis. In 10 further cases a surgeon was consulted because the abdominal pains were at first suspected to be due to cholecystitis, pancreatitis or other abdominal emergencies. Thus, acute phase of Campylobacter infection may mimick acute abdominal emergency. The diagnosis is sometimes hampered by the late onset of diarrhoea or even by its total absence, as well as by the usual presence of abdominal tenderness and severe abdominal pains.
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PMID:Campylobacter enteritis mimicking acute abdominal emergency. 734 86

The timely diagnosis and treatment of intra-abdominal conditions during pregnancy can challenge the surgical consultant. Familiarity with the anatomic and physiologic changes present in normal pregnancy is essential, as is the knowledge of relative risk by trimester. The general surgeon will be called upon to diagnose and treat appendicitis, biliary tract disease (including pancreatitis), and liver disease. Knowledge of how these conditions become manifest is essential. The surgical consultant should be aware that virtually all complications that occur in the management of these conditions are caused by delay in the detection of the disease process.
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PMID:The surgical management of intra-abdominal inflammatory conditions during pregnancy. 785 15

Laparoscopic procedures have changed the indications for appendectomy. Routine exeresis should not be performed if a normal organ is observed during an exploratory procedure, but should be in cases with clinical manifestations of right flank pain since neurogenic appendicitis is not rare. We report a recent case observed in a 76-year-old woman. The patient was initially hospitalized for right flank pain with nausea and irregular episodes of diarrhoea. Clinical examination and complementary exploration led to cholecystectomy via subcostal access. On per-operative cholangiography the common bile duct appeared normal. Immediate follow-up was uneventful and the patient was discharged. Twelve days later, the patient complained of the same type of abdominal pain and was hospitalized with a fever at 38 degrees C and shivers. The right flank was very painful at palpation. Echography and computed tomography eliminated a subphrenic abscess or secondary pancreatitis. Pain localized at MacBurney's point 8 days later. Barium study showed a normal colon with the exception of uncomplicated diverticulosis. Subjective pain persisted and appendectomy was decided. Pathological examination revealed neurogenic appendicitis. First described in 1924, neurogenic appendicitis is relatively frequent. Macroscopically, a sclerous fibromyxomatous nodule obliterates the lumen. Microscopically, the central obliterating lesion is composed of hyperplastic nervous tissue in a fibromyxoid matrix, particularly important at the point of the appendix. Clinically neurogenic appendicitis is usually chronic and the appendix appears healthy in situ. Cure is always achieved with resection. Laparoscopic procedures can identify para-appendicular causes of painful abdominal syndromes and sclero-atrophic appendicitis, but in the absence of another explanation exeresis appears to be justified due to the possibility of neurogenic appendicitis.
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PMID:[Neurogenic appendicitis. A case]. 793 31

Abdominal sepsis after surgery is decreasing in incidence but has a high mortality, especially in those with other complicating factors. The most difficult abscesses to localize are those in intermesenteric folds. Pyrexia of unknown origin is much less of a clinical problem since the advent of ultrasound and computerized tomography (CT) scanning. Laparotomy still has an occasional role but laparoscopy should precede it and may be therapeutic using minimally invasive surgical techniques; for example, in appendicitis and cholecystitis. Pancreatitis remains a serious clinical problem in which imaging plays an important role. Percutaneous drainage has a similar morbidity and success rate to open drainage. In certain cases of diverticular disease it may obviate altogether the need for surgical resection. The differentiation between abscess and necrotic tumour is important, and CT is most helpful in this area.
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PMID:What is needed from imaging? The surgeon's point of view. 797 39


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