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

Perforation of the gallbladder is a life-threatening complication of acute cholecystitis that is often difficult to diagnose at an early stage. Standard radiographic and laboratory tests have not been reliable in identifying patients with this complication. In contrast, biliary sonography correctly diagnosed pericholecystic abscesses preoperatively in three patients with acute cholecystitis. The ultrasonic appearance of acute cholecystitis with a pericholecystic abscess was similar in all three patients. There was an extraluminal fluid collection located contiguous to a thick-walled gallbladder in the fundic region. The fluid collection was constant in location and could be seen in at least two different views. Two of these three patients had acalculous cholecystitis; the initial clinical diagnosis in one was pancreatitis, and in the other alcoholic hepatitis. Biliary sonography, by demonstrating a thickened gallbladder wall in the absence of ascites, strongly suggested that these two patients had acute acalculous cholecystitis, and not hepatitis or pancreatitis. The ultrasonic examination was a critical factor in the decision for prompt surgery instead of continued nonoperative management in these patients. These data suggest that not only can biliary sonography aid in the diagnosis of acute cholecystitis, calculous as well as acalculous, but can also visualize a pericholecystic abscess when it is present.
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PMID:Ultrasonic detection of acute cholecystitis with pericholecystic abscesses. 701 38

In the Cape Town Children's Hospital ascariasis is the commonest cause for an acute abdominal emergency; over a thousand cases have been admitted with ascariasis to the paediatric surgical wards. There was a high incidence of biliary ascariasis (424 cases) and routine intravenous cholangiography should be performed in all children with abdominal pain where ascariasis is suspected. The normal host/parasite relationship is described and the frequent invasion of the ampulla of Vater by the worm is discussed. The typical worm biliary colic is described and the classical surgical findings reported. The radiographic, ultrasonic and duodenoscopic diagnoses of the disease are evaluated. The management of the patient is described. Ninety-five percent of them were uncomplicated cases, but in 20 or 5% of the patients complications arose, the most important of them being ascariasis cholangitis, pyogenic cholangitis, perforation of the bile duct, cholecystitis and pancreatitis. The diagnosis and surgical management of these complications are described in some detail.
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PMID:Biliary ascariasis in children. 714 48

Two cases of acute pancreatitis in pregnancy are reported together with a short review of the literature relating to this condition. Gallstones, cholecystitis or alcoholism were not at hand in our patients and no other etiologic factor of the pancreatitis than the pregnancy could be found. Both patients developed pancreatic pseudocysts. Our first patient delivered a stillborn baby in the 29th week of pregnancy and our second patient delivered a normal baby in week 38. Even if acute pancreatitis in pregnancy is rare it is important to be aware of the condition especially in the first trimester when it should be considered in differential diagnosis of hyperemesis gravidarum.
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PMID:Acute pancreatitis in pregnancy. Report of two cases. 719 93

A 40-year-old woman presented with acute epigastric pain with vomiting. Within 24 hours, the pain spread to the right periumbilical region. Tc-99m disofenin hepatobiliary scan failed to demonstrate the gallbladder on a 60-minute view. The presumative diagnosis of acute cholecystitis was thought to be confirmed on this basis by the patient's physicians. However, a 75-minute view demonstrated filling of the gallbladder. In hepatobiliary scanning for acute abdominal pain, delayed views (2 to 24 hours) are recommended when the gallbladder is not visualized on the 60-minute view. If the gallbladder is visualized, cystic duct obstruction can be excluded and diagnoses such as pancreatitis, acalculous cholecystitis, and acute appendicitis should be investigated.
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PMID:Hepatobiliary scan with delayed gallbladder visualization in a case of acute appendicitis. 720 Aug 46

In patients with suspected severe acute pancreatitis and known or suspected cholelithiasis, it may be extremely difficult to exclude the diagnosis of gangrenous cholecystitis or obstructive cholangitis by nonoperative means. Since early intra-abdominal surgery has, in our experience, led to markedly increased morbidity in patients with gallstone pancreatitis, non-operative visualization of the biliary tree by percutaneous transhepatic Chiba-needle cholangiography (PTCNC) has been evaluated in 14 patients with suspected acute pancreatitis in whom life-threatening acute biliary disease could not be excluded by other nonoperative means. The final diagnosis was acute pancreatitis in nine patients (Group A) (mean serum amylase 3242 SU%) and acute biliary disease with hyperamylasemia in five patients (Group B) (mean serum amylase 2084 SU%). PTCNC made visualization of the biliary system possible in all patients and excluded the diagnosis of cystic duct or common duct obstruction in each case. Following PTCNC, potentially hazardous early laparotomy was avoided in eight of nine Group A patients. Biliary surgery was undertaken on day 3 to 13 in four Group B patients. When early laparotomy may be needed to evaluate or treat possible life-threatening acute biliary disease but is considered undesirable because of possible acute pancreatitis. PTCNC appears to be a safe and effective nonoperative method of obtaining precise anatomical delineation of the biliary tree.
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PMID:The role of Chiba-needle cholangiography in the diagnosis of possible acute pancreatitis with cholelithiasis. 721 1

The authors propose a new model of acute pancreatitis by infusing duodenal content, obtained both from animals with experimental pancreatitis and from patients with pancreatitis, hepatitis and cholecystitis, into the duodenum of experimental animals without pressure for a period of several days. Pancreatitis was established functionally and histomorphologically. The control group of animals did not reveal deviations from the norm after infusion of duodenal content. The authors suggested the presence of pathogenic substances in the duodenal content of animals and sick persons, and these components damaged the pancreas, liver and kidneys by means of blood and lymph ways.
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PMID:[New model of acute pancreatitis]. 722 80

Ultrasonography is an effective and accurate diagnostic test for acalculous cholecystitis. Until recently, however, little attention was focused on the gallbladder wall as an indicator of disease. By accurately visualizing and measuring the gallbladder wall, ultrasonography can be used to screen patients in whom acute acalculous cholecystitis is suspected. If the gallbladder wall measures 3.5 mm or greater, in the absence of ascites, a diagnosis of acalculous cholecystitis can be made safely with a specificity greater than 98 percent. Four of our five patients with acute acalculous cholecystitis had ultrasonically measured gallbladder walls 3.5 mm or greater in width. We have found ultrasonography useful in any clinical situation, even in the face of ileus, jaundice or pancreatitis. In addition, with the use of the portable real-time ultrasound machine, postoperative, traumatized and other critically ill patients can be examined at the bedside.
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PMID:Acute acalculous cholecystitis. Ultrasonic diagnosis. 725 43

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

Prospective analysis of the first three hundred patients who underwent laparoscopic cholecystectomy was carried out in three surgical centres of Hong Kong. Over a 20-month period, 300 consecutive patients were recruited, including elective and emergency cases. The indications for laparoscopic cholecystectomy were symptomatic gallstones (78%), cholangitis (6%), pancreatitis (5%) and cholecystitis (11%). Patients with common duct stones (12) had preoperative endoscopic sphincterotomy and stone extraction prior to cholecystectomy. Laparoscopic cholecystectomy was accomplished successfully in 287 patients. Thirteen patients (4.3%) required conversion to open cholecystectomy. The reasons for conversion were: inability to identify cystic duct and common bile duct clearly (6); bleeding (5); Mirizzi syndrome (1); and slippage of cystic duct clip (1). The median operation time was 80 min with a range of 28-270 min. The median hospital stay was 3 days. Seventy-five per cent of patients required only a single dose of pethidine injection. None of the patients required blood transfusion. The overall complication rate was 7%. These included mild cellulitis of the subumbilical wound (3%) and postoperative chest infection (3%). One patient developed subphrenic abscess which resolved on percutaneous drainage under ultrasound guidance. Iatrogenic injury to the common bile duct was seen in one patient who had an impacted stone at Hartmann's pouch. With adequate training laparoscopic cholecystectomy can be performed safely. The advantages over open cholecystectomy are less wound pain, better cosmesis and shorter convalescence.
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PMID:Laparoscopic cholecystectomy: results of first 300 cases in Hong Kong. 751 26

We used serial weekly ultrasonography to prospectively screen 19 critically ill trauma victims for the development of biliary sludge. Fourteen patients had sludge formation during their hospitalization. Sludge development was positively associated with increased transfusion requirements, but not with any other laboratory or clinical findings, including injury severity scores. The enteral feedings administered to most patients did not prevent sludge formation in the majority of cases; all five patients receiving total parenteral nutrition had sludge. Three patients had complications that could possibly be attributed to the sludge (one case of acalculous cholecystitis and two cases of mild pancreatitis). No such problems occurred in the five patients who did not have sludge. No long-term clinical problems related to sludge have occurred. We conclude that gallbladder sludge frequently develops in critically ill trauma patients and that sludge may be associated with pancreatobiliary complications.
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PMID:Biliary sludging in critically ill trauma patients. 748 1


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