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

Since April 1977, we have used splenorrhaphy as the procedure of choice for splenic trauma. To evaluate the efficacy of this procedure, we graded splenic injury based upon the extent of splenic repair in 77 patients with blunt abdominal trauma. This grading system is as follows: Grade 1-capsular treatment (five patients); Grade 2-capsular or parenchymal injuries requiring topical hemostatic agents (13 patients); Grade 3-parenchymal injuries requiring suture repair (nine patients); Grade 4-parenchymal injuries requiring partial splenic resection (seven patients); Grade 5-total splenic devascularization or uncontrollable bleeding from the splenic pedicle requiring splenectomy (43 patients). Twenty-nine patients had associated orthopedic injuries, and 42 patients had associated intra-abdominal or thoracic injuries. Mean operative time was 130 +/- 10 minutes. Operative time increased with severity of associated intra-abdominal injuries. Mean operative transfusion requirement was 500 +/- 100 cc of packed red blood cells. Transfusion requirements were not related to the severity of splenic injury. Twenty-three patients developed complications. Pancreatitis occurred in three patients, atelectasis of pneumonitis in eight patients, ten developed wound infections, and two patients required reoperation for small-bowel obstruction. Complication rates were not related to the degree of splenic injury. The grading system described herein provides a framework for sound clinical judgment and comparison of results in the management of splenic injuries.
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PMID:Evaluation of splenorrhaphy: a grading system for splenic trauma. 725 50

Nonspecific complications from staging laparotomy are usually related to general anesthesia or abdominal exploration. Specific complications for the procedure do exist: intubation difficulties during administration of anesthesia to patients with untreated mediastinal disease, sepsis in up to 20% of patients, depending on stage of disease and intensity of postoperative chemotherapy and radiotherapy, arterial and possibly venous thromboemboli from extensive retroperitoneal node dissection, pancreatitis, small bowel obstruction from adhesions to node biopsy sites, operative mishaps, subphrenic abscesses, and bleeding from liver biopsies. Certain patient subpopulations are at especially high risk for some of these complications and their identification and possible measures to minimize such problems are proposed.
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PMID:Complications from staging laparotomy for Hodgkin disease. 725 52

Peutz-Jeghers syndrome is characterized by hamartomatous polyposis of the small and large bowel and mucocutaneous pigmentation. The authors describe a 9-year-old girl with small bowel obstruction related to duodenal intussusception caused by polyposis in the fourth portion of the duodenum. Operative reduction of the intussusception and excision of the polyps were performed, at which time the pancreas appeared to have mild pancreatitis. A liver biopsy specimen showed mild portal fibrosis and ductal proliferation. The patient did well postoperatively, but later presented with symptoms consistent with biliary obstruction. Percutaneous transhepatic cholangiography showed pancreatic and biliary duct dilatation as well as obstruction of the common bile duct, which extended into the left upper quadrant. Exploration showed ampullary obstruction several centimeters proximal to the line of resection. Sphincteroplasty was performed. The postoperative course was uncomplicated. The authors conclude that Peutz-Jeghers syndrome with polyps in the duodenum can markedly distort duodenal and ductal anatomy and can lead to ampullary obstruction.
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PMID:Common bile duct obstruction related to intestinal polyposis in a child with Peutz-Jeghers syndrome. 787 37

Duodenal malformations are the third commonest cause of intestinal obstruction in infants. A spectrum of intrinsic obstructive lesions within the duodenum ranges from atresia to congenital bands. Rarely, duodenal malformations may first present in adulthood. Less than 70 cases of duodenal web presenting in an adult have been reported in the literature. In 10 patients the presentation was associated with pancreatitis. We report a case of congenital duodenal web associated with pancreas divisum which first presented in an adult with the clinical characteristics of recurrent acute pancreatitis.
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PMID:Duodenal web and pancreas divisum causing pancreatitis in an adult. 815 90

From 1986 to 1990, 26 patients with blunt renal trauma were hospitalized and received surgery in this Hospital. Included were 23 males and 3 females with a mean age of 28.6 years (range: 5 to 82). The mean duration of follow-up was 37 months. The severity of renal injury was classified by using the renal injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) in 1989. According to operative findings, the renal injuries of the 26 cases were classified as follows: Grade I, 3 cases; Grade II, 4 cases; Grade III, 2 cases; Grade IV, 6 cases; and Grade V, 12 cases. One case had bilateral renal injuries. Among the patients, four were treated with drainage. Three cases underwent repair and drainage. One case was treated with partial nephrectomy. Nineteen cases underwent nephrectomy. The mortality rate was 7.6% and the morbidity rate, 15.2%. The most frequent postoperative complications related to renal injury in the patients who survived initial operation were intra-abdominal abscesses (3.8%), small bowel obstruction (3.8%), pulmonary infection (3.8%) and pancreatitis (3.8%).
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PMID:[Surgical management of blunt renal trauma]. 825 60

Early postoperative small bowel obstruction (SBO) is a known complication of intestinal surgery, but its frequency, etiology, and morbidity after abdominal aortic procedures have not been reported. To study this complication, the records of 1475 patients who had an abdominal aortic operation for aneurysmal (n = 818) or occlusive (n = 657) disease on a private surgical service from 1963 to 1990 were reviewed. Forty-four patients (2.9%) developed a postoperative SBO. Small bowel obstruction occurred from 4 to 28 (mean 6) days postoperatively. All patients were treated with nasogastric suction. Eighteen of the 44 (41%) required reoperation from 6 to 30 (mean 14.2) days after the initial aortic procedure. All 18 had lysis of adhesions, and two required small bowel resections. There were no bowel infarctions and no late graft infections. Overall mortality was 5 per cent, and morbidity was 16 per cent. Incidence of pancreatitis in the entire series was 0.5 per cent, and incidence of colonic ischemia in the aneurysm group was 0.9 per cent. We conclude that 1) Early postoperative small bowel obstruction is an unusual complication of aortic surgery but is more frequent than other gastrointestinal complications such as intestinal ischemia and pancreatitis; 2) Management principles are similar to those for early postoperative bowel obstruction following other procedures; 3) Reoperation is required in nearly half of patients, particularly when SBO does not resolve within 2 weeks.
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PMID:Small bowel obstruction after abdominal aortic surgery. 825 41

From 1986 to 1990, 175 patients with blunt abdominal trauma were hospitalized and operated on in Kuang Tien General Hospital. Included were 140 males and 35 females with a mean age of 33 years (range: 2 to 82). The mean duration of the follow-up was 42 months. We classified the severity of the injured organs with the organ injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A. A. S. T.) in 1989 and 1990. Among the patients, 12 cases were treated with splenorrhaphy. Eighty-two cases underwent splenectomy. Four cases underwent partial resection of the liver. Three cases required repair of the inferior vena cava. Seventeen cases were treated with partial resection of the small intestine and anastomosis. Seven cases underwent colostomy. Three cases were treated with distal pancreatectomy. Nineteen cases underwent nephrectomy. One case was treated with partial nephrectomy. The mortality rate was 6.3%, and the morbidity rate 20.6%. The most frequent postoperative complications related to blunt abdominal trauma in the patients who survived the initial operation were wound infection (8.0%), small bowel obstruction (4.0%), pulmonary infection (2.3%), intra-abdominal abscesses (2.3%), pancreatitis (1.7%), pancreatic fistula (1.7%), and pseudocyst (0.6%).
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PMID:[Surgical management of blunt abdominal trauma]. 827 28

Experience in surgical treatment of 53 patients with internal biliodigestive fistulas is analysed. The formation of the fistula in all cases was caused by cholelithiasis with obstruction of the bile ducts, purulent cholangitis, angiocholitis, cholangiolytic abscesses of the liver, pancreatitis, hepatitis, as well as cholelithic ileus. Cholecystectomy, removal of the stones from the bile ducts, restoration of the main route of bile drainage, elimination of the pathological communication, and closure of the defect in a hollow organ should be considered the operation of choice. In cholelithic ileus operation for correction of the intestinal obstruction is also expedient. Postoperative complications were encountered in 35.8% of cases. Hepatorenal insufficiency developed in 8, incompetence of the choledochus sutures in 3, an external biliary fistula in 2, hepatic abscess in 1, pancreatitis in 2, and suppuration of the postoperative wound in 3 patients. Among the 53 patients treated by operation, 49 (92.5%) recovered and 4 (7.5%) died from various postoperative complications.
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PMID:[Internal biliodigestive fistulas]. 829 90

From 1986 to 1990, 22 patients with blunt pancreatic trauma were hospitalized and operated on in Kuang Tien General Hospital. Included were 19 males and 3 females with a mean age of 31 years (range: 2 to 58). The mean duration of the follow-up was 42 months. We classified the severity of pancreatic injury with the pancreatic organ injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) in 1990. According to the operative findings, the pancreatic injury of the 22 cases were classified as follows: grade I 8 cases, grade II 9 cases, grade III 4 cases, grade IV 1 case, and no grade V pancreatic injuries. Among the patients, 12 cases were treated with drainage. Seven cases underwent repair and drainage. Three cases were treated with distal pancreatectomy. The mortality rate was 18.2%, and the morbidity rate 40.9%. The most frequent postoperative complications related to the pancreatic injury in the patients who survived the initial operation were pancreatic fistula (13.7%), small bowel obstruction (9.2%), intraabdominal abscesses (4.5%), wound infection (4.5%), pancreatitis (4.5%), and pseudocyst (4.5%).
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PMID:[Surgical management of blunt pancreatic trauma]. 832 Jul 58

Over the past 14 years, 146 patients with penetrating colon trauma were managed by primary repair with/without resection (PR, n = 55), and by diverting colostomy (DC, n = 91). These groups did not differ in terms of age, ISS (Injury Severity Scale), PATI (Penetrating Abdominal Trauma Index), a-AIS (abdominal Abbreviated Injury Scale), or preoperative hypotension. No intergroup differences were manifested in intra-abdominal complications (fistula/leak, abscess, pancreatitis, intestinal obstruction, wound dehiscence). The percentage of patients who experienced at least one major intra-abdominal complication did not differ statistically when the two groups were compared--12.7% in PR versus 11% in DC--although risk in both groups increased with the additional number of organs injured. Wound infection was significantly higher (p < 0.05) in the PR group (19.6%) compared with the DC group (9.4%). Mortality in the PR and DC groups was 0% and 3.6%, respectively. One hundred and ten patients who underwent elective colostomy closure following trauma had a 9.1% intra-abdominal complication rate and a 3.6% wound infection rate. These risks should be considered when colostomy is selected to manage patients with penetrating colon injury. These data support primary repair of all colon injuries, reserving skin closure for patients with limited collateral damage.
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PMID:A convincing case for primary repair of penetrating colon injuries. 832 27


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