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

Laparostomy is a well recognized strategy for the management of patients who have necrotizing pancreatitis and may require multiple re-intervention. The open wound can be left to heal through a process of granulation and contraction. This article describes intestinal obstruction secondary to entrapment of a loop of small bowel within the cicatrix of the contracting cutaneous scar. An awareness of the potential for entrapment of the small bowel in the healing scar is critical for clinicians using laparostomy in the management of acute necrotizing pancreatitis.
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PMID:Small-bowel obstruction secondary to subcutaneous small-bowel entrapment: a late complication of laparostomy for necrotizing pancreatitis. 1187 49

A 69-year-old man presented to the emergency department with a 12-hour history of severe abdominal pain. His medical history was significant for a small-bowel obstruction that resolved with conservative therapy 4 months prior to admission. In the distant past, a Billroth II gastric resection was performed for ulcer disease. He was hypothermic, and laboratory studies showed elevated serum liver and pancreatic enzymes. A CT scan of the abdomen demonstrated fat stranding and a small amount of free air in the area of the pancreas. Gram-negative rods subsequently grew from blood cultures. A presumptive diagnosis of necrotising pancreatitis was made, and supportive care was instituted. Follow-up CT scan performed several days later demonstrated a large filling defect in the stomach. Endoscopy showed this defect to be a giant gallstone, and the diagnosis of Bouveret's syndrome was made. The patient underwent laparotomy. A duodenal perforation in the posterior aspect of the fourth portion was identified. The perforation had been caused by chronic impaction of the giant stone. The stone was removed through the perforation, and the perforation was closed in multiple layers. Drainage of the retroperitoneum was effected through large catheters placed through the flank. The presentation, diagnostic evaluation, treatment, and complications of this condition are discussed.
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PMID:An unusual case of Bouveret's syndrome. 1190 65

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films--bowel obstruction, pneumoperitoneum, and the search of ureteral calculi--are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain.
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PMID:Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. 1219 63

Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum "ante perforationem". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.
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PMID:[Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen]. 1252 Aug 48

Authors operated on 416 patients for gastric cancer between 1st of June 1991 and 31st of May 2001. Among them 305 lesions were resectable. So the resection rate was 73.3 per cent. Gastrectomy was performed in 161 patients (52.8 per cent of resections). Total gastrectomy with omentectomy was performed in 44 patients. In 96 patients splenectomy, in 19 patients splenectomy with the resection of the left side of the pancreas, in 33 patients distal esophageal resection and in 8 patients other organ resection was performed with total gastrectomy. Standard, two field lymphadenectomy has been performed only in the past few years. Uneventful recovery followed in 100 cases (62 per cent), 61 patients (38 per cent) suffered complications in the postoperative period. The most frequent surgical complication was anastomotic leak, which was observed in 8 patients (5 per cent). Septic complications, intraluminal bleeding, postoperative pancreatitis, intraabdominal bleeding, pancreatic fistula and small bowel obstruction were the most frequent surgical complications. Most general complications occurred in the cardiorespiratory system. In 9 patients reoperation was necessary. Eight patients (5 per cent) died in the postoperative period. In patients with extended gastrectomy significantly more complications occurred--compared with gastrectomy + omentectomy only. This could also be observed in patients with only splenectomy. If more organs were removed or resected with total gastrectomy and splenectomy, the complication rate increased only if pancreatic resection was performed. Mortality rate increased in these patients as well. The esophageal or other neighbouring organ (colon, small-bowel, liver, diaphragm etc.) resection had no influence on the postoperative morbidity or mortality. Extended operations should be performed, as the risk is acceptable, if there is hope for tumour clearance.
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PMID:[Effect of extending the resection on postoperative complications of total gastrectomies: experience with 161 operations]. 1261 21

New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.
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PMID:Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy. 1268 43

Laparostomy is a well recognized strategy for the management of patients who have necrotizing pancreatitisand may require multiple re-intervention. The open wound can be left to heal through a process ofgranulation and contraction. This article describes intestinal obstruction secondary to entrapment of a loopof small bowel within the cicatrix of the contracting cutaneous scar. An awareness of the potential for entrapmentof the small bowel in the healing scar is critical for clinicians using laparostomy in the managementof acute necrotizing pancreatitis.
 ...
PMID:Small-Bowel Obstruction Secondary to Subcutaneous Small-Bowel Entrapment: A Late Complication of Laparostomy for Necrotizing Pancreatitis. 1275 96

Radiography is a familiar and available imaging modality for the evaluation of patients with acute abdominal distress. Potential causes for acute abdominal distress include the hepatobiliary system, spleen, urogenital tract, and gastrointestinal tract. Radiographic signs associated with specific conditions are described, including gastric-dilation volvulus, urinary bladder rupture, ureteral rupture, urethral rupture, pancreatitis, and small intestinal obstruction. Additionally, contrast procedures that can be beneficial in evaluating the patient with acute abdomen, including positive contrast cystography, urethrography, excretory urography, and peritoneography, are described.
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PMID:Radiographic techniques and interpretation of the acute abdomen. 1277 65

Complications from abdominal surgery may necessitate reoperation and can be associated with significant morbidity and mortality. This review aims to analyse the incidence and outcome of relaparotomy for various indications. In a retrospective review of case notes of patients who had undergone one or more relaparotomies during the same hospitalisation between 1996 and 2000, 55 patients required relaparotomy. Indications included bleeding, infection, anastomotic leakage, wound dehiscence, necrotising pancreatitis, bowel necrosis, bowel obstruction and miscellaneous indications. Relaparotomy for dehiscence and obstruction carried minimal risk; for bleeding and infection entailed moderate risks; and for anastomotic leak had the highest mortality rate. The mortality rate increased in older age groups, multiple system and organ failure and multiple relaparotomies. The overall mortality rate was 38%. Twenty-nine per cent of patients had MRSA infection contributing to sepsis and multiple system and organ failure. Reintervention had brought to evidence technical errors, which could be corrected, and resulted in patient salvage in some cases. The mortality rate of relaparotomy has remained unchanged compared with data published previously, despite improvements in surgical techniques and critical care. Timely relaparotomy is valuable in the identification and treatment of complications following abdominal surgery.
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PMID:Relaparotomy: a five-year review of indications and outcome. 1280 Apr 67

Patients with normal or borderline sweat tests present a diagnostic challenge. In spite of the availability of genetic analysis and measurement of nasal potential difference, there is still uncertainty in diagnosing cystic fibrosis in some patients. CA 19-9 is a tumor-associated antigen whose levels were previously found to be elevated in some cystic fibrosis patients. We investigated whether serum CA 19-9 levels can contribute to establishing the diagnosis of cystic fibrosis in patients with a borderline sweat test, and evaluated the influence of different clinical variables on CA 19-9 levels. Serum CA 19-9 levels were measured in 82 cystic fibrosis patients grouped according to their genotype and in 38 healthy individuals. Group A included 50 patients who carried two mutations previously found to be associated with a pathological sweat test and pancreatic insufficiency (DeltaF508, W1282X, G542X, N1303K, and S549R). Group B included 13 compound heterozygote cystic fibrosis patients who carried one mutation known to cause mild disease with a borderline or normal sweat test and pancreatic sufficiency (3849+10kb C-->T, 5T). Group C included 38 normal controls. Nineteen cystic fibrosis patients carried at least one unidentified mutation. An association between CA 19-9 levels and age, pulmonary function, pancreatic status, sweat chloride, previous pancreatitis, serum lipase, meconium ileus, distal intestinal obstruction, liver disease, and diabetes was investigated. The distribution of CA 19-9 levels was significantly different between the three groups ( p<0.01); high CA 19-9 levels were found in 60% (30/50) of group Apatients and in 46.6% (6/13) of group B patients, but in only 5.2% (2/38) of the controls. CA 19-9 levels were inversely related to forced expiratory volume in 1 s, while no association was found with the other clinical parameters examined. Our findings suggest that the serum CA 19-9 in cystic fibrosis patients originates in the respiratory system, and has a useful ancillary role, particularly when diagnostic uncertainty exists. Hence, the diagnosis of cystic fibrosis should be considered in patients with borderline sweat tests and high CA 19-9 levels, but normal levels do not exclude cystic fibrosis.
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PMID:Serum CA 19-9 levels as a diagnostic marker in cystic fibrosis patients with borderline sweat tests. 1459 87


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