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

Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cause complications in 7-25% of patients with pancreatitis or pancreatic trauma. The first step in the management of PPs is to exclude a cystic tumor. A history of pancreatitis, no septation, solid components or mural calcification on CT scan and high amylase content at aspiration favor a diagnosis of PP. Endoscopic ultrasound (EUS)-guided FNAC is a valuable diagnostic aid. Intervention is indicated for PPs which are symptomatic, in a phase of growth, complicated (infected, hemorrhage, biliary or bowel obstruction) or in those occurring together with chronic pancreatitis and when malignancy cannot be unequivocally excluded. The current options include percutaneous catheter drainage, endoscopy and surgery. The choice depends on the mode of presentation, the cystic morphology and available technical expertise. Percutaneous catheter drainage is recommended as a temporizing measure in poor surgical candidates with immature, complicated or infected PPs. The limitations include secondary infection and pancreatic fistula in 10-20% of patients which increase complications following eventual definitive surgery. Endoscopic therapy for PPs including cystic-enteric drainage (and transpapillary drainage), is an option for PPs which bulge into the enteric lumen which have a wall thickness of less than 1 cm and the absence of major vascular structures on EUS in the proposed tract or those which communicate with the pancreatic duct above a stricture. Surgical internal drainage remains the gold standard and is the procedure of choice for cysts which are symptomatic or complicated or those having a mature wall,. Being more versatile, a cystojejunostomy is preferred for giant pseudocysts (>15 cm) which are predominantly inframesocolic or are in an unusual location. In PPs with coexisting chronic pancreatitis and a dilated pancreatic duct, duct drainage procedures (such as longitudinal pancreaticojejunostomy) should be preferred to a cyst drainage procedure.
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PMID:Issues in management of pancreatic pseudocysts. 1699 50

A 29-year-old man with a previously known Peutz-Jeghers syndrome (PJS) was admitted for epigastric pain, emesis and weight loss due to both intestinal intussusception causing bowel obstruction and obstructive pancreatitis. The patient had cholestasis with an enlarged common bile duct on imaging. Because duodenal and/or pancreatic cancer was suspected due to weight loss, the pancreatic and bile duct obstruction, and the increased risk of small intestine and pancreatic adenocarcinoma in patients with PSJ, a pancreatoduodenectomy was performed. Pathological examination revealed a duodenal polyp with epithelial misplacement invading the ampulla and compressing the main bile duct. Twenty months after surgery, there was no relapse of symptoms or cholestasis. This is the first case showing a direct role of pseudo-invasive duodenal harmatomas in the development of biliary obstruction and chronic obstructive pancreatitis.
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PMID:[Suspected malignant cancer of the pancreas associated with pseudo-invasive duodenal hamartomas in a patient with Peutz-Jeghers syndrome]. 1754 48

The gastrointestinal tract is the preferred route for nutritional support in hospitalized patients. Patients with a functioning gastrointestinal tract, including those with pancreatitis or inflammatory bowel disease and those receiving chemotherapy, should be fed enterally. Parenteral nutrition (PN) should be limited to patients with gastrointestinal failure, including those with short gut syndrome, high-output fistula, prolonged ileus, or bowel obstruction. PN is associated with numerous complications, most notably increased risk of serious infection. Emerging data suggest that immunologic complications of PN may result from hyperglycemia and use of n-6 polyunsaturated fatty acids. Safety may be improved with a low-calorie formula and ensuring tight glycemic control with an insulin protocol. A lipid emulsion containing fish oil, olive oil, or both should replace soybean-containing emulsions. Supplemental glutamine, 0.2 g/kg/d to 0.5 g/kg/d, has been shown to reduce the risk of infection and to improve glycemic control.
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PMID:Maximizing efficacy from parenteral nutrition in critical care: appropriate patient populations, supplemental parenteral nutrition, glucose control, parenteral glutamine, and alternative fat sources. 1788 85

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. During the intestinal phase of the disease, the adult worms usually remain clinically silent, sometimes causing a variety of non-specific abdominal symptoms. When present in large numbers, the worms may get intertwined into a bolus, causing intestinal obstruction, volvulus or even perforation. Occasionally, the adult Ascaris worm may migrate into the Vater's ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Imaging plays a significant role in showing the presence of worms and possible complications in intestinal as well as hepatobiliary ascariasis. This pictorial essay aims to illustrate various imaging features of ascariasis and its associated complications.
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PMID:Imaging of ascariasis. 1795 83

Rapunzel, the girl with long golden tresses in the fairy tale, inspired Vaughan et al to describe, in 1968, cases of trichobezoar with a long tail causing bowel obstruction as "Rapunzel syndrome." A 22-year-old Egyptian woman had been suffering from episodes of epigastric pain and vomiting throughout her pregnancy and puerperium. After diagnosing pancreatitis, we discovered a trichobezoar in her stomach. In an emergent gastrotomy, she was found to have a gastric trichobezoar with a long tail extending down to her duodenum. This is one of the very few cases of Rapunzel syndrome to be complicated by pancreatitis; to our knowledge, it is the first to be reported postpartum.
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PMID:Rapunzel and pregnancy. 1937 62

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.
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PMID:Unusual presentations of eosinophilic gastroenteritis: case series and review of literature. 1941 90

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
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PMID:[A case of intramural duodenal hematoma accompanied by acute pancreatitis following endoscopic hemostasis for duodenal ulcer bleeding]. 1945 68

Single- and double-balloon enteroscopes have similar efficacy. The entire small bowel can be examined through the oral route in 60-90minutes in 25-40% of patients. Using the oral and rectal routes, complete examinations can be performed in 75% of patients The diagnostic indications are mid-gastrointestinal bleeding tumors, Crohn's disease, intestinal obstruction and atypical malabsorption. Therapeutic indications include access to enterostomy, hemostasis, foreign body withdrawal, dilatation and polypectomy in the small bowel. This procedure is also useful to place enteral feeding tubes in patients with an excluded stomach. Hemostatic efficacy is high in patients with elevated transfusional requirements. For polypectomy, this technique has not been demonstrated to have the same efficacy/risk as colonoscopy. Complications include pancreatitis (0.34%) and perforation (0.34-6.4%). The level of evidence for almost all indications is low, since few prospective and homogeneous studies have been performed.
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PMID:[Utility of single- and double-balloon enteroscopy]. 1950 Aug 78

Annular pancreas is a rare embryonal abnormality. Its manifestation in adulthood is often pinpointed with a substantial delay, which is most often attributed to pancreatitis, biliary pathology or dyspepsia. We present a case of a 28-year-old woman who had exacerbating symptoms of high bowel obstruction from 20th week of pregnancy, progressing after premature delivery. Diagnostic work-up revealed partial annular pancreas compressing the duodenum. Despite attempts of conservative treatment, her state deteriorated to such an extent that surgery was indicated and gastrojejunal bypass created. Her postoperative recovery was uneventful. In cases in which symptoms of high bowel obstruction in pregnancy persist and prostration occurs, we suggest close monitoring and a more thorough diagnostic approach. The question remains whether annular pancreas presents a cause of pathologic findings, a cofactor, or a mere accidental diagnosis in the development of superposed pathologies.
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PMID:Symptoms of annular pancreas exacerbated by pregnancy. 1962 72

Brucellosis is hyperendemic in the Kingdom of Saudi Arabia (KSA) with more than 8,000 cases reported each year to the public health authorities. The disease can affect almost any organ system in the body including the gastrointestinal system. In some instances, gastrointestinal manifestations may be the only presenting features of the disease. These range from milder complaints like diarrhea, vomiting to more serious complications like involvement of the liver, the spleen and the gallbladder to rarely life-threatening complications like colitis, pancreatitis, peritonitis and intestinal obstruction. Recognition of this type of presentation of brucellosis is important because early diagnosis and treatment usually result in complete recovery without complications.
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PMID:A review of gastrointestinal manifestations of Brucellosis. 1986 43


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