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

Between 1954 and 1975, 80 pancreaticojejunostomies were performed on 77 patients for intractable pain of chronic pancreatitis. All patients had a history of chronic alcoholism. Drainage operations done primarily for pseudocysts were excluded. Operative procedures included seven caudal pancreaticojejunostomies, 42 longitudinal pancreaticojejunostomies with splenectomy and implantation of the pancreas into the jejunum, and 31 side-to-side pancreaticojejunostomies. Eighty-one percent of the patients noted substantial improvement or complete resolution of their abdominal pain on follow-up that ranged up to 21 years. The operative mortality was 5%. Thirty-two patients died during the period of the follow-up. Continued alcohol abuse, carcinoma, and cardiovascular disease were the leading causes of mortality. Data from this review confirm the effectiveness of pancreaticojejunostomy in relieving the pain of chronic relapsing pancreatitis.
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PMID:Pancreaticojejunostomy for chronic pancreatitis. Two- to 21-year follow-up. 7 68

In this review of the surgical experience with pancreatitis, 55 patients had acute relapsing pancreatitis associated with gallstones and 47 had chronic pancreatitis of alcoholic, idiopathic, or familial causation. The severity of pancreatitis associated with gallstones could not be correlated with results of preoperative biochemical tests; only one-third of patients were found to have stones within the biliary ductal system; and postoperative mortality (5%) could not be correlated with the severity of pancreatic inflammation or the timing of surgical intervention. Postoperative observations have revealed that all but four of the patients have remained asymptomatic. With regard to the patients with alcoholic, idiopathic, or familial disease who had significant pancreatic ductal dilatation or obstruction, ductal drainage procedures with or without resection benefited 80%. In the absence of ductal dilatation or obstruction, major resective surgery benefited 50% of patients. Continuing alcohol abuse limited the effectiveness of any operative procedure, and diabetes occurred more often after major resective procedures.
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PMID:Surgical treatment of pancreatitis: review of a series. 44 16

Thirty-three patients with pancreas divisum studied by endoscopic retrograde cholangiopancreatography (ERCP) are described. Documented pancreatitis was present in fifteen patients, and another eleven had recurrent episodes of pain typical of pancreatitis. The major papilla was cannulated in all patients, but the duct of Wirsung was opacified in only twenty-eight and showed changes of pancreatitis in one. Attempts were made to cannulate the minor papilla in fifteen of the thirty-three patients and were successful in four. The duct of Santorini showed typical changes of pancreatitis in one. One patient had pancreatic cancer, and the duct of Wirsung demonstrated only nonspecific abnormalities. In only two cases was pancreatitis due to alcohol abuse. The high incidence of pancreatitis and pancreatic-like pain in patients with pancreas divisum, may be due to the very small ampulla of the duct of Santorini which in these patients drains the majority of the pancreas, creating a marked relative stenosis of the ampulla. Surgery for relief of pain was required in five patients. The operation of choice, when pancreatitis involves the dorsal pancreas, appears to be distal resection with drainage.
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PMID:Pancreas divisum: its association with pancreatitis. 92 Aug 76

A case of a 48 year old male with a history of alcohol abuse, chronic relapsing pancreatitis, and massive hemorrhage into the small intestine is reported. The patient had previously undergone a cholecystojejunostomy. Imaging studies demonstrated occlusion of the splenic, superior mesenteric, and distal portal veins with large varices in the jejunum. He recovered following jejunal resection and Roux-en-Y cholecystojejunostomy. The mechanism for formation of varices in the small bowel in this clinical setting is discussed.
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PMID:Bleeding varices of the small bowel as a complication of pancreatitis: case report and review of the literature. 145 87

A 27-year experience in the surgical management of 160 patients with pancreatic pseudocysts was reviewed. Sixty-eight patients treated from 1964 to 1981 (Group I) were compared to 92 patients managed from 1982 to 1990 (Group II). During the recent period, computed tomography (CT) scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective visceral angiography, and percutaneous catheter drainage (PCD) techniques were available. The mean age of patients was similar in both groups (45 vs 44 years). Most pseudocysts in both periods represented complications of chronic pancreatitis due to alcohol abuse (82% vs 87%). Pancreatitis-associated complications occurring before management (fistula, obstruction, hemorrhage) were more frequent in Group II (19% vs 40%, P less than .05). There was a significant increase in the number of patients managed with external drainage in Group II (10% vs 52%) attributable to the use of PCD as definitive therapy in 46 per cent of patients in the recent period. Use of internal drainage procedures (cystgastrostomy, cystduodenostomy, cystjejunostomy) decreased in Group II (38% vs 16%, P less than .05). The use of lateral pancreaticojejunostomy (LPJ) combined either with caudal resection or cyst drainage has remained constant in both periods (32% vs 24%, NS). Patient morbidity was similar (26% vs 28%, NS) and mortality improved in Group II (9% vs 1%, P less than .05). Internal or external drainage for pseudocyst is often not definitive because of the underlying ductal disease. The authors' current approach is to manage large symptomatic cysts either with internal drainage or PCD; they employ octreotide acetate in the management of persistent pancreatic fistula following external drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changing concepts in the surgical management of pancreatic pseudocysts. 155 35

The clinical, biochemical and radiological data of 25 patients with carcinoma of the head of the pancreas were compared with the same parameters of 25 patients with chronic pancreatitis producing cholestasis. History of alcohol abuse, pruritus and palpable gallbladder were the only clinical findings useful for the differential diagnosis. Plasma bilirubin levels were significantly higher in patients with malignancy (20.0 +/- 14.3 vs 2.5 +/- 2.4) but the course of the bilirubinemia was similar in the two groups after hospital admission. Preoperative ultrasound and cholangiography were usefull in differentiating both groups of patients. Sensibility of a point score based on significant differences was 100% for pancreatitis and 96% for malignancy.
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PMID:[Differential diagnosis of cholestasis in pancreatic cancer and chronic pancreatitis]. 166 25

In 427 samples of serum and urine, collected during their stay at hospital from 40 patients affected with acute pancreatitis, the sensitivity and the specifity of total amylase and lipase in serum, total amylase and pancreas isoamylase in urine, as well as the amylase-/creatinine clearance were determined. The pancreas isoamylase in serum was used as reference value. It appeared that the sensitivity of the lipase was next to that of the pancreas isoamylase in serum, even in limit ranges. Usually the lipase stayed pathological the longest and could therefore be used to identify in the best way even an easing-off pancreatitis. The diagnostic accuracy of the total amylase in serum and urine, of the pancreatic isoamylase in urine and of the amylase-/creatinine clearance was found to be obviously less reliable. The specifity of all examined tests was reduced in patients with renal insufficiency, liver disease, alcohol abuse and in patients with abdominal pains of non pancreatic origin. Concluding form our results and with regard to the expenditure of laboratory technique and to the time required by the methods of determination, we found that of all the examined parameters, the lipase was the most convenient for both emergency and routine diagnose of an acute pancreatitis.
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PMID:[Diagnostic value of various laboratory parameters in acute pancreatitis]. 169 1

From 1981 to 1990, 14 of 70 patients hospitalized at our institution for severe acute pancreatitis were selected to undergo percutaneous drainage of pancreatic abscess, under computed tomographic (CT) scan guidance. Pancreatic abscess was defined, on contrast-enhanced CT scan, as an infected fluid collection without pancreatic necrosis. There were nine men and five women, ranging in age from 28 to 46 years. The main cause of pancreatitis was alcohol abuse (eight patients). Other causes were gallstones (two patients), hyperlipidemia (two patients), postoperative (one patient) and one unknown. Ranson criteria were available in ten patients and ranged from three to six. Percutaneous drainage was performed as the primary treatment in 13 patients and for removal of a residual collection postoperatively in one patient. In two critically ill patients, percutaneous drainage was performed as a temporizing measure. In 12 patients with well-limited hypodense collections, percutaneous drainage was expected to result in the definitive cure of the abscess. Pigtail drains (No. 14F), were inserted using local anesthesia and CT scan guidance. Two patients had two drains and 12 patients had only one drain. Two patients were definitively cured by percutaneous drainage and all other patients were operated upon for removal of infected necrosis. In this study, the lack of accuracy of contrast-enhanced CT scan in the diagnosis of peripancreatic necrosis is highlighted and that percutaneous drainage has a better efficiency in the treatment of residual collections postoperatively than as a primary treatment of infected fluid collections is illustrated.
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PMID:Failure of percutaneous drainage of pancreatic abscesses complicating severe acute pancreatitis. 173 73

Pancreatic pseudocysts represent a complication of severe pancreatic inflammatory disease. Although operative drainage is the cornerstone of therapy for pseudocysts, we have undertaken percutaneous catheter drainage in a selected group of 28 patients over a six-year period (1982-88). This represents 42 per cent of pseudocyst patients managed by the senior author and 1.7 per cent of admissions for pancreatitis at the Medical University Hospitals during that period of time. There were 26 men and two women with an age range of 26-66 years (mean = 42.1). Twenty-six patients had alcohol abuse as the cause of pancreatitis; two were due to surgical trauma. Nondilated pancreatic ducts were demonstrated in 25 patients. Six had pancreatic ascites associated with pseudocysts. Four had previous operative drainage (2 internal and 2 external drainage procedures). Five patients received octreotide acetate, a synthetic peptide which mimics the action of somatostatin, in an attempt to aid closure of external fistulas. The mean length of catheter drainage was 48 days (range 7-210 days). Eight (29%) patients developed procedure-related complications (1 pneumothorax, 1 sheared guidewire, six drain tract infections). There was no mortality. Successful resolution of pseudocysts was achieved in 26 patients (93%). Two patients subsequently had elective caudal pancreaticojejunostomy (CPJ), and one lateral pancreaticojejunostomy (LPJ) to drain obstructed pancreatic ducts. One patient has required repeat external drainage. Percutaneous external drainage is successful in pseudocyst eradication. When underlying pancreatic pathology remains uncorrected, elective surgical decompression of obstructed, dilated ducts may be necessary.
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PMID:Percutaneous catheter drainage of pancreatic pseudocysts. 179 94

This paper reports three cases of acute pancreatitis that occurred after repair of an abdominal aortic aneurysm. The aneurysms were ruptured in two patients and asymptomatic in one. No patient had biliary disease or history of pancreatitis or alcohol abuse. Two of the patients required operation for drainage and debridement; one died. The etiology and diagnosis are discussed.
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PMID:Acute pancreatitis following aortic aneurysm repair: report of three cases. 187 95


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