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

Few data exist regarding nutritional assessment during pancreatic abscess. We compared nonprotein caloric requirements calculated by Harris-Benedict equation and measured by indirect calorimetry in patients with pancreatic abscess. Seven patients with pancreatitis and pancreatic abscess had determinations of resting energy expenditure via Medicor metabolic cart with 20% added for activity. Caloric requirements were also estimated using the Harris-Benedict equation with stress factors. Determinations from indirect calorimetry ranged from 22.4-46.8 (mean 36.1) kcal/kg/d. Harris-Benedict calculations with stress factor 1.7 differed from indirect calorimetry by at least 15% in seven of ten determinations. Stress factor 1.9 results overestimated indirect calorimetry by over 25% in four of ten determinations. Energy requirements via indirect calorimetry of some patients with pancreatic abscess cover a wide range and do not correlate with Harris-Benedict calculations. Harris-Benedict equation with a stress factor of 1.9 may estimate adequate nonprotein calories for hyperalimentation, but there is risk of overfeeding.
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PMID:Nonprotein caloric requirements for patients with pancreatic abscess as measured by indirect calorimetry. 210 57

Some surgeons avoid placing a jejunostomy in patients with complications, fearing either exacerbation of the disease during enteral feedings or complications from the jejunostomies. Eleven patients with hemorrhagic pancreatitis (four), pancreatic abscess (five), or infected pseudocyst (two) underwent placements of needle (five) or Red Robinson (six) jejunal catheters during laparotomy. Five patients had been given 30.8 +/- 16 liters of TPN over 25 +/- 12 days preoperatively. Only two patients received TPN postoperatively because of progressive sepsis with enteral intolerance to feedings. One of these patients developed a jejunal leak near the placement of the Red Robinson catheter. Both patients died of complications from their pancreatic disease. The remaining nine patients received 35.6 +/- 8.6 liters of enteral feedings over 31 +/- 6.8 days before resuming oral intake. Glucosuria and hyperglycemia were common, but easily managed. No catheters were lost, and diarrhea necessitating slowing and diluting the diet was unusual after the first week. Enteral feeding did not elevate amylase values. Therefore, jejunal feedings can be given safely in patients with severe acute pancreatic disease to provide prolonged nutrition without aggravating the disease.
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PMID:Postoperative jejunal feedings following complicated pancreatitis. 210 78

Achieving reduced mortality rates in patients with necrotizing pancreatitis and pancreatic abscess is possible by employing a comprehensive management plan. Components of the plan include (1) rapid evaluation and assessment of the degree of physiologic and anatomic derangement, the latter by the prompt use of vascular enhanced computed tomographic scan; (2) adequate fluid resuscitation determined by early institution of advanced hemodynamic monitoring; (3) attempts to identify and document septic foci via computed tomography-guided percutaneous aspiration; and (4) aggressive surgical debridement. Close adherence to these policies allowed us to keep mortality in this seriously ill group of patients to 14%. Most deaths occurred in patients who were referred to this service late in the course of their disease. The Acute Physiology and Chronic Health Enquiry (APACHE) II severity of illness index applied at the time of admission proved an accurate predictor of mortality. A score of 25 or greater was highly predictive of death, and a lesser score, of survival.
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PMID:Comprehensive management of acute necrotizing pancreatitis and pancreatic abscess. 222 68

Pancreatic abscess is a severe complication of pancreatitis usually caused by alcohol, gallstones, abdominal trauma, or prior operative procedures. Pancreatic cancer is a rare cause of acute pancreatitis and an extremely rare cause of pancreatic abscess. We report three patients with pancreatic abscess caused by cancer who experienced a prolonged, complicated course with delay in diagnosis and substantial morbidity.
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PMID:Adenocarcinoma of the pancreas producing pancreatitis and pancreatic abscess. 229 11

We reviewed 574 endoscopic sphincterotomy procedures. Fifty-six precut papillotomies were performed. Presenting conditions included choledocholithiasis, cholangitis, benign and malignant papillary strictures, and stenosing papillitis. Complications were identified in 16 percent: perforation in 9 percent, pancreatitis in 5 percent, bleeding in 2 percent, and pancreatic abscess in 2 percent. One patient died. Six patients required operation for complications. Perforation of the duodenum or common bile duct seen within 8 hours was managed with drainage and closure of the perforation with minimal complications. Duodenal perforations operated on later than 8 hours required more extensive procedures. All these patients had significant post-operative complications. Three patients were managed nonoperatively. Precut papillotomy carries a significantly higher complication rate than conventional sphincterotomy. Our experience suggests that there is no place for conservative management of duodenal perforation.
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PMID:Surgical management of complications of endoscopic sphincterotomy with precut papillotomy. 173 84

This is a report on 108 cases collected from 1970 to 1987, in the same department, of surgically-detected pancreatic abscesses or pus-harboring collections. The purulent areas were either of a spreading pattern or represented a clearly localized mass. To the spreading pattern belong 47 cases of necrotizing pancreatitis, without discontinuity in the clinical course from the early toxic to the late septic phase, 4 cases of acute pancreatitis, initially in remission and later complicated by septic collections, and 4 cases which developed after an acute attack of chronic pancreatitis. The abscess pattern was made up of 19 each of pseudocysts and predisposing pancreatitis, 10 cases of chronic pancreatitis, and only 5 necrotizing "nonstop" pancreatitis. The surgical treatment in all cases consisted of multiple drainages and postoperative irrigation. We exclude 3 cases of associated open packing. The etiological, clinical, and biochemical features of each group of patients are reported and discussed. Computed tomography availability seems to be the most important improvement reported as regards diagnosis and surgical tactics. The overall mortality rate was 15.7% with a significant difference between the 2 patterns (23.6% for the spreading pattern versus 7.5% for the abscess pattern). On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality. Finally, a simple nomenclature can be chosen which is capable of distinguishing between the diverse pancreatic purulent collections. While the presence of pus may characterize the course of severe acute pancreatitis in many cases, the low incidence of "true" pancreatic abscess is emphasized.
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PMID:Pancreatic abscess and other pus-harboring collections related to pancreatitis: a review of 108 cases. 238 54

In a patient with acute hemorrhagic pancreatitis complicated by pancreatic abscess, closure of the abdominal wall 7 days following marsupialization was difficult owing to the marked distension and edema of the bowel wall, especially the transverse colon. A simple technique using retention sutures with internal and external rubber "booties" above and below the fascia was used to prevent injury to the edematous bowel. The rubber catheters, or "booties," were removed at the bedside, thus making it a simple procedure in a difficult situation.
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PMID:A modified retention suture technique with external and internal "booties" to close difficult abdominal wounds. 252 10

Over the past ten years, 21 cases of pancreatic abscess were diagnosed at our university teaching hospital. On the basis of the findings from CT scan, sonography, and exploratory laparotomy, five patients were determined to have poorly localized disease and 16 patients were felt to have well localized purulent fluid collection. The five patients with poorly localized disease had an overall mortality rate of 80%, an average of 5.2 Ranson criteria, and 80% required partial pancreatic resection. Of the 16 patients with well localized disease there was a mortality rate of 20%, an average of 3.3 Ranson criteria, and only 6% required resection. All five patients who had pancreatic resection died. These data suggest the following conclusions: 1. Patients with pancreatic abscess which is poorly localized have a greater severity of pancreatitis as indicated by a higher average number of Ranson criteria. 2. Patients with a poorly localized phlegmonous abscess more often require pancreatic resection, which is associated with a higher mortality. 3. The high mortality rate seen with patients with a poorly localized phlegmonous pancreatic slough designates this group as a high risk subset of all pancreatic abscess patients.
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PMID:Pancreatic abscess: analysis of a high risk subgroup. 258 45

Between February 1984 and May 1988, 55 patients underwent orthotopic cardiac transplantation at the Brigham and Women's Hospital, Boston, Mass. Basic immunosuppression was accomplished with steroid and cyclosporine therapies. Twelve patients suffered 14 major complications, including perforated ulcer in 3 patients; pancreatitis in 3 patients; pneumatosis coli in 2 patients; and cholecystitis, colonic necrosis, appendicitis, incarcerated umbilical hernia, pancreatic abscess, and toxic epidermal necrolysis in 1 patient each. Aggressive management of the patients included laparotomy in all but 2 patients with mild pancreatitis and the patient with toxic epidermal necrolysis, who was treated as a patient with a severe burn. In all of the patients, there was a resolution of these complications, except in one 59-year-old man with fatal hemorrhagic pancreatitis. Eleven of the 14 complications occurred during the initial hospitalization. The fatal case of pancreatitis was 1 of 5 (9%) operative mortalities in the entire series. Fifty operative survivors have been followed up for an average of 19 months, with four late deaths (8%) related to rejection. The actuarial probability of survival in patients discharged from the hospital was 90% at 12, 24, and 48 months.
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PMID:Management of general surgical complications following cardiac transplantation. 265 77

Pancreatitis induced by malignant disease is uncommon. A case of lymphoma presenting as acute pancreatitis and subsequent pancreatic abscess is reported; this led to the patient's death, 6 weeks after the initial attack of pancreatitis. Five other reports are reviewed. The pancreatitis always preceded the diagnosis of lymphoma and the preoperative diagnosis was always difficult. Lymphoma pancreatitis should, therefore, be considered in the etiology of acute pancreatitis, especially if the more likely causes have been ruled out.
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PMID:Lymphoma pancreatitis: a real entity. 267 Jan 64


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