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

A case report is presented of a patient with acute postoperative pancreatitis who developed a pancreatic abscess secondary to Candida albicans. Recovery followed operative drainage and amphotericin B therapy. Because this is the only such patient in the author's career experience, and because only one other report currently addresses the problem, this report is offered.
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PMID:Pancreatic abscess secondary to Candida albicans. 271 1

In analysing 106 patients with pancreatitis admitted to Ramathibodi hospital from 1969 to 1984, 71 were males and 35 females. Their ages ranged from 8-83 years. Of the 106 patients, 92 were diagnosed as acute, and 14 as chronic pancreatitis; 49(46.2%), 48(45.3%), and 9(8.5%) had mild, moderately severe, and fulminant disease, respectively. Etiologically, chronic alcoholism, biliary tract stones, and unknown cause were found associated in 33.0, 24.5 and 22.6 per cent, of the total cases respectively. Relapsing pancreatitis occurred in 35 patients (33.0%), 27(77.1%) of whom were chronic alcoholic. Five (62.5%) of the 8 patients with traumatic induced pancreatitis were children. Among the more common clinical symptoms and findings: abrupt epigastric pain occurred in 76 patients (71.7%), localized abdominal tenderness in 59(55.7%), generalized abdominal tenderness in 33(31.1%), nausea and vomiting in 34(32.0%), fever of over 38 degrees C in 20 (18.8%), palpable mass in 17(16.0%), and ascites in 8(7.5%). Laboratorically, elevated serum amylase was the most useful single diagnostic test, i.e. it was elevated in 100(94.3%) of the 106 patients. Pseudocyst, pancreatic abscess, and GI hemorrhage with liver failure occurred in 10 (9.4%), 2(1.8%), and 3(2.8%) patients, respectively. Sixty-six patients were treated medically and 40 patients were subjected to surgery. Regardless of whether they were treated medically or surgically, 7 of the 9 patients with fulminating pancreatitis died, and another 2 remaining patients were taken home in moribund state.
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PMID:Pancreatitis: an analysis of 106 patients admitted to Ramathibodi Hospital during 1969-1984. 273 90

Pancreatic abscess is a serious complication of acute pancreatitis and the best treatment is surgical drainage, even when morbidity and mortality are high. We present a patient with a pancreatic abscess after cholecystectomy and bile duct drainage because of cholelithiasis and pancreatitis. The abscess was manifested by a palpable painful mass in the epigastrium, fever, leukocytosis, and confirmed by ultrasound. Through a nasogastric tube we drained necrotic and purulent material with gradual and complete recovery. This is the first case in our hospital in which a pancreatic abscess drained spontaneously into the digestive tract without requiring external drainage.
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PMID:[Spontaneous drainage of a pancreatic abscess into the digestive tract]. 277 79

Without surgical treatment, pancreatic abscess remains a highly lethal complication of acute pancreatitis. Many surgical series have reported mortality rates of 32 to 65 per cent in treated cases. Although pancreatic abscess is a rare condition, it is more common in patients with severe pancreatitis. A retrospective study of 130 patients admitted to our unit with severe acute pancreatitis during the period from 1965 to 1987 revealed 18 cases of pancreatic abscess. All pancreatic abscesses were primary in nature, and no infected pseudocysts were included in the series. Clinical surveillance, repeated laboratory tests, conventional radiology, and especially ultrasonography and CT scan all contributed to the preoperative diagnosis. The applied treatment was surgical debridement of all necrotic tissue and either local or extensive external drainage. In 12 cases this procedure was combined with other surgical interventions. The recorded mortality rate was 16.66 per cent. Factors adversely affecting survival include: 1) severity of precipitating pancreatitis; 2) difficulty in making early and accurate diagnosis of the pancreatic abscess; 3) marked tendency for recurrence of sepsis; and 4) life-threatening associated complications and/or diseases.
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PMID:Pancreatic abscess following acute pancreatitis. 278 35

Parenchymal necrosis has recently been recognized as the principal determinant of the incidence of secondary infection in acute pancreatitis. Because secondary infection of pancreatic necrosis accounts for more than 80% of all deaths from acute pancreatitis, a method for determining the presence or absence of parenchymal necrosis would offer considerable prognostic and therapeutic information. Thirty seven patients with unequivocal acute pancreatitis and five normal controls were prospectively studied with intravenous bolus, contrast-enhanced computed tomography (dynamic pancreatography). In the absence of pancreatic necrosis, there were no significant differences in parenchymal enhancement between any of the following patient groups: controls (5), uncomplicated pancreatitis (20), pancreatic abscess (7), or peripancreatic necrosis (4)(p less than 0.05). On the other hand, pancreatic parenchymal enhancement was significantly reduced or absent in all six patients with segmental or diffuse pancreatic necrosis (p less than 0.05). Postcontrast pancreatic parenchymal enhancement was also found to be inversely correlated with the number of Ranson signs (p less than 0.001). Dynamic pancreatography offers prognostic information and is a safe and reliable technique for predicting the presence or absence of pancreatic parenchymal necrosis.
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PMID:Prediction of pancreatic necrosis by dynamic pancreatography. 280 34

Following laparotomy for severe intra-abdominal sepsis, the abdominal cavity was left open to heal by granulation in 18 patients. In 14 patients, operation was required because of recurrent gastrointestinal perforation or anastomotic dehiscence. In three, the indication for this procedure was recurrent pancreatic abscess. Of the 17, 13 had previously undergone multiple operations which had failed to control sepsis. Laparostomy was performed as a primary procedure in only one case, a patient with fulminating pancreatitis requiring pancreatic necrosectomy. All patients received parenteral nutrition. The overall mortality was 28 per cent. However, there was only one death among the last 9 patients treated compared with 4 in the previous 9. The median sepsis score in the first 9 (19, range 10-26) was not significantly different (P greater than 0.05) from that in the subsequent 9 patients (17, range 8-21). Three of the four who had initially presented with severe acute pancreatitis died. No patient eviscerated and only 9 (50 per cent) required mechanical ventilation for a median duration of 5 days. The median time for wound healing was 10 weeks and 6 patients have subsequently undergone definitive surgery with satisfactory results. Laparostomy is a valuable technique in the management of severe, intractable intra-abdominal sepsis.
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PMID:'Laparostomy': a technique for the management of intractable intra-abdominal sepsis. 293 61

We report four patients with a protracted history of acute pancreatitis complicated by infected pseudocysts or abscesses. Ultrasonography showed that each patient had cholelithiasis. Endoscopic biliary sphincterotomy was performed resulting in the release of stones, gravel, or pus in all four cases. Three of the patients had successful percutaneous abscess drainage, and one patient was drained surgically. The abscesses all resolved, but one patient died suddenly of acute pulmonary embolism. The other three patients are well. We recommend this combined approach to pancreatic abscess drainage because, if there is obstruction to the flow of pancreatic juice at the ampulla of Vater, it is likely that the pancreatitis and abscess will fail to resolve.
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PMID:The combination of endoscopic sphincterotomy and percutaneous abscess drainage in the management of complicated biliary pancreatitis. 295 Jan 6

Pancreatic necrosis and sepsis are the major causes of death in instances of acute pancreatitis. No widely accepted definition of these conditions in individuals exists, and, yet, accurate differentiation is mandatory for effective therapy. A series of operational definitions conforming to known clinopathologic factors are proposed for the necrotizing septic complications of acute pancreatitis. These complications, as distinguished from acute interstitial pancreatitis, are fat sequestra, pancreatic necrosis, infected pancreatic necrosis, pancreatic abscess and acute pseudocyst. Imprecise definitions of these complications of necrotizing pancreatitis make inter-institutional comparisons of previously identified data dubious.
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PMID:Progress in acute pancreatitis. 304 92

A 43-year-old man underwent orthotopic heart transplantation for end-stage ischemic cardiomyopathy. Immunosuppressive therapy consisted of cyclosporine and corticosteroids. The diagnosis of acute pancreatitis was made on the ninth postoperative day and was based on clinical symptoms and an upper gastrointestinal barium study. Both serum and urine amylase values were normal. Abdominal ultrasound examination was nondiagnostic. Two weeks postoperatively, the patient's clinical condition deteriorated sharply. Chest and abdominal roentgenograms revealed free intraperitoneal air, as well as air in the lesser sac. Diagnosis of a ruptured pancreatic abscess was made, and he underwent immediate exploratory laparotomy. Four liters of purulent fluid were present in the peritoneal cavity. A ruptured pancreatic abscess was found, and it had dissected above the superior mesenteric vessels and down the right gutter over the inferior vena cava. After extensive retroperitoneal debridement and copious irrigation, multiple surgical drains were placed. The patient is now well and is performing normal daily activities 16 months after the transplantation procedure. The incidence and proposed causes of pancreatitis occurring after heart transplant are reviewed, and we discuss our management of this complication.
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PMID:Survival following rupture of a pancreatic abscess in a heart transplant recipient. 311 39

Pancreatic abscess was diagnosed by exploratory celiotomy in 6 dogs. The most common clinical signs included acute onset of lethargy (n = 5), anorexia (n = 6), vomiting (n = 5), and diarrhea (n = 2). Physical examination revealed pain response to abdominal palpation (n = 5), depression (n = 5), icterus (n = 3), fever (n = 3), and cranial abdominal mass (n = 2). Consistent preoperative clinicopathologic abnormalities included leukocytosis with left shift, observance of toxic neutrophils on the blood smear, hyperlipasemia, hyperamylasemia, hyperbilirubinemia, and increased serum alkaline phosphatase activity. In 5 of 6 dogs, abdominal radiography revealed increased soft tissue density in the cranial portion of the abdomen. Ultrasonography performed on 4 dogs confirmed pancreatic mass. In all dogs, exploratory celiotomy revealed a cavitary pancreatic mass that contained sterile, mucopurulent material. Histopathologic diagnoses included acute necrotizing or chronic-active pancreatitis and steatitis. Two dogs were euthanatized at the time of diagnosis, and the remaining 4 were treated by use of pancreatic debridement(s), open abdominal drainage, and intensive administration of fluids and antibiotics. One dog was euthanatized 4 days after surgery, because of progressive pancreatic abscessation. Three dogs recovered and were discharged.
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PMID:Pancreatic abscess in dogs: six cases (1978-1986). 319 66


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