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

Primary pancreatic abscess should be suspected in patients with acute or subsiding pancreatitis who have a tender abdominal mass with evidence of local and systemic sepsis. These individuals have a prolonged course of illness compared with patients with uncomplicated pancreatitis. Another group of patients without overt signs of sepsis may have abdominal masses thought to be pseudocysts, with unexplained temperature elevation and leukocytosis. This latter group may also have pancreatic suppuration, termed secondary because of its natural history. The distinction between primary and secondary abscesses is difficult unless time of onset of the preceding pancreatitis is known. Both groups of patients require early, thorough operation. Signs of sepsis or progressive deterioration in patients with acute pancreatitis must be recognized early since untreated abscess is usually fatal. Extensive debridement and external drainage of all abscess cavities present, preferably via posterolateral flank drain sites, are essential to successful surgical treatment of pancreatic abscess.
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PMID:Pancreatic abscess after alcoholic pancreatitis. 739 98

Primary pancreatic abscesses are infrequently encountered. Diagnosis and appropriate surgical treatment are often delayed because of the confusing clinical picture that this condition presents. The mortality rate is high, especially when there is an underlying disease of the biliary tract. Prompt external drainage is the specific treatment for pancreatic abscesses, but if an underlying disease of the biliary tract is present and is not surgically treated, pancreatitis and pancreatic abscess may recur, thus increasing morbidity and mortality. Six patients with pancreatic abscess preceded by pancreatitis secondary to biliary tract disease are presented. A short review of the relevant recent literature is included.
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PMID:Pancreatic abscess and its relation to biliary tract disease. 742 5

For clinical use a classification system for acute pancreatitis based on morphological and clinical criteria into four different entities has been proved to be very efficient in clinical practice. These are acute interstitial-edematous pancreatitis, acute necrotizing pancreatitis (sterile or infected), pancreatic abscess and postacute pseudocyst. In acute pancreatitis the first two major steps in the clinical management of these patients is to establish a reliable diagnosis and to stage the disease, that is, to estimate the severity of acute pancreatitis. The discrimination between acute interstitial-edematous and necrotizing pancreatitis has been shown to be the most relevant prognostic criterion. The "gold standard" for discriminating these two forms is by performing contrast-enhanced CT-scanning. For routine clinical use as an alternative to CT serum necrosis indicating parameters such as, C-reactive protein or LDH are useful in this respect. Therefore, CT-scanning for the evaluation of the extent of intra- and extrapancreatic necrosis can be restricted to those patients with increased values of necrosis indicating markers.
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PMID:Classification and severity staging of acute pancreatitis. 766 92

Retroperitoneal abscess with multiple organ failure, after traumatic duodenal rupture followed by dehiscence of duodenal sutures, is a condition associated with a very high mortality. We report on a case treated by retroperitoneal laparostomy, a technique proposed as treatment for pancreatic abscess after an acute necrotizing pancreatitis. The retroperitoneal laparostomy creates a wide open cavity in a gravity-favorable position, allowing drainage and daily debridement of necrotic collections.
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PMID:Retroperitoneal laparostomy as an effective emergency treatment of abscess and multiple organ failure after blunt duodenal trauma: report of a case. 774 66

Pancreatic abscess remains a potentially lethal disease. Efforts to relate outcome to the severity of associated pancreatitis or the type of surgical drainage employed have yielded conflicting results. This study was designed to test the validity of traditional prognostic criteria in the clinical setting of pancreatic abscess and to determine whether the technique of surgical drainage employed correlated with survival. The records of 40 consecutive patients with pancreatic abscess were reviewed. In each case the diagnosis was confirmed by operation. Prognostic factors analyzed included number of Ranson criteria, etiology, type, and number of microorganisms isolated, extent of abscess, time to diagnosis and operation, and technique of surgical drainage. Of the 11 Ranson criteria evaluated, only an elevation in blood urea nitrogen > 5 mg/dl correlated with decreased survival (p < 0.001). Polymicrobial abscesses (three or more organisms) resulted in a higher mortality than abscesses where fewer than three organisms were isolated (45.4 vs 13.8%; p < 0.05). Intraperitoneal extension of the abscess was associated with an increased mortality rate compared to those confined to the retroperitoneum (57.1 vs 15.2%; p < 0.01). In patients requiring unplanned reexploration, mortality was significantly increased (42.9 vs 11.5%; p < 0.05). The technique of surgical drainage employed (open versus closed) did not influence overall mortality (23.5 vs 21.7%; p = NS). Extent of disease at operation, polymicrobial abscess, reexploration for persistent or recurrent disease, and deterioration in renal function were all predictive of increased mortality in cases of pancreatic abscess.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Are traditional prognostic criteria useful in pancreatic abscess? 779 88

We reviewed the records of 32 adult patients with choledochal cysts (CDC) to determine the characteristics of the associated pancreatic disease. Eighteen patients (56%) had 30 documented episodes of pancreatitis with epigastric pain and elevated serum amylase levels. Three patients developed a prolonged course with a pancreatic phlegmon and one patient died secondary to a pancreatic abscess after endoscopic retrograde cholangiopancreatography (ERCP). Pancreatitis occurred in all types of CDC and was not related to the age, gender or race of the patient. There was an association with the size of the CDC: 90% of patients with CDC > or = 5 cm developed pancreatitis compared with only 9% of patients with CDC < 5 cm (p < 0.0004). In addition, ERCP was performed in 14 patients and demonstrated an abnormal pancreaticobiliary duct junction in eight (57%). All eight patients with an abnormal pancreaticobiliary junction developed pancreatitis compared with only 2 out of 6 patients with normal pancreatic duct anatomy (p < 0.006). Patients undergoing surgical bypass rather than resection also tended to have higher rates of pancreatitis (80 vs. 50%). One patient with a Type I CDC and chronic pancreatitis was treated with surgical resection of the CDC and pancreatic head; this combined procedure relieved the pain. Microscopic examination of the CDC and the abnormal "common channel" within the pancreas revealed identical fibrous thickening of the duct walls with focal chronic inflammation and loss of surface epithelium. In conclusion, these data stress the previously unrecognized high incidence of symptomatic pancreatic inflammatory disease that accompanies adult CDC.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pancreatitis associated with adult choledochal cysts. 780 18

Levels of leukocyte elastase and neutrophil protease 4 (NP4(3)) in plasma and peritoneal exudate were studied in 25 patients with severe, acute pancreatitis. Pancreatitis was diagnosed from the clinical picture and an increased serum amylase level. The diagnosis was verified by computerized tomography, ultrasound, and findings at operation or autopsy. Peritoneal exudate on admission contained high concentrations of leukocyte elastase (6100 +/- 2000 micrograms/l) and NP4(3) (2310 +/- 900 micrograms/l). High initial levels were found also in plasma, which contained 659 +/- 110 micrograms/l of leukocyte elastase and 254 +/- 33 micrograms/l of NP4(3). The levels in plasma were still increased 3 weeks after the acute attack, also in the absence of complications, indicating that the resolution of acute pancreatitis is a protracted process. Plasma levels of both leukocyte proteases were persistently increased in patients with pancreatic abscess, in contrast to the gradual decrease seen in patients with a pseudocyst or uncomplicated recovery. The levels were increased already before the abscess was diagnosed clinically, which indicates that determinations of leukocyte elastase and NP4(3) may be helpful in detecting this complication. A pathophysiologic role for leukocyte proteases in the development of severe, acute pancreatitis should be considered.
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PMID:Levels of leukocyte proteases in plasma and peritoneal exudate in severe, acute pancreatitis. 804 15

The decision to operate on a patient with severe acute pancreatitis is often difficult and requires mature clinical judgment. Those indications that are widely accepted include: 1. For differential diagnosis, when the surgeon is concerned that the symptoms are the result of a disease other than pancreatitis for which operation is mandatory; 2. In persistent and severe biliary pancreatitis, when an obstructing gallstone that cannot be managed endoscopically is lodged at the ampulla of Vater; 3. In the presence of infected pancreatic necrosis; and 4. To drain a pancreatic abscess, if percutaneous drainage does not produce the desired result. Other indications that are less well defined and somewhat controversial are: 1. The presence of sterile pancreatic necrosis involving 50% or more of the pancreas; 2. When the pancreatitis persists in spite of maximal medical therapy; and 3. When the patient's condition deteriorates, often with the failure of one or more organ systems. For these latter three indications, guidelines have been presented that permit a logical approach to management, although uncertainty remains. Surgeons should strive to describe in precise terms the clinical state of their patients at the time that operation is performed, as well as the findings at and technical details of the surgery. This should allow further refinement in the management of this still vexing problem.
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PMID:Indications for surgery in severe acute pancreatitis. 807 74

The clinical spectrum of acute pancreatitis ranges from mild, self-limiting symptoms to fulminant illness that may rapidly lead to multiple organ failure and death. Differentiation between acute interstitial pancreatitis, necrotizing pancreatitis, pancreatic abscess and acute pseudocyst is mandatory for the choice of surgical treatment. If morphological evaluation by dynamic pancreatography reveals pancreatic or peripancreatic necrosis, bacteriological evaluation by CT-guided fine-needle aspiration is the mainstay of further decision-making, and should be performed if general signs of inflammation are not improved by conservative therapy. Basically, operative treatment may be directed against underlying pathology (e.g. cholelithiasis), or may aim to manage complications. Infected necrosis is the only clear indication for surgery. Whether the choice should be debridement and gravity drainage, continuous closed lavage of the lesser sac, staged relaparotomies, or open packing, depends on the extent of the process and the individual situation. Peripancreatic fluid collections and pancreatic pseudocysts without major ductal pathology rarely need operative treatment in the early stages, whereas abscesses resulting from infected necrosis should be dealt with by surgery rather than by percutaneous drainage.
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PMID:Indications for surgical treatment of acute pancreatitis. 811 40

The decision to operate on a patient with severe acute pancreatitis is often difficult and requires mature clinical judgment. Indications that are widely accepted include to establish the differential diagnosis, when the surgeon is concerned that the symptoms are due to a disease other than pancreatitis for which an operation is mandatory; in persistent and severe biliary pancreatitis, when an obstructing gallstone is lodged in the ampulla of Vater and cannot be managed endoscopically; in the presence of infected pancreatic necrosis; and to drain a pancreatic abscess, if percutaneous drainage does not produce the desired result. Other indications that are less well defined and somewhat controversial are the presence of sterile pancreatic necrosis involving 50% or more of the pancreas, when the pancreatitis persists despite maximal medical therapy, and when a patient's condition deteriorates. For these last three indications, guidelines have been presented that permit a logical approach to management, although uncertainty remains. Surgeons should strive to describe in detail and precisely the clinical state of their patients at the time that an operation is done, as well as the findings and technical details of the operation. This should allow further refinement in the management of this vexing problem.
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PMID:Indications for surgery in necrotizing pancreatitis. 812 76


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