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

In 717 endoscopic papillotomies there were 52 complications in 48 patients, requiring 15 emergency operations with 11 deaths. Surgical intervention was undertaken in six patients for cholangitis after obstruction by stone, in four for retroperitoneal perforation, in two each for bleeding or jamming of the dormia basket, and in one for pancreatitis. Cause of death was very poor general condition or age over 80 years in four; retroduodenal abscess in four; haemorrhagic pancreatitis in two, and cholangiogenic sepsis in one.
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PMID:[Treatment of complications after endoscopic papillotomy (author's transl)]. 30 39

In the beginning of this century the "early operation" in acute pancreatitis was widely used. The irreversibility of the local necrosis and the failure of conservative treatment again lead to the application of this procedure. Early operation is indicated when the pancreatitis shows a more severe degree and when there is no success on conservative therapy or even deterioration in the patient's condition. Early operation means digital removal of the necrosis and/or resection of the pancreas, procedures on the biliary tract, methods for suppression of the secretory activity and installation of jejunal fistulas for external feeding. The mortality rate of partial necrotizing pancreatitis was lowered by this means. In case of total necrosis the mortality was still about 100%. In the postacute stage complications such as sequestration, abscess formation, sepsis, hemorrhage, fistulas can arise. In some of these complications only a "delayed operation" is successful. If a biliary acute pancreatitis was not early and definitively treated, the causative diseases of the biliary tract have to be cured in the postacute stage.
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PMID:[Acute pancreatitis--the current state of surgical treatment]. 40 92

Clinical and pathological information from forty patients who died with pathologically severe acute pancreatitis was correlated. Patients were classified into four etiologic groups: those with biliary pancreatitis (11 patients), alcoholic pancreatitis (13 patients), idiopathic pancreatitis (10 patients), and renal failure (6 patients). Antemortem diagnosis was made in only 57 per cent of the patients studied. The diagnosis was determined before death in 91 per cent of the biliary patients but in none of the renal patients. Thirty-seven patients died from their first clinical attack of pancreatitis. Operation in patients with biliary pancreatitis failed when biliary decompression was not provided. Peripancreatic sepsis was a frequent lethal mechanism in patients with biliary pancreatitis, but renal and respiratory failure were more common in patients with alcoholic pancreatitis.
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PMID:Lethal pancreatitis: a diagnostic dilemma. 42 98

The reported complication rate from T-tube infusion of sodium cholate for dissolution of retained biliary stones is low. Among 84 patients reported in the English-language literature, and 10 additional cases of our own, there have been no deaths, an incidence of liver enzyme elevation in 7%, fever in 5%, cholangitis in 2%, and pancreatitis in 2%. Recently, we have infused 100mM sodium cholate at 30 cc/hr into patients through transhepatic biliary stents in an effort to rid the intrahepatic biliary tree of retained stones and biliary sludge. Appropriate precautions were taken to prevent increased biliary pressures by the insetion of a 30 cm manometer into the perfusion system. During four transhepatic infusions in three patients, all experienced nausea and vomiting, and two of the three patients developed diarrhea and abdominal pain. Liver enzymes became elevated during all four infusions, and two of the three patients became septic and died shortly after their infusions. Experimental work in animals suggests that intrahepatic sodium cholate infusion results in injury to the ductal epithelium and predisposes patients to bactermia and sepsis. Even though T-tube infusion of sodium cholate into the common bile duct is well tolerated, direct infusion into the intrahepatic biliary tree through a transhepatic tube is not and carries a high risk of sepsis and death.
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PMID:Sodium cholate dissolution of retained biliary stones: mortality rate following intrahepatic infusion. 43 6

Pancreatic necrosis is a principal determinant of the severity, duration, and infectious complications of acute pancreatitis. There has been no objective index for pancreatic necrosis, and its recognition has necessarily rested upon nonspecific clinical signs, including later deterioration or appearance of sepsis. In search of such an index, we have measured serum levels of a poly-[C]-specific acid ribonuclease (RNase) in 38 patients with acute pancreatitis, 12 patients with chronic pancreatitis, and 50 control patients. The values in chronic pancreatitis (mean, 52 units; range, 33 to 80 units) were within observed normal limits (mean, 51; range, 17 to 94). The values in acute pancreatitis segregated into two groups, normal values (group A) and high values (group B). Of 25 patients in group A (mean, 46; range, 19 to 87), only one developed evidence of pancreatic necrosis or abscess. In contrast, of the 13 patients in group B (mean, 192, range, 98 to 385), 11 required surgical debridement/drainage for pancreatic necrosis (six) or abscess (five) (P less than 0.001). Each of the other two patients had prolonged pancreatic inflammation with fever and a pancreatic mass which persisted for more than 2 weeks. RNase levels in group B patients rose within a few days after onset of pancreatitis and tended to parallel the clinical course. These findings suggest that measurement of serum RNase in acute pancreatitis gives a reliable indication of pancreatic necrosis. Therefore RNase determinations should be of value for earlier identification and monitoring of patients at high risk of late complications, and for helping to select those who will benefit from early debridement before secondary infection occurs.
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PMID:Serum ribonuclease elevations and pancreatic necrosis in acute pancreatitis. 46 72

Two patients had an unusual complication of pancreatitis: pancreaticocolonic fistula, frequently associated with life-threatening gastrointestinal hemorrhage and sepsis. To avoid these complications, early diagnosis is important, but it may be difficult. Treatment consists of external drainage of the pancreatic pseudocyst or abscess and colonic diversion.
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PMID:Pancreaticocolonic fistula: a complication of pancreatic pseudocysts in childhood. 71 23

To aid in case selection for pancreatoduodencetomy and to gain information on the technical management of this operation and its complications, records of 279 patients who were treated for neoplasm or pancreatitis by this procedure between the years 1957 and 1975 were reviewed. The overall operative mortality was 12.5 per cent and was 10.7 per cent for the years 1969 throught 1974. The use of vagotomy did not prevent postoperative bleeding from the stomach, and the use of a stent did not make a statistically significant difference in morbidity or mortality. Postoperative hemorrhage is an ominous complication and is best treated conservatively until blood loss cannot be replaced. Preoperative serum bilirubin levels above 20 mg/100 ml indicate a two-stage operative procedure as does the presence of right upper quadrant sepsis. The resection of malignant disease of the duodenum and lower bile duct is followed by a high mortality and requires total pancreatectomy if a satisfactory pancreatojejunostomy cannot be constructed.
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PMID:Considerations that lower pancreatoduodenectomy mortality. 84 82

Acute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X-ray findings of an intra-abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X-rays to locate new intra-abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.
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PMID:Survival of patients with duodenal fistulas from necrotizing pancreatitis. 86 47

Hemodynamic data were obtained within 15 hours of admission in 11 previously healthy patients (20 to 51 years of age, 7 men and 4 women) who had developed transient, reversible pulmonary edema without cardiac dilation in association with near-death from freshwater drowning (2 cases), pentobarbital overdose, heroin overdose (2 cases), smoke inhalation, chest trauma, sepsis (2 cases), pancreatitis, or prolonged abdominal surgery with suspected sepsis. Using a balloon-tipped flow-directed catheter, the pulmonary artery systolic/diastolic pressures (in mm Hg) were 25/12, 22/9, 31/11, 26/15, 20/10, 35/15, 40/15, 32/18, 20/10, 24/10, and 20/7; the corresponding pulmonary capillary wedge pressures (in mm Hg) were 8, 9, 6, 14, 6, 6, 15, 15, 10, 10, and 5, respectively. Plasma colloidal osmotic pressures measured in the latter 5 cases were 26, 18, 18, 18, and 15 mm Hg, respectively. In addition, the protein content of the alveolar fluid was 5.1, 3.4, 4.0, and 7.1 g per 100 ml in 4 patients. The concentration and distribution of the protein in plasma and alveolar fluid were very similar. These findings provide strong efidence that altered capillary permeability is responsible for the pulmonary edema.
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PMID:Hemodynamic and alveolar protein studies in noncardiac pulmonary edema. 98 76

The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28). Septicaemia occurred in 12 patients (10%), with 1 death, and was unrelated to the type of operation. Thirty patients (26%) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9%), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4%), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9-5 days after primary closure, 14-0 days after choledochoduodenostomy and 16-8 days after T tube drainage. Wound sepsis (32%) and thrombo-embolism (12%) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3% respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.
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PMID:Complications of supraduodenal choledochotomy: a comparison of three methods of management. 99 Jun 95


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