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

The chronic pancreatitis population of Wadsworth VA Hospital over the past five years was screened for two-fold or greater alkaline phosphatase elevation at any time during their course, as a marker for either distal common bile duct stenosis or other hepatobiliary disease. Forty-seven of 207 patients screened met this criterion and are reviewed in detail. Of the 16 patients with persistent alkaline phosphatase elevation (group B), 15 had proven common bile duct stenosis, demonstrating a clear pathophysiologic role of partial bile duct obstruction in their liver disease. Three had developed secondary biliary cirrhosis, marking this entity the commonest cause of secondary biliary cirrhosis at our hospital. Of the remaining 31 patients with transient alkaline phosphatase elevation (group A), only 4 had proven duct abnormalities which may resolve during recovery. Alcoholic liver disease was demonstrated with normal extrahepatic ducts in the remainder in group A adequately studies. Persistent greater than two-fold alkaline phosphatase elevation in pancreatitis thus represents a reliable marker of distal common bile duct stenosis, whose sequelae may include cholangitis and secondary biliary cirrhosis and which requires operative intervention in these cases. When a persistent alkaline phosphatase elevation greater than two-fold is encountered in a chronic pancreatitis patient, adequate cholangiography and liver histology are both necessary to confirm and grade this frequent and treatable complication.
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PMID:Common bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum. 51 65

The biliary complications of pancreatitis include cholestasis, secondary biliary cirrhosis, cholangitis, and pseudocyst or fistula affecting the hepatobiliary system. Of these, the most relevant for radiologists is cholestasis caused by biliary duct stenosis in an inflamed pancreatic head. Radiologic assessment of these complications is based on judicious use of ultrasound, computed tomography, and direct cholangiography. The typical imaging finding of common bile duct stenosis due to chronic pancreatitis is gradual tapered narrowing of the intrapancreatic common bile duct, which can be portrayed by carefully accomplished computed tomography, and ultrasound as well as cholangiography. When combined with clinical assessment, imaging tests can help determine strategies for treatment, which include traditional operations as well as transhepatic, endoscopic, or percutaneous interventions.
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PMID:Biliary complications of pancreatitis. 264 80

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain. The benign nature of CBDS in chronic alcohol-induced pancreatitis (CAIP) in patients without persistent jaundice is emphasized. In particular, no histologically proved cases of secondary biliary cirrhosis were noted. The majority of patients with CBDS due to CAIP may be safely managed without biliary bypass but require close follow-up.
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PMID:The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis. 281 30

Pyogenic liver abscess is a rare presentation of common bile duct stenosis secondary to chronic calcific pancreatitis. Two cases are described in this report; in both cases, biliary obstruction was present in the absence of jaundice. Successful therapy of the abscesses was accomplished with antibiotics alone and without continuous percutaneous drainage or surgical intervention. Definitive therapy should include eventual surgical correction of the biliary obstruction.
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PMID:Pyogenic liver abscess complicating common bile duct stenosis secondary to chronic calcific pancreatitis. A rare presentation. 670 78

A total of 40 patients with pancreatitis had associated extrahepatic biliary obstruction. Eighteen had biliary-induced pancreatitis. Comprehensive correction of the biliary tract disease, including cholecystectomy, common duct exploration and, when indicated, transduodenal sphincteroplasty, resulted in a high recovery rate (83%) with no recurrence of pancreatitis. Twenty-two patients had chronic pancreatitis with involvement of the terminal biliary tract by a long tapering stenosis. Nineteen of these patients had chronic fibrocalcific pancreatitis secondary to chronic alcohol abuse. In five patients, the stenosis produced a high grade obstruction which required biliary bypass with choledochoduodenostomy (four) or cholecystoduodenostomy (one). The remaining 14 patients maintained patency of the biliary tract following correction of the underlying pancreatic pathology. The latter consisted of drainage (nine) or resection (five) of 14 associated pseudocysts (present in 64% of the 22 patients), combined with side-to-side pancreaticojejunostomy to decompress an obstruction of the major pancreatic duct. In assessing the degree of terminal bile duct stenosis, calibration of the duct with Bakes dilators or rubber catheters was a useful aid. Two of the 22 patients ultimately proved to have carcinomas, producing obstruction of the pancreatic duct in the head of the gland. Both were treated initially with choledochoduodenostomy. This possibility must be considered in the management of these patients.
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PMID:Extrahepatic biliary obstruction associated with pancreatitis. 685 77

Intraoperative electron beam radiotherapy (IORT) is clinically used as a potential adjunctive treatment to surgery of locally advanced pancreatic and gastric cancer. The tolerance of the pancreas to IORT was studied in 15 adult beagles, divided in 3 groups of 5 beagles in which 25, 30 or 35 Gy IORT was delivered through a 6-7 cm circular lucite cone with 6-8 MeV electrons to the pancreas and medial wall of the duodenum. The dogs were followed for endocrine and exocrine pancreatic insufficiency. Two dogs (13%) developed radiation-induced morbidity which consisted of a common bile duct stenosis and an enterocolic fistula, as was confirmed at autopsy after 8 and 18 months, respectively. After a follow-up of 1 year, none of the dogs had developed pancreatitis, diabetes or exocrine insufficiency. There was a significant reduction in serum insulin levels and glucose clearance rates without overt diabetes for 30 Gy and 35 Gy (p < 0.05). No significant changes were found for 25 Gy. This study suggests that 25 Gy IORT to the pancreas may be used clinically, and that higher IORT doses may induce endocrine pancreatic insufficiency in the long-term.
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PMID:Intraoperative irradiation of the canine pancreas: short-term effects. 812 87

We report a series of five patients with nonalcoholic chronic pancreatitis who underwent abdominal radiotherapy for Hodgkin's disease (n = 4) or seminoma (n = 1) at doses ranging from 3600 to 4050 rads, 6 to 20 years (median, 7 years) before the onset of pancreatitis. Patients were in complete remission for their malignant disease. Other causes of chronic pancreatitis were excluded. The manifestations of chronic pancreatitis (median follow-up after the diagnosis of pancreatitis, 5 years) were pancreatic pain (n = 5), acute pancreatitis (n = 3), pseudocysts (n = 3), common bile duct stenosis (n = 2), duodenal stenosis (n = 1), splenic vein obstruction (n = 1), diabetes mellitus (n = 4), steatorrhea (n = 4), and pancreatic calcifications (n = 1). Other abdominal radiation injuries were severe chronic ulcer of the genu superius (n = 1), stenosis at the junction of the right and left hepatic ducts (n = 1), and splenic and left renal atrophy (n = 1). In one patient, pathological examination of the pancreas showed signs of chronic pancreatitis, severe fibrous endarteritis, and lack of inflammation. Abdominal radiotherapy should be added to the list of causes of chronic pancreatitis. We suggest that the physiopathology of postradiotherapy chronic pancreatitis is a vascular process.
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PMID:Abdominal radiotherapy is a cause for chronic pancreatitis. 803 46

Choledochocele is an extremely rare congenital lesion of the biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally the therapy for this malformation has been surgery. Recently endoscopic therapy has been utilized alternatively for the treatment of choledochocele in adults. We report the case of a 2-year-old girl with a choledochocele who was treated by endoscopic sphincterotomy and placement of a biliary stent. The prosthesis was removed after 4 months. After a follow-up of 20 months the patient remains free of symptoms. Our experience suggests that endoscopic treatment of congenital biliary disease can be performed accurately. Further studies will be necessary to confirm the value of stent implantation in congenital bile duct stenosis.
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PMID:Endoscopic treatment of a choledochocele in a 2-year-old child. 956 75

Endoscopic sphincterotomy (ES) is a minimally invasive technique which is the standard of reference in many clinical situations (e.g distal choledocolithiasis, recurrent lithiasis or bile duct stenosis). Complication are rare but are often misdiagnosed although radiological aspects are demonstrative. The purpose of this study is to illustrate the patterns of the complications. Ten patients have been treated for the last four years in our institution for ES complications. There were eight cases of pancreatitis, three of which had associated perforation, one arterioportal fistula, and one isolated perforation. Diagnosis was reached with CT in all but one case. Two patients have been successfully treated with percutaneous treatment (one embolization with Gianturco coils, and one drainage). Two patients died, one of necrotizing pancreatitis and the second of decubitus complication. The other patient were followed with CT. We give exemples of different observations and discuss their follow up. The severity and extent of post ES pancreatitis were readily assessed by CT and response to therapy monitored by serial examinations. Severity of disease, evaluated according to the length of hospitalization, correlated well with the presence and degree of pancreatic necrosis. CT also highlights perforations including minimal effusions. In our study differential diagnosis between post ES pancreatitis and perforation is not significant regarding the initial conservative therapy in both situations. CT scan helps us to opt for a surgical decision or for a percutaneous drainage. It also permits to follow the evolution of the lesions. In our cases involving perforations, we noted a spontaneous complete resolution of gas effusion on control and we also observed that pancreatitis evolution was similar to standard pancreatitis evolution. In a life threatening post ES hemobilia, not responding to standard medical treatment, angiography is the diagnostic exam of choice before embolization which is regarded as the best initial treatment of vascular lesions. We conclude that CT is the exam of choice in the initial diagnosis and follow up post ES complications.
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PMID:[Radiologic aspects of endoscopic sphincterotomy complications]. 888 95

"Groove pancreatitis", a form of segmental pancreatitis affecting the head of the pancreas, is localized within the "groove" between pancreas head, duodenum, and common bile duct. Differentiation between groove pancreatitis and pancreatic head carcinoma is often difficult. We report a case of groove pancreatitis in which a hypoechoic mass between the duodenal wall and pancreas was clearly imaged, and narrowing of the second portion of the duodenum and bile duct stenosis were also found. The diagnosis was confirmed by surgery (pylorus-preserving pancreato duodenectomy). The patient was relieved from abdominal pain post operation. Up to the present, the patient has been good condition. We review the clinicopathologic and radiologic features of groove pancreatitis in the Japanese literature and discuss the possible role of Santorini's duct in its pathogenesis. We consider that impacted protein plugs in Santorini's duct are a pathogenic factor in the development of groove pancreatitis. Therefore, the findings of Santorini's duct on endoscopic retrograde pancreatography are very important in the diagnosis of groove pancreatitis. Groove pancreatitis presents various clinical features, such as biliary stenosis, duodenal stenosis, and pancreatic mass, and often masquerades as pancreatic head carcinoma. This condition should be kept in mind in the differential diagnosis of pancreatic head carcinoma.
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PMID:Segmental groove pancreatitis accompanied by protein plugs in Santorini's duct. 960 65


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