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

A patient with spontaneous resolution of complete extrahepatic biliary obstruction shortly after the neonatal period is described. Liver biopsy prior to resolution revealed widened portal tracts and extensive fibrosis; these changes normalized following resolution. The aetiology was not established but possibilities included a choledochal cyst, localized inflammation; for example, pancreatitis, a calculus of the common bile duct or a congenital membrane. Management of this patient would have been advanced if there were a paediatric size side-viewing duodenoscope which would have diagnostic and therapeutic potentials.
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PMID:Spontaneous resolution of extrahepatic biliary obstruction in a neonate. 332 76

Gallstone-associated pancreatitis continues to have a mortality rate that approaches 10 percent. In a review of 132 fatal cases of acute pancreatitis, no less than a third of the gallstone-associated cases were diagnosed for the first time at autopsy. Early diagnosis of gallstones in these patients remains problematic, but clinical and biochemical factors may aid ultrasonography in defining patients who require endoscopic retrograde cholangiopancreatography. Early operation is advisable in patients with mild disease, but endoscopic papillotomy should be considered in those with severe disease who fail to stabilize after admission. Chronic pancreatitis is frequently associated with cholangiographic evidence of biliary obstruction, and serum alkaline phosphatase concentrations offer a valuable means of monitoring cholestasis. If operation is needed to deal with biliary obstruction, the options are to carry out Roux-Y hepaticojejunostomy or resection of the pancreatic head, the choice being dictated by the indications for direct pancreatic operation.
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PMID:Pancreatitis and the biliary tree: the continuing problem. 272 20

Review of the diagnosis and treatment of patients with pancreatic pseudocysts over the past 8 years has led us to three conclusions regarding controversial aspects of their treatment. We found that patients who present with chronic pseudocysts can be identified with the help of computerized axial tomography and promptly undergo successful internal drainage, whereas patients with acute peripancreatic fluid secondary to pancreatitis can be observed expectantly with a 43 percent frequency of spontaneous resolution. Patients with infected pancreatic pseudocysts can be safely drained internally. The most common cause of extrahepatic biliary obstruction in this group of patients with pancreatic pseudocysts was stricture due to pancreatitis and fibrosis, not extrinsic compression.
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PMID:Controversies in the management of pancreatic pseudocysts. 334 30

In a review of pediatric autopsies from 1951 to 1985, we identified 40 cases in which pancreatitis was diagnosed pathologically. Twenty-six of these patients were under 4 years of age, and the male-to-female ratio was 1.5. Six groups of patients were identified: 10 with hepatobiliary disease, including 9 with biliary atresia; 7 with immunosuppressive therapy for tumors (n = 2), leukemia (n = 4) and aplastic anemia (n = 1); 6 with viral infections; 8 with congenital anomalies, including congenital heart disease (n = 3); and 9 with miscellaneous problems. Several patients had surgery and various intercurrent complications. Clinical features attributable to the pancreatitis included vomiting or excessive nasogastric drainage (60%), pleural effusions (40%), and abdominal pain (25%). However, the diagnosis was suspected clinically in only 5 of 40 patients. Our findings suggest several pathogenic mechanisms exist for childhood pancreatitis: biliary obstruction, infections, drug toxicity, immunosuppression (acting in synergy with drug toxicity, trauma, and low-flow states resulting from shock, heart failure, and vasculopathy.
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PMID:Clinicopathologic studies in childhood pancreatitis. 334 10

Review of hepatobiliary scintigrams in patients with serologically documented pancreatitis revealed scintigraphic abnormalities in 19 of 21 studies (90%) in 19 patients. Abnormalities included duodenal loop widening (14/21 or 65%) and duodenogastric reflux (10/21 or 48%). Total biliary obstruction was seen in five studies, thereby precluding evaluation of the gastrointestinal phase in these patients. Excluding these, duodenal loop widening and duodenogastric reflux were seen in 88% and 63% of patients respectively. We evaluated three patients in whom initial scans showed obstruction, but repeat examination showed resolution of obstruction following passage of common duct stone, with duodenal loop widening and duodenogastric reflux suggestive of acute pancreatitis. Duodenal loop widening as demonstrated by hepatobiliary scintigraphy is a sign of pancreatic enlargement in acute pancreatitis, whereas duodenogastric reflux appears to be an indirect manifestation of an adjacent inflammatory process.
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PMID:Acute pancreatitis: secondary findings on hepatobiliary scintigraphy. 337 71

The efficacy of nasogastric (NG) suction was evaluated in a prospective, randomized trial in 60 patients with acute pancreatitis of mild to moderate severity. Group I, NG (29 patients) was treated with NG suction, and group II, no NG (31 patients) was treated without NG suction. The presentation, cause of pancreatitis, and clinical parameters at the time of admission of the two groups were similar. The use of NG suction had no discernible benefit during hospitalization. There were no differences in duration of abdominal pain, the interval until bowel sounds returned, the need for narcotic administration, or the length of time intravenous fluid therapy was needed. When compared with group II, no NG, patients in group I, NG tended to resume oral intake later (5.0 +/- 0.3 versus 3.9 +/- 0.5 days) and remain hospitalized longer (13.1 +/- 2.6 versus 10.7 +/- 2.0 days). The incidence of serious complications, such as pancreatic abscess, pseudocyst, biliary obstruction, or pulmonary failure, was no different between the groups. This study demonstrates that the routine use of NG suction in patients with acute pancreatitis of mild to moderate severity is of no benefit in altering the clinical course.
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PMID:Prospective, randomized trial of nasogastric suction in patients with acute pancreatitis. 352 10

The clinical, diagnostic, and therapeutic aspects of 27 patients with pancreatopleural fistula (PPF) reported in the literature, and two additional patients managed by the authors, form the basis of this report. The diagnosis of PPF is based on the triad of massive pleural effusions, elevated pleural fluid amylase, and protein levels. PPF is a complication of chronic fibrocalcific pancreatitis in most cases. It may develop as a consequence of disruption of a dilated obstructed pancreatic duct. Pseudocysts are involved in the process in at least half of reported cases. A substantial number of PPF will close spontaneously utilizing conservative measures including pancreatic rest, total parenteral nutrition, and repeated thoracentesis. Surgical correction of the underlying pancreatic disease, including ductal decompression and drainage or resection of associated pseudocysts, is indicated to prevent recurrence of the fistula and to avoid other complications of advanced chronic pancreatitis. Associated terminal biliary obstruction should be identified and managed with biliary-enteric bypass.
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PMID:Pancreatopleural fistula. 357 10

Primary lymphoma of the small bowel resulting in pancreatic duct or biliary obstruction is rare. Only 1 case of pancreatic obstruction causing pancreatitis has previously been reported. A patient with primary small-bowel lymphoma of the 'Western' variety is described. This was associated with extensive duodenal involvement and obstruction of the pancreatic and biliary system accompanied by obstructive jaundice and pancreatitis.
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PMID:Primary lymphoma of the small bowel with obstructive jaundice and pancreatitis. A case report. 360 99

Bronchobiliary fistulas are rare. One aetiological cause is biliary obstruction with secondary suppuration and subsequent hepatic and subphrenic abscesses. Only a few cases of bronchobiliary fistulas in patients with chronic pancreatitis have been reported and we record another case. A 47-year-old white male, with chronic alcohol-induced pancreatitis who had earlier undergone several laparotomies related to this disease, was admitted with a hepatic abscess. Drainage was not successful. The patient developed bilioptysis and a bronchobiliary fistula was diagnosed. The fistulous tract was demonstrated using PTC as well as bronchography. Laparotomy was performed and the fistulous tract was excised. The hepaticoduodenal ligament was completely obstructed by the inflamed pancreatic gland. An earlier but now obstructed cholecystojejunostomy was revised. This case was complicated by episodes of severe gastrointestinal bleeding probably caused by thrombosis of the portal vein and local varices around the gallbladder and common duct.
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PMID:Bronchobiliary fistula in chronic pancreatitis. Case report. 367 59

Twenty-eight patients underwent surgery for intractable pain, duodenal or extrahepatic biliary obstruction secondary to chronic pancreatitis. Eleven had pancreatic duct obstruction alone, six biliary obstruction alone, seven combined pancreatic and biliary, two combined biliary and duodenal, one combined pancreatic and duodenal, and one simultaneous pancreatic, biliary, and duodenal obstruction. Pancreatitis was secondary to alcohol in all but one case. The following operations were performed: longitudinal pancreatojejunostomy (20), choledochoduodenostomy (8), choledochojejunostomy (7), cholecystojejunostomy (1), and gastrojejunostomy (4). Of the 20 patients with pancreatic duct drainage, pain relief was complete in 11 and partial in six. Initial incomplete relief of pain, or recurrence, stimulated further diagnostic procedures, leading to improvement or correction of the problem in five patients. A significant (p less than 0.01) fall in alkaline phosphatase (935 +/- 228 to 219 +/- 61 U/L) occurred following surgery. One patient was subsequently found to have pancreatic carcinoma. Two patients were lost to follow-up and four patients died (one perioperative and three late). In conclusion, the possibility of pancreatic, biliary, and duodenal obstruction must be considered in symptomatic patients with chronic pancreatitis. Surgery must be individualized. Drainage procedures, either alone or in combination, are associated with a low morbidity and improved clinical condition and may be preferable to resection in the surgical management of these patients.
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PMID:Selective drainage for pancreatic, biliary, and duodenal obstruction secondary to chronic fibrosing pancreatitis. 370 34


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