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

An experience with 68 patients with hemorrhagic pancreatitis identified at operation or autopsy is reported. Sixteen of the patients were subjected to operation, and 6 survived after celiotomy and peritoneal irrigation. There were no survivors in the unoperated group. Death when the pancreas is hemorrhagic and due to pancreatitis occurs an average of 10 days after the onset of symptoms or within 7 days of hospitalization. In eight patients who presented in coma, the diagnosis was not established before death. Early recognition of patients with hemorrhagic pancreatitis can be facilitated by the routine use of amylase and methemalbumin determinations and peritoneal lavage. Translocation of large volumes of albumin-rich fluid from the intravascular compartment to the retroperitoneum and pleural and abdominal cavities is in part responsible for many of the signs, symptoms, and complications of hemorrhagic pancreatitis. These include hemoconcentration, hypotension, tachycardia, tachypnea, ascites, abdominal distress, respiratory insufficiency, and renal failure. Adequate initial resuscitation and intensive follow-up are probably the most important elements in the management of patients with hemorrhagic pancreatitis. Careful monitoring of fluid and electrolytes and blood gases is required to avoid shock and renal and pulmonary failure. The need for careful monitoring is emphasized by the number of our patients in whom inadequacies of fluid replacement and ventilation were often not appreciated until the patient was in extremis from shock or respiratory or renal failure. Antibiotics are indicated in patients with biliary tract disease and penetrating ulcer in whom the risk of secondary infection is considerable. Associated diseases that initiated pancreatitis and that in themselves may be life-threatening, such as acute cholecystitis or cholangitis, should be promptly treated by operation. Diagnostic and therapeutic lavage are justified in the treatment of hemorrhagic pancreatitis. Resection of the necrotic pancreas should be considered when the patient fails to improve after lavage and nonoperative resuscitation.
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PMID:Hemorrhagic pancreatitis. 45 56

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

Compared with the general hospital population of patients with pancreatitis, patients with biliary tract or peptic ulcer disease have de novo pancreatic abscesses develop more commonly than patients with alcoholic pancreatitis. The apparent greater predisposition of the patient with biliary tract or peptic ulcer disease to infection does not seem to be due so much to these patients having potential sources of infection, such as an infected biliary tract or leaking ulcer, as to the fact that many patients with alcoholism and hemorrhagic pancreatitis never survive the fluid loss phase of pancreatitis long enough to have a secondary infection and abscess. The mortality associated with the development of de novo pancreatic abscesses is higher in patients with biliary disease, peptic ulcer or idiopathic pancreatitis in comparison with those patients with alcoholic pancreatitis. Some complications of pancreatic abscesses, such as renal failure, may be avoided through appropriate management of fluid losses during the hemorrhagic phase of pancreatitis preceding absecess formation. Good medical management and aggressive use of newer diagnostic and therapeutic modalities may reduce the mortality and complications of pancreatic abscess. Prompt drainage of an abscess once identified is essential to survival. Proximal colostomy or ileostomy is indicated in the patient with a colonic fistula. Large particulate chunks of necrotic pancreas are not easily evacuated through Penrose, cigarette or sump drains. Marsupialization of the abscess may be considered in patients with this type of abscess.
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PMID:Pancreatic abscess. 50 47

This study was performed to elucidate the role of bacterial infection in acute pancreatitis in young female mice fed a choline-deficient diet supplemented with 0.5% DL-ethionine (CDE diet). Mice were randomly classified into two groups: one had been fed CDE diet alone (nonantibiotic group), the other was fed a CDE diet with oral administration of antibiotics (antibiotic group). Survival rates at 96 and 144 h after introduction of the CDE diet were significantly improved in the antibiotic group, 25.0 and 19.4%, respectively, as compared with 3.6 and 0% in the nonantibiotic group (p, 0.05). Aerobic and anaerobic bacterial cultures of blood, ascites, spleen, and pancreas were taken from living mice 72 h after introduction of the CDE diet. Positive bacterial growth from one or more of the specimens occurred in 29.4% of the nonantibiotic group, and in 10.0% of the antibiotic group. Mice with pancreatic necrosis had a higher positive culture rate, 62.5% in the nonantibiotic group vs 20.0% in the antibiotic group. These results suggest that reduction of intestinal flora in mice inhibits secondary infection caused by bacterial translocation and improves survival in diet-induced hemorrhagic pancreatitis. We believe the development of bacterial infection of gut origin may be a factor influencing mortality in severe pancreatitis.
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PMID:Role of bacterial infection in diet-induced acute pancreatitis in mice. 158 55

Without surgical debridement in patients with infected pancreatic necrosis, survival can not be expected. Previous surgical series reported postoperative survival in the range of 50%; however, more recent reports demonstrate improved mortality of 10% to 20%. Despite the demonstrated advances in surgical management, much remains to be done. Ongoing sepsis and the multiorgan failure syndrome (including ARDS, renal, and hepatic failure) are frequently part of the terminal phase of necrotizing pancreatitis, and further declines in mortality await future improvements in supportive therapy for overwhelming sepsis. Finding a means to prevent secondary infection of necrotizing pancreatitis would also have a very significant impact on survival. Defining the various form of severe acute pancreatitis and its infectious complications by dynamic pancreatography and CT-directed aspiration will permit meaningful trials of new methods to treat these unfortunate patients.
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PMID:Current management of pancreatic abscess. 199 28

Diagnostic and therapeutic interventional radiology techniques in 41 patients with complications of pancreatic inflammatory disease (noninfected pseudocyst, infected pseudocyst, phlegmon, abscess, hemorrhagic pancreatitis) are described. Computed tomography or ultrasound-guided aspiration or percutaneous pancreatic ductography enabled specific diagnoses in 43 of 45 patients (96%). In almost half the patients, diagnostic aspiration with 22-gauge needles was unsuccessful due to viscous contents or firm cavity walls. Single-step needle aspiration of noninfected pseudocysts was successful in only three of ten patients (30%). Catheter drainage cured six of seven noninfected pseudocysts (85.7%) and seven of nine infected pseudocysts (77.7%). Pancreatic phlegmons were aspirated in five patients to exclude secondary infection and help determine the need for surgery. Pancreatic abscesses were drained successfully in nine of 13 patients (69.2%); temporizing benefit was achieved in the other four who eventually underwent surgery in improved condition. Early diagnosis of the complications of pancreatitis may be established almost uniformly, and at least 70% of patients with infected or noninfected pseudocysts and pancreatic abscesses may be cured by nonoperative drainage.
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PMID:Complicated pancreatic inflammatory disease: diagnostic and therapeutic role of interventional radiology. 258 Mar 32

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

An analysis of 98 cases of acute postoperative pancreatitis has been made. The development of acute postoperative pancreatitis was found to be associated with the appearance of fat tissue necrosis under the influence of the activated enzymes of the pancreas The involvement of exocrinous and endocrinous structures of the pancreas into the inflammatory process was developing with progressing of the disease. Postoperative purulent pancreatitis was caused by the secondary infection of the pancreas and the pancreatic fat tissue.
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PMID:[Morphological and bacteriological aspects of development of acute postoperative pancreatitis]. 641 May 71

The authors report their results with percutaneous drainage of 29 abdominal abscesses in 28 patients. Two types of catheters were used: the pigtail angio-catheter and the trocar-catheter. CT scan and ultrasonography were the diagnostic technics used to localize the majority of these collections (20). Seventeen abscesses (58.6%) were cured by this drainage technique. Surgical drainage was necessary in 10 patients (34.4%). Six patients died: 4 of those had surgical drainage and 2 percutaneous drainage only. The cause of death in all cases was multiple organ failure secondary to a virulent noncontrolled infection. Analysis of the results uncovers 3 poor indications for percutaneous drainage: the digestive fistulous tract abscess, acute necrotic pancreatitis with secondary infection and the multi-loculated abscess. The best results are obtained in the case with a hepatic or left subdiaphragmatic abscess. No serious complication was related to the technique itself.
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PMID:[Percutaneous drainage of infected abdominal collections. Guiding principles and results]. 665 53

Acute pancreatitis is in the majority of patients a mild, self-limiting illness. Five to fifteen percent of the patients develop acute necrotizing pancreatitis, a severe illness with a high morbidity and mortality. Secondary infection of the pancreatic necrosis (infected pancreatic necrosis) is the main cause of death. Pancreatic necrosis is identified with a high accuracy by contrast-enhanced computed tomography. The differentiation between sterile and infected necrosis requires demonstration of bacteria or fungi isolated from the necrosis. Surgical treatment of a sterile necrosis remains controversial, but there is a tendency towards conservative non-operative treatment. Infected pancreatic necrosis is regarded as an absolute indication for surgery, untreated the mortality is approximately 100%. The aim of modern treatment is to remove the pancreatic necrosis continuously. This has successfully been done by the open packing method, with or without subsequent drainage. At present no randomized trials comparing the different treatment modalities are available. The question of prophylactic antibiotics still remains unanswered. For the present imipenem 0,5 g x 3 is recommended.
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PMID:[Necrotizing pancreatitis]. 757 Oct 95


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