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

Since the natural history of pancreatitis associated with cholelithiasis is one of recurrence, surgery for the biliary tract disease is mandatory. But appropriate timing of the surgery remains controversial. Seventy-eight patients have been treated with early surgery once a diagnosis of cholelithiasis associated pancreatitis was made. Eighteen patients had previous episodes of nonalcoholic pancreatitis. Utilizing Ranson's prognostic signs, 52 patients had mild pancreatitis and 26 severe. Sixty-eight patients (87%) had surgery within 72 hours after admission and ten patients (13%) within 5 days. All patients had a cholecystectomy and operative cholangiogram performed. Fifty-six (72%) positive operative cholangiograms were obtained and common bile duct exploration revealed choledocholithiasis in 42 patients (75%). No mortality occurred, and four had six complications including mild persistent pancreatitis (two), wound infection (one), urinary tract infection (one), cardiac arrhythmia (one) and heart block requiring permanent pacemaker (one). The average hospital stay was 10.4 days. T-tube cholangiogram done prior to discharge was normal in all patients, and there have been no episodes of recurrent pancreatitis. Early definitive surgery for pancreatitis associated with cholelithiasis is recommended and can be accomplished with minimal morbidity and mortality coupled with judicious utilization of hospital resources.
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PMID:Early definitive surgery for acute pancreatitis associated with cholelithiasis. 395 71

Review of a 26-year experience with transduodenal sphincteroplasty and sphincterotomy was undertaken (1) to analyze critically the indications for and results of these procedures and (2) to determine which preoperative factors correlate with a good or poor outcome. Of 109 patients, 78 underwent sphincteroplasty, whereas 31 had a transduodenal sphincterotomy. Surgical indications included: group 1, 53 patients with common duct stones; group 2, 28 patients with dyskinesia or stenosis of the sphincter of Oddi (without choledocholithiasis or recurrent pancreatitis); and group 3, 28 patients with recurrent pancreatitis. Three elderly group 1 patients who presented with cholangitis died after surgery (a hospital mortality of 2.7%). Seventy-nine of the 103 patients (77%) in whom follow-up was obtained achieved an excellent or good result. Results were almost identical with sphincteroplasty and sphincterotomy. Abnormal preoperative liver function tests were the only predictors of a good postoperative outcome (p less than 0.05). Group 3 patients (good results in 63%) had significantly poorer (p less than 0.05) outcome than group 1 and 2 patients. Results were worst in group 3 patients who had undergone previous abdominal or pelvic surgery (p less than 0.025) and in group 2 patients who were narcotic users (p less than 0.025). The authors conclude that transduodenal sphincteroplasty or sphincterotomy can be performed relatively safely, but caution that careful selection of patients is important when the indication for surgery is either ampullary stenosis or recurrent pancreatitis.
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PMID:Experience with sphincteroplasty and sphincterotomy in pancreatobiliary surgery. 397 43

During a 7 year period, 200 consecutive morbidly obese patients underwent a standardized gastric exclusion procedure. Group A was composed of the first 120 patients and Group B of the last 80 patients. In Group A, 22 patients had undergone a previous cholecystectomy and 12 patients had a cholecystectomy at the time of gastric exclusion because of positive diagnostic studies or palpation of stones. Of the remaining 87 patients in this initial group who were at risk for the development of gallbladder disease, 24 (27.6 percent) required a cholecystectomy in the first 3 postoperative years (mean 15.6 months). Twelve patients had acute cholecystitis, 3 patients had choledocholithiasis, and 1 patient had acute gallstone pancreatitis. In Group B, 18 patients had a previous cholecystectomy, 15 had positive diagnostic studies (ultrasonography and oral cholecystography) preoperatively, and 47 had negative studies. Cholecystectomy was routinely performed at the time of gastric exclusion surgery in the 62 patients with gallbladders in Group B. Of the 47 patients who had normal preoperative diagnostic studies, 40 (85.1 percent) had abnormal histologic findings in the gallbladder. Only seven patients in Group B had a normal gallbladder (14.7 percent). We conclude that gallbladder disease is considerably more frequent in the morbidly obese population (91.3 percent) than has previously been recognized, that diagnostic studies are frequently inaccurate, and that postoperative gallbladder disease is common (28.7 percent). On the basis of these results, routine cholecystectomy at the time of gastric exclusion surgery is recommended.
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PMID:Gallbladder disease in the morbidly obese. 398 93

To assess the predictive ability of various indicators of common bile duct calculi, 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria of possible choledocholithiasis. The predictive ability of the criteria, individually and in combinations, was determined. For all criteria, except a history of pancreatitis, a significantly increased incidence of choledocholithiasis was found. The number of positive criteria correlated positively with the frequency of common bile duct calculi. The negative predictive value and sensitivity of the total set of criteria were 98% and 89.5%, respectively. Following common duct exploration, the number of complications and the duration of postoperative hospitalization were significantly increased as compared with simple cholecystectomy. Peroperative cholangiography with cholecystectomy is recommended in all patients, with one or more criteria of possible choledocholithiasis. Routine peroperative cholangiography in patients with no positive criteria does not seem to be necessary.
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PMID:Predictive ability of choledocholithiasis indicators. A prospective evaluation. 401 13

Four patients had the characteristic features of choledochal cyst except for the cystic component. All patients had stenosis of the distal common bile duct, a "long common channel" secondary to a proximal junction of the common bile and pancreatic ducts, cholecystitis and the classic pathological microscopic features of choledochal cyst in the wall of the common bile duct. Three children had coexisting intrahepatic duct cysts and/or stenosis and one had intrahepatic choledocholithiasis. The clinical presentations were cholangitis (2), pancreatitis (1) and biliary obstruction (1). In all cases the common bile duct was resected and biliary reconstruction was carried out by choledochojejunostomy (Roux-en-Y). Morbidity was minor except in one patient with ductal disease extending far into the intrahepatic ducts. This child developed an anastomotic stricture requiring revision of the anastomosis and long-term "U" tube stenting. Forme fruste choledochal cyst appears to be another variation in the spectrum of pancreaticobiliary malformations of choledochal cyst. Treatment is identical, that is, excision of all malformed ductal tissue.
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PMID:Forme fruste choledochal cyst. 404 74

The charts of 55 patients with clinical and surgical evidence of pancreatitis, secondary to gallstones, were reviewed. Patients with a history of high alcoholic intake were excluded. Gallstones were retrieved from all patients, 18 (33%) of whom had choledocholithiasis. Severe pancreatitis with extensive fat necrosis was documented during surgery in 27 patients (49%). We found an inverse relationship between the preoperative serum amylase levels and the severity of pancreatitis. Cholecystectomy was performed in 53 patients (96%). The operative mortality rate was 5.5%, and severe postoperative complications developed in five patients (9%). The follow-up period ranged from two to 24 years, and 39 of the patients in the follow-up evaluation remained completely asymptomatic postoperatively.
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PMID:Gallstone pancreatitis. 619 78

Recent developments of manometric and endoscopic instrumentation have rekindled interest in sphincter of Oddi function. As a result of human and animal studies, our understanding of normal sphincter of Oddi physiology has increased and possible motility abnormalities are being identified. Manometric studies have shown that the sphincter of Oddi is characterized by prominent phasic contractions which are super-imposed on a low tonic pressure. The phasic contractions are orientated mainly in an antegrade direction; however, both simultaneous and retrograde contractions are registered. Cineradiography has demonstrated that the phasic contractions have a propulsive function, expelling small volumes of fluid from the common bile duct into the duodenum. Intravenously administered cholecystokinin-octapeptide normally inhibits the phasic contractions and reduces the sphincter tone. Motility abnormalities may occur if the sphincter of Oddi exhibits abnormally high tone, alteration in the direction of the phasic contractions, abnormal changes in the contraction frequency, or abnormal responses to hormonal stimulation. Preliminary human studies demonstrate disorders in sphincter of Oddi motility patterns, suggesting that motility abnormalities may be associated with choledocholithiasis, dyskinesia and idiopathic relapsing pancreatitis.
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PMID:Sphincter of Oddi motility. 632

Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978-1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p less than 0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high-risk patients with choledocholithiasis without cholecystectomy.
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PMID:Endoscopic sphincterotomy of the papilla of Vater: an analysis of 300 cases. 644 36

In acute biliary pancreatitis it is the acute inflammatory pancreatitis rather than the cholelithiasis which dominates. Among 2161 patients with cholelithiasis seen from 1972 to 1983, 21% were found to have choledochal stones at operation. A total of 121 patients (5.6%) had "associated pancreatitis" according to the history as well as clinical and intra-operative findings. Frequency and site of cholelithiasis, as well as treatment and its results were compared with those in a group of patients with "acute pancreatitis of biliary origin" (145 of 447 patients from 1972 to 1983). Choledocholithiasis occurred equally often in both groups (36-39%). Impacted papillary concrements were found in 2.9% of patients with acute biliary pancreatitis, in 7.4% of those with "associated pancreatitis". Early intervention is practised only in case of impacted papillary stones, preferably by endoscopic papillotomy. Otherwise the timing of any operative procedure will be determined entirely by the severity and course of the acute pancreatitis.
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PMID:[Cholelithiasis and acute pancreatitis]. 646 98

Whether bile reflux through a common channel into the pancreatic duct is a causative factor in the development of gallstone pancreatitis is controversial. To address this issue, we have reviewed a consecutive series of cholecystectomies performed with intraoperative cholangiograms. The cholangiograms and the patients' charts were reviewed independently to determine the incidence of a common channel in patients both with and without pancreatitis and to analyze their clinical courses. The group of patients who had pancreatitis showed a common channel in 19 (90%) of 20 cases, while those patients who did not have pancreatitis showed a common channel in 23 (35%) of 66 cases. The patients who had pancreatitis were less likely to have choledocholithiasis than were those patients who did not have pancreatitis, and these patients were less likely to require exploration of the common bile duct.
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PMID:Development of gallstone pancreatitis. The role of the common channel. 649 35


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