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

In the recent years the number of patients with cholelithiasis has been increasing. The absolute majority of the patients are admitted to hospitals for urgent indications. Elderly patients with long histories, complications and concomitant diseases prevail. Not only the disease but complications as well must be exactly diagnosed. On the basis of the experience with 1298 operations on biliary ducts (178 of them subjected to choledochoduodenal anastomosis) the authors have determined the following indications for choledochoduodenal anastomosis: choledocholithiasis and dilated bile duct over 1,5 cm in diameter, cleavage of concrements in the bile duct, uncertainty of complete sanitation of the dilated duct and constricted terminal end of the choledochus with a concomitant pancreatitis. A one-row suture and the Yurash-Vinogradov method of choledochoduodenal anastomosis are preferred.
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PMID:[Supraduodenal choledochoduodenal anastomosis in treating cholelithiasis]. 652 31

The records of all patients undergoing hepatobiliary imaging at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.
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PMID:Etiology of the obstructive pattern in hepatobiliary imaging. 653 82

19 167 autopsy records are analysed to the frequency and to risk-groups for a lethal biliary pancreatitis. In cholecystolithiasis biliary pancreatitis was the far most stone caused lethal complication, in choledocholithiasis the 4. An increased incidence of the lethal biliary pancreatitis was found in younger individuals, in male individuals and in choledocholithiasis.
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PMID:[Incidence of fatal, biliary pancreatitis--an analysis of 19167 autopsy protocols]. 664 92

One thousand case reports of patients treated in eleven French surgical departments for stones in the common bile duct between 1975 and 1982 were analyzed. One in three cases were asymptomatic and detected by peroperative radiology during treatment of a simple or complicated gallstone, most forms were painful, with jaundice in 9 p. cent, an angiocholitis in 12 p. cent, and biliary pancreatitis in 2 p. cent. The most reliable exploratory procedure for gallstones is ultrasound imaging, as positive results were obtained in 90 p. cent of cases, but it enabled the diagnosis of choledocholithiasis in only one out of five patients. Intravenous cholangiography is a useful diagnostic tod for painful forms (60 p. cent). The failure of these two methods to establish the diagnosis in forms complicated by jaundice, pancreatitis, or angiocholitis has to be compared with the good results (85 p. cent) observed with endoscopic retrograde cholangiography. Treatment was surgical in 99 p. cent of patients, peroperative radiology being performed in 95 p. cent of these cases and endoscopy in 30 p. cent. In one out of two cases a single large stone was present while multiple stones were present in 8 p. cent. A "ideal" choledochotomy was carried out in 77 patients (7,7 p. cent) without mortality. External biliary drainage in 702 cases resulted in a 1.7 p. cent mortality rate, this increasing to 8 p. cent after 192 biliodigestive shunt operations, and 7 p. cent after 146 sphincterotomies, including 18 under endoscopic control. Unrecognized lithiasis, detected during follow-up radiography two weeks after external biliary drainage, accounted for 2-8 p. cent of cases. Of the 30 patients with residual stones and open biliary pathways, 6 were treated by mechanical removal, 6 by endoscopic sphincterotomy, and the others by repeat surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Common bile duct lithiasis. Reflections apropos of 1000 cases]. 665 16

At the Medical Clinic of the St. Elisabeth Krankenhaus, Cologne, 108 endoscopic papillotomies (EPT) were carried out between September 1977 and May 1983; 90% have been successful. Choledocholithiasis in 91 patents (84,2%) was the most frequent indication. Approximately half of the cases had had previous cholecystectomy; in the other half the still existing gall-bladder contained stones. These latter patients were definite risk-patients; their average age was 16 years above that of patients with previous cholecystectomy. Other indications have been the inflammatory (14 patients) or tumorous stenosis (3 patients) of the papilla. Complications occurred with 8 patients (7,4%); mortality-rate: 1,9%. The good results and the low rate of complications make EPT the method of choice in case of residual or recurring stones after cholecystectomy as well as in case of risk patients with existing gall-bladder and stones in the common bile duct. Further indications have been: malignant or benign papillary stenosis and acute emergency situations (acute biliary pancreatitis or cholangitis through a stone blocking the duct). The nasobiliary permanent probe, the possibility of direct litholysis, the dilatation by catheter and prolonged draining of stenosis open new applications.
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PMID:[Results of 108 endoscopic papillotomies]. 665 32

A series of 346 patients with cholelithiasis were followed up 6, 12, 24, and 48 months after the operation and the results were determined by self-assessment and objective criteria (Visick grading) The results were good in over 80% of the patients. The more serious, painful and threatening the situation was before the operation, the better seem to be the later results. The frequency of the postoperative complications and the number of choledochotomies is dependent on the age of the patient. The type of operation and sex has no effect on the duration of postoperative unemployment. On the average the younger patients return to work more rapidly. From the preoperative criteria which may lead to revision of the choledochus the frequency of pain, duration of history and attacks of fever in the history were unreliable, whereas increased age of patient, icterus or pancreatitis in the previous history were increasingly associated with pathology of the choledochus. Intraoperatively numerous small stones, enlarged choledochus and poor flow ( debit ) suggested strongly a stone in the choledochus or stenosis of the papilla. The stones which were palpable intraoperatively were always found, whereas almost one third of the stones in the bile ducts were not palpable. The intraoperative X-ray picture is an useful but not an absolute reliable auxiliary help. Several of the pre- and intraoperative criteria and tests used for the selection of patients for choledochotomy have statistically significant reliable results for the presence of choledocholithiasis or papillary stenosis. Singularly however, there is always the possibility of a false positive or false negative result.
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PMID:[Bile duct revision, yes or no? Reliability of selection criteria for choledochotomy, tested on the basis of late results following gallbladder operations]. 671 16

Endoscopic sphincterotomy (papillotomy) was performed in 289 patients for choledocholithiasis (250, of whom 223 had undergone cholecystectomy previously), papillary stenosis or spasm (32) and ampullary neoplasm (7). The complications encountered in 39 patients were hemorrhage (15 patients), perforation (4), hemorrhage and perforation (1), cholangitis (5), pancreatitis (11), impaction (1) and others (2). Laparotomy was required in seven of these patients for hemorrhage (two), perforation (two), hemorrhage and perforation (one), pancreatitis (one) and impaction (one). Bleeding required duodenotomy with an extension of the sphincterotomy incision to control hemorrhage, and a formal sutured sphincteroplasty. Perforation occurred at the junction of the distal bile duct and duodenum and was managed by mobilization of the duodenum, with T-tube drainage through the perforation, and sutured closure. A pancreatic abscess following pancreatitis required surgical drainage. An impacted Dormia basket with entrapped stone in the bile duct required duodenotomy for its removal. There was a high risk of perforation in those patients who did not have choledocholithiasis or who had had a previous Billroth II gastrectomy. There were two deaths but the overall complication rate of 2.4% is considered low, because many of the patients were elderly or debilitated.
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PMID:Surgical complications of endoscopic sphincterotomy. 672 68

Under analysis were 235 repeated operations upon the external bile-excretory ducts, fulfilled in 218 patients. The main indications for repeated operations on the biliary ducts were choledocholithiasis, stenosis of Vater's papilla, stricture of biliary ducts, pancreatitis, external biliary fistula. The pathological conditions were most frequently observed in combinations. During repeated interventions choledochotomy and revision of the biliary ducts were made in 182 patients. Biliodigestive anastomosis was performed in 97 patients, in 54 patients choledochotomy was completed by external drainage of ductus choledochus, in 31 patients the common biliary duct was sutured tightly in combination with the creation of drainage into the stump of the biliary duct after Halsted. Lethality after repeated operations was 3.6%. The remote results were good in 110 patients (80.8%), satisfactory in 23 (16,9%), bad results were in 3 (2,2%) patients.
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PMID:[Experience with repeated operations on the external bile ducts]. 677 3

A multicenter study of 25 centers covering 9041 endoscopic sphincterotomies showed that choledochal concrements still represent the main indication (83,9%). Circumscript papillary stenosis (10.64%) and papillary tumour(2.06%) are the next most frequent indications. Complications after endoscopic sphincterotomy may be expected in 7.55% of cases, somewhat more frequent after papillary stenoses than after choledochal concrements. The most frequent complication is haemorrhage, followed by pancreatitis, cholangitis in cases of choledochal concrements, and perforation. Mortality is around 1.12%. Late results after endoscopic sphincterotomy a satisfactory and concrement-free bile ducts are seen in 91.62%. Freedom of complaints or improvements of symptoms occur in 93.4%. Recurrent stones occur in 5.77%, restenoses were seen in 3.14%. Late results after endoscopic sphincterotomy ar worse in papillary stenosis than in choledocholithiasis. Mortality figures are twice as high and danger of perforation seems to be more frequent. Endoscopic sphincterotomy is done increasingly as an emergency measure.
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PMID:[Long term results after endoscopic sphincterotomy]. 697 46

The history of the development and technique of endoscopic sphincterotomy are discussed. This includes a review of 796 successful sphincterotomies out of 838 attempts. The indications for sphincterotomy were choledocholithiasis in 632 patients, stenosis of the papilla of Vater in 136, periampullary tumor in 24, and stones in the main pancreatic duct in 4 patients. Of 632 patients with choledocholithiasis, 234 passed the stone spontaneously, and 358 has the stone extracted. Residual stones remained in 40 patients. Complications, such as bleeding, retroperitoneal perforation, pancreatitis, cholangitis, and impaction of the Dormia basket, were noted. This indicates a morbidity of 6.9 percent. Fifteen patients required laparotomy. The overall mortality was 1.13 percent. Endoscopic laparotomy. The overall mortality was 1.13 percent. Endoscopic sphincterotomy is a relatively safe and effective method for treatment of extrahepatic cholestasis. The complication rate for patients at high risk is significantly lower than for patients undergoing conventional transabdominal operations.
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PMID:Intraduodenal manipulations of the common bile duct. 699 71


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