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

Under observation were 111 patients with ampullar choledocholithiasis. Variants of the clinical course of choledocholithiasis are characterized. The most rational method for the surgical treatment of ampullar choledocholithiasis is the transduodenal transpapillary extraction of concrements from the major papillar followed by papillocholedochoplasty. In a number of cases papillocholedochoplasty was accompanied with additional creation of biliodigestive anastomosis and plasty of the opening of the pancreatic duct. Remote results of the operations on the major papilla of the duodenum are dependent on the amount of preoperative complications of ampullar choledocholithiasis and first of all pancreatitis.
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PMID:[Ampullar choledocholithiasis]. 706 11

In many centers endoscopic sphincterotomy is replacing surgery, which has never been an ideal treatment for retained common duct calculi. We attempted endoscopic sphincterotomy in 70 patients, succeeding in 60 (85%). Sixty-one patients had choledocholithiasis (58 postcholecystectomy), 7 had papillary stenosis, 1 carcinoma of the papilla of Vater, and 1 hydatid disease. Repeat cholangiography in 56 patients with gallstones showed spontaneous passage in 44. In three patients the sphincterotomy required extension, and in three the stones were extracted using a Dormia basket. In four patients the stones did not pass, and surgical removal was necessary. Satisfactory biliary drainage was obtained in all the other patients, and the only complications noted were cholangitis and severe pancreatitis. Endoscopic sphincterotomy is reasonably safe and an acceptable, if not preferable, alternative to surgical removal of retained gallstones, and it is also effective in relieving papillary stenosis.
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PMID:Endoscopic sphincterotomy in biliary tract disease. 709 46

There is some doubt whether a clinical entity like old age pancreatitis exists. According to Ammann, a so-called senile chronic pancreatitis can be differentiated from chronic alcohol-induced pancreatitis. With increasing incidence, secondary concomitant pancreatitis is seen in old patients, initiated by disorders of the biliary system. Whereas in senile chronic pancreatitis therapy consists of enzyme substitution and compensation of deficiency syndromes, therapy of secondary pancreatitis is aimed at basic disorders like choledocholithiasis, papillary sclerosis and stenosis, juxtapapillary diverticula and peptic ulcers in stomach and duodenum by surgical or endoscopic-operative means.
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PMID:[Geriatric pancreatitis]. 710 27

Endoscopic papillotomy is a major therapeutic advance in the management of common bile duct obstruction. During 1981, the procedure was performed in 48 of 51 patients between 17 and 93 years of age. There were 13 men and 35 women. Common duct stones were removed in 26 of 31 patients (84%), six of whom had their gallbladders in place and two of whom had cholangitis. Failure in five patients occurred because of stone adherence to the common duct wall, stone size, ductal stenosis, or caught Dormia basket. Papillotomy was done in 10 of 11 patients for stenosis, two for recurrent pancreatitis, two with the sump syndrome, one for hemobilia, and one for bile duct tumor biopsy. The "precut" technique was required in 11 patients. Mild pancreatitis developed in three patients and severe hemorrhagic pancreatitis in one. Three of the four had the precut technique. One patient had minor bleeding, and two developed acute cholangitis requiring laparotomy, one of whom died (2.1%) 40 days after initial endoscopic papillotomy. A Dormia basket became caught in one patient. The duration of hospitalization was 24 to 36 hours after endoscopic papillotomy. Endoscopic papillotomy is considered the method of choice in the management of postcholecystectomy choledocholithiasis.
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PMID:Endoscopic papillotomy. 712 78

The authords present the series of 59 patients with biliary pancreatitis, being observed in the period of January 1st 1971 to December 31st 1979. In the observed material the disease appears in 63,4 per cent of the total pancreatitis. Pancreatitis in our material has appeared in 7,30 per cent of cases with cholelithiasis, in 43,45 per cent when cholelithiasis and choledocholithiasis appear together and in 39,13 per cent when cholelithiasis, choledocholithiasis and stenosis of distal choledochus are present. The stenotic papillitis in our cases has let to pancreatitis up to 57,14 per cent, and the tumours of papillae and the mutal gall bladder channel in all cases. The diagnosis is stated on the basis of clinical examination, serum and urine analyses, the intravenous cholangiography and manometry. A whole spectrum of surgical interventions are also presented which were performed for the aim of therapy. The mortality reached 7 per cent, three patients were not subjectively cured, while the others have achieved the subjective and objective healing. We assume the active surgical attitude either during the first attack of the disease or after the latent acute course, or in the repeated attack. Each case should be carefully led on, and tie of the surgical intervention should be defined on the basis of both end objective facts.
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PMID:[Surgical aspects of biliary pancreatitis]. 717 Aug 95

Endoscopic sphincterotomy (ES) is a simple, effective and remarkably safe method of treatment of choledocholithiasis and papillary stenosis. In this series, ES was technically successful in 255 (86.1 per cent) of 296 patients in whom it was attempted. Forty-nine of the successful cases had papillary stenosis complicated by pain, cholangitis and/or jaundice in patients after cholecystectomy; 205 had choledocholithiasis, of whom 164 had a cholecystectomy and 41 were poor surgical risks and did not have cholecystectomy. One patient had a tumour of the ampulla of Vater. ES has been performed as an emergency in 16 subjects because of severe septic cholangitis in 11 and acute biliary pancreatitis in 5. Of the 205 patients with choledocholithiasis, spontaneous passage of calculi after ES occurred in 151 cases (73.6 per cent), and instrumental extraction of stones was possible in 44 (21.5 per cent); 10 patients (4.9 per cent) had residual stones and required surgery. In this series the overall success rate of ES in removing common bile duct stones was 82 per cent in 238 cases; in the patients with benign papillary stenosis ES was successful in relieving symptoms and biochemical cholestasis in 72 per cent of 57 cases. Complications occurred in 18 cases (7 per cent): cholangitis in 4 (1.6 per cent) and haemorrhage in 14 (5.4 per cent). Two patients (0.8 per cent) with acute bleeding following ES died; in one of these surgery had been performed to arrest the haemorrhage, but the patient died 3 days after operation of hepatorenal failure. The other complications were treated conservatively without mortality.
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PMID:Endoscopic sphincterotomy: indications and results. 723 63

Gallstone disease as the etiology of pancreatitis is much more common in private hospital patients than was once described. Common duct stones (choledocholithiasis) have been proven not to coexist in the majority of cases. The objectives of surgery for gallstone pancreatitis therefore should be adequate drainage of the pancreas, evaluation of the common duct, and cholecystectomy. Common duct exploration usually is not warranted or advised.A pseudocyst may occur subsequent to the acute phase of pancreatitis, or subsequent to surgery for pancreatitis if the pancreas is not adequately and widely drained. The collection of fluid adjacent to or within the pancreas must be determined to be either a pancreatic abscess or a pancreatic pseudocyst. The management of the pseudocyst, which is usually diagnosed by the ultrasonographic finding of a thickened wall, is adjacent internal drainage. By contrast, the pancreatic abscess must have wide, radical, external drainage.Mature judgement must be exercised in the approach to, the timing of, and the management of surgery for gallstone pancreatitis or pseudocyst formation.
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PMID:Acute gallstone pancreatitis with pseudocyst as a complication. 727 23

A series of 500 cholecystectomies performed over a 7-year period was reviewed retrospectively. The reliability of preoperative clinical features such as jaundice and pancreatitis was assessed in determining the presence of choledocholithiasis, and was found to be of limited value. Investigations such as intravenous cholangiography and liver function tests were found also to be inaccurate in the detection of common duct stones as was the appearance of the duct at operation. The usefulness of the peroperative cholangiogram in the detection of common duct stones that would otherwise have been overlooked is emphasized. Common duct stones would have remained undetected in 25 per cent of patients with choledocholithiasis. Despite the use of routine peroperative cholangiography common duct stones were overlooked in 11.25 per cent of patients who underwent exploration.
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PMID:Exploration of the common bile duct--the relevance of the clinical picture and the importance of peroperative cholangiography. 744 11

Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P < 0.01, chi-square test). The negative predictive value of the total set of risk indicators was 100%. Following our diagnostic concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.
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PMID:[Selective intraoperative cholangiography in laparoscopic cholecystectomy]. 750 Aug 3

Laparoscopic cholecystectomy has emerged as the treatment of choice for uncomplicated cholelithiasis. Despite early concerns, many surgeons have applied this new technique to more complicated biliary tract disease states, including biliary pancreatitis. To evaluate the safety of laparoscopic cholecystectomy in this setting, we retrospectively reviewed 29 patients with clinical and laboratory evidence of biliary pancreatitis who underwent this procedure between March 1990 and December 1992. The severity of pancreatitis was determined by Ranson's criteria. Two patients had a Ranson's score of 6, one of 5, one of 4, five scored 3, nine scored 2, nine also scored 1, and two patients scored 0. The mean serum amylase level on admission was 1,610 (range 148 to 7680). All patients underwent laparoscopic cholecystectomy during the same hospital admission for biliary pancreatitis, with the mean time of operation being 5.5 days from admission. Operative time averaged 123 minutes (range 60-220 minutes). Intraoperative cholangiography was obtained in 76 per cent of patients. Three patients had choledocholithiasis on intraoperative cholangiography and were treated with choledochoscopy, laparoscopic common bile duct exploration, and saline flushing of the duct. The mean length of hospital stay was 11 days (range 5-32 days). There were seven postoperative complications requiring prolonged hospitalization with all but one treated non-operatively. One patient with a preoperative Ranson score of 6 developed necrotizing pancreatitis and subsequently required operative pancreatic debridement and drainage. There were no deaths in this series and no postoperative wound infections. The average recovery period for return to work was 2 weeks. These statistics compare favorably with literature reports for open cholecystectomy in biliary pancreatitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Laparoscopic cholecystectomy in biliary pancreatitis. 750 11


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