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

Pain typical of that from the diseased reno-ureteral unit can emanate from any adjacent organ or any organ with the same innervation. It may also be the result of, or be exacerbated by, mental illness. Case examples of herniated thoracic disk, T12 neuralgia and short leg syndrome, costovertebral joint arthritis, metastatic carcinoma, myofascial syndrome and pancreatitis demonstrated the need for an orderly approach to the problem. Currently, patient screening with the Cornell medical index and the urology questionnaire allows direction of the physical examination, special radiographic and laboratory studies and psychiatric evaluations. An orderly evaluation of flank pain will prove rewarding and may prevent unnecessary urologic operations.
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PMID:Non-urologic flank pain: a diagnostic approach. 112 8

A case of right pyelonephritis with hydronephrosis complicating relapsing acute pancreatitis and right pararenal phlegmon formation is presented. Hydronephrosis is a reportedly rare complication of extrapancreatic inflammation; the only 6 previous cases involving the right side are reviewed. The present case report, to our knowledge, is the first to describe clinical and laboratory evidence of pyelonephritis secondary to partial obstruction of the right upper renal tract by an extrapancreatic phlegmon. The clinician caring for patients with acute pancreatitis should be aware of this important complication, since the presentation of pyelonephritis-flank pain and fever--could erroneously be attributable solely to the pancreatitis.
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PMID:Pyelonephritis complicating relapsing acute pancreatitis. 266 64

Laparoscopic procedures have changed the indications for appendectomy. Routine exeresis should not be performed if a normal organ is observed during an exploratory procedure, but should be in cases with clinical manifestations of right flank pain since neurogenic appendicitis is not rare. We report a recent case observed in a 76-year-old woman. The patient was initially hospitalized for right flank pain with nausea and irregular episodes of diarrhoea. Clinical examination and complementary exploration led to cholecystectomy via subcostal access. On per-operative cholangiography the common bile duct appeared normal. Immediate follow-up was uneventful and the patient was discharged. Twelve days later, the patient complained of the same type of abdominal pain and was hospitalized with a fever at 38 degrees C and shivers. The right flank was very painful at palpation. Echography and computed tomography eliminated a subphrenic abscess or secondary pancreatitis. Pain localized at MacBurney's point 8 days later. Barium study showed a normal colon with the exception of uncomplicated diverticulosis. Subjective pain persisted and appendectomy was decided. Pathological examination revealed neurogenic appendicitis. First described in 1924, neurogenic appendicitis is relatively frequent. Macroscopically, a sclerous fibromyxomatous nodule obliterates the lumen. Microscopically, the central obliterating lesion is composed of hyperplastic nervous tissue in a fibromyxoid matrix, particularly important at the point of the appendix. Clinically neurogenic appendicitis is usually chronic and the appendix appears healthy in situ. Cure is always achieved with resection. Laparoscopic procedures can identify para-appendicular causes of painful abdominal syndromes and sclero-atrophic appendicitis, but in the absence of another explanation exeresis appears to be justified due to the possibility of neurogenic appendicitis.
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PMID:[Neurogenic appendicitis. A case]. 793 31

62-year-old female, who had been under observation for an indolent myeloma for six years without therapy, was admitted because of left flank pain. Various imaging modalities disclosed left pleural effusion, and a huge abdominal tumor involving the left crus of the diaphragm, spleen, stomach, pancreatic tail, left adrenal gland, left kidney and left posterior abdominal wall. Morphological and immunological examinations revealed extensive proliferation of more anaplastic myeloma cells within the tumor and in the pleural effusion than those in bone marrow on admission or at the beginning of the period of observation. Chemotherapy reduced serum M-protein, but LDH, the volume of the pleural effusion, and the size of the tumor increased. She died of pancreatitis associated with massive bleeding from the gastric tumor. Renal function was well preserved until her terminal phase. The clinical course showed the progression of indolent myeloma into an aggressive one without chemotherapeutic intervention, implying a rare subtype in terms of the natural history of multiple myeloma.
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PMID:[Aggressive transformation of an indolent myeloma with abdominal extramedullary plasmacytoma after 6-year period of observation]. 802 86

Acute pancreatitis is not an uncommon disease in an emergency department (ED). It manifests as upper abdominal pain, sometimes with radiation of pain to the back and flank region. Isolated left flank pain being the sole manifestation of acute pancreatitis is very rare and not previously identified in the literature. In this report, we present a case of acute pancreatitis presenting solely with left flank pain. Having negative findings on an ultrasound initially, she was misdiagnosed as having possible "acute pyelonephritis or other renal diseases". A second radiographic evaluation with computed tomography showed pancreatitis in the tail with abnormal fluid collected extending to the left peri-renal space. We performed a literature review and discussed this rare occurrence of acute pancreatitis. We also discussed the clinical pitfalls in this case.
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PMID:Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis. 1591 61

Lymphoplasmacytic sclerosing pancreatitis is a rare entity that has been described under many different names and constitutes a diagnostic challenge as it may simulate a neoplastic process. Herein, we report a case of a 61-year-old woman who presented to our institution complaining of left flank pain and was found to have normal levels of amylase and lipase. An abdominal magnetic resonance image showed thickening of the pancreatic tail and compression of the pancreatic duct. The radiographic differential included both chronic pancreatitis and a neoplastic process. She underwent an exploratory laparotomy, during which a pancreatectomy and splenectomy were performed. Grossly, the pancreas contained a yellowish white, firm homogeneous mass measuring 6.5 x 3.3 x 2.9 cm involving the entire pancreatic tail and hilum of the spleen. Histologically, pancreatic sections showed extensive fibrosis admixed with an inflammatory infiltrate. This infiltrate was composed mainly of lymphocytes with multiple germinal centers, as well as plasma cells and eosinophils that surrounded pancreatic ducts and extended into the peripancreatic adipose tissue. No malignancy was identified, and the process was diagnosed as lymphoplasmacytic sclerosing pancreatitis.
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PMID:Lymphoplasmacytic sclerosing pancreatitis. 1619 61

A renal pseudocyst due to pancreatitis should be suspected when a child with pancreatitis develops flank pain. Percutaneous drainage of the pseudocyst provides effective treatment of this rare condition.
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PMID:Pediatric renal pseudocyst due to pancreatitis. 1716 61

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6 x 13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.
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PMID:A case of pancreatic pseudocyst with a large subcapsular splenic hematoma treated successfully by ultrasonography-guided percutaneous drainage. 2151 81

IgG4-related sclerosing disease is a novel clinicopathological entity characterized by fibrosis, extensive infiltration of IgG4-positive plasma cells, and serum IgG4 elevation. This disorder includes a variety of diseases, such as autoimmune pancreatitis, retroperitoneal fibrosis, sialadenitis, thyroiditis, inflammatory abdominal aneurysm, tubulointerstitial nephritis, and inflammatory pseudotumor [World J Gastroenterol 2008;14:3948-3955]. A 71-year-old man visited our hospital with the complaint of left flank pain and gross hematuria. Computed tomography (CT) revealed left hydronephrosis and a thick retroperitoneal soft tissue mass around the ureteropelvic junction, suspicious of renal pelvic cancer. Urine cytology using a urine sample from the left renal pelvis was negative. On laboratory examination, serum levels of IgG and IgG4 were found to be elevated. The patient refused tumor biopsy. Therefore, he was treated with corticosteroid therapy on the basis of a clinical diagnosis with IgG4-related retroperitoneal fibrosis. Regression of the retroperitoneal mass as well as improvement of left hydronephrosis and decrease in serum IgG4 levels were accomplished. These effects strongly suggested that the present case was an IgG4-related retroperitoneal fibrosis. However, in this instance, since we could not completely rule out malignancies by biopsy, careful follow-up was necessary with these points in mind.
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PMID:A case of IgG4-related retroperitoneal fibrosis mimicking renal pelvic cancer. 2296 62

A 25-year-old man was admitted with the chief complaints of right flank pain, watery diarrhea, and fever. Blood tests revealed high levels of inflammatory markers, and infectious enteritis was diagnosed. A stool culture obtained on admission revealed no growth of any significant pathogens. Conservative therapy was undertaken with fasting and fluid replacement. On day 2 of admission, the fever resolved, the frequency of defecation reduced, the right flank pain began to subside, and the white blood cell count started to decrease. On hospital day 4, the frequency of diarrhea decreased to approximately 5 times per day, and the right flank pain resolved. However, the patient developed epigastric pain and increased blood levels of the pancreatic enzymes. Abdominal computed tomography revealed mild pancreatic enlargement. Acute pancreatitis was diagnosed, and conservative therapy with fasting and fluid replacement was continued. A day later, the blood levels of the pancreatic enzymes peaked out. On hospital day 7, the patient passed stools with fresh blood, and Campylobacter jejuni/coli was detected by culture. Lower gastrointestinal endoscopy performed on hospital day 8 revealed diffuse aphthae extending from the terminal ileum to the entire colon. Based on the findings, pancreatitis associated with Campylobacter enteritis was diagnosed. In the present case, a possible mechanism of onset of pancreatitis was invasion of the pancreatic duct by Campylobacter and the host immune responses to Campylobacter.
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PMID:Case of acute pancreatitis associated with Campylobacter enteritis. 2496 23


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