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

Within the last years 70 transduodenal sphincterotomies at stringent indication have been carried out at the Department of Surgery of the RWTH Aachen. This means 9.2% of all operations caused by cholelithiasis. The lethality was 4.2%. The following postoperative complications where stated: a) the bleeding from the divided duct of sphincter with or without haemobile (1.4%), b) the post-sphincterotomy pancreatitis (9.5%) owing to lesion of the pancreatic duct, c) the retroperitoneal abscess with biliary peritonitis (1.8%), d) insufficiency of the duodenal wall or duodenal fistula (1.9%), e) postoperative disturbances of passage of the transsected sphincter Oddi. The haemorrhagic necrosing pancreatitis, the insufficiency of the duodenal wall, the retroperitoneal abscess and the bleeding postsphincterotomy force us to immediate re-operation, while functional disturbances like a spasm or an oedema are controllable pharmacologically and functionally for a short time.
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PMID:Lesions after sphincterotomy. 30 46

The extensive experience of the authors in endoscopic retorgrade pancreaticography is correlated with data in the literature to illustrate the spectrum of characteristic changes and diagnostic accuracy in several entities. These include chronic pancreatitis, calculous pancreatitis, necrotizing lesions and pseudocysts, carcinoma of the pancreas, and papillary stenosis, spasm, and carcinoma.
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PMID:Endoscopic retrograde pancreaticocholangiography in chronic diseases of the pancreas and in papillary stenoses. 70 Mar 15

The purpose of this prospective study was to investigate the complication rate of endoscopic retrograde cholangiopancreatography (ERCP) in the management of jaundiced and unjaundiced patients with laboratory findings suggesting cholestasis. ERCP was performed in 144 jaundiced patients and in 27 patients with unjaundiced cholestasis (age range 18-89 years, mean 66 years). Endoscopic papillotomy was performed in 45 patients, three for spasm of the sphincter of Oddi and the rest for choledochal stones. Seven bile duct prostheses were inserted endoscopically, all for treatment of malignant obstruction. The complications of ERCP were as follows: four cases of pancreatitis (2.3%), five cases of cholangitis (2.9%), two cases of bleeding (1.2%) and two perforations (1.2%). The overall complication rate was thus 7.6% (13/171) and there was no primary mortality. ERCP seems to be a safe and effective method in the diagnostic study and management of bile duct obstruction even in the elderly patients with jaundice or unjaundiced cholestasis.
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PMID:Complications of endoscopic retrograde cholangiopancreatography in jaundiced and cholestatic patients. 162 48

Dysfunction of the sphincter of Oddi (SOD) is an uncommon condition which must be considered in cases of persistent pain in the upper abdomen following uncomplicated cholecystectomy, when disease in other organs, such as gastric ulcer, esophagitis and pancreatitis has been eliminated. The pathogenesis is not fully elucidated, but it is assumed that the cholecystectomy in some cases induces an increased tendency to spasm in the sphincter of Oddi (SO), and, perhaps in connection with an increased sensitivity to pressure elevations in the biliary tree, results in attacks of pain. Whether fibrosis (stenosis) of the SO due to instrumentation or passage of stones is part of the etiology is obscure. Endoscopic retrograde cholangiopancreaticography with papillary manometry should be performed in all cases where SOD is suspected. An elevated basal pressure in SO seems to be the best indicator of SOD. In cases unresponsive to conservative treatment, endoscopic sphincterotomy may be considered. This treatment is not finally evaluated, but apparently the effect is good, especially in patients with elevated basal pressure in SO. It is emphasized that the knowledge of the behavior and regulation of SO is incomplete and that this should be remembered when criteria for SOD are applied.
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PMID:[Oddi's sphincter dysfunction]. 267 55

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

Spasms of the mesenteric and renal arteries are of great concern to the radiologist specialized in angiography. In most cases, they appear to be of iatrogenic origin, due to difficulties in selective catheterization and especially in superselective catheterization of the mesenteric and renal arteries. In this case, spasm may be a most unwelcome side-effect. In other less frequent cases, spasms appear as indirect signs of an underlying spasmogenic disease, such as G. I. tract carcinoid, pheochromocytoma, pancreatitis or poisoning such as ergotism or digitalis overdosage. Most of all, it may occur during some non-occlusive intestinal ischemias. On the other hand, spasm can be considered as a way of treatment, especially in cases of G. I. bleeding, particularly due to ulcerations.
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PMID:[Spasm of the renal and digestive arteries. Radiologic aspect]. 716 70

Endoscopic retrograde cholangiopancreatography (ERCP) is complicated by acute pancreatitis in up to 12% of the examinations. One possible mechanism for this complication is the cannulation-induced sphincter of Oddi spasm with temporary pancreatic duct obstruction. Nifedipine is known to relax the sphincter of Oddi, thus possibly inhibiting or reducing post-ERCP +/- endoscopic sphincterotomy (EST) pancreatic irritation. To test this hypothesis 166 adult patients undergoing ERCP +/- EST were randomized to receive nifedipine (n = 82) 20 mg 3 times at 8-hour intervals during the day of ERCP +/- EST or placebo (n = 84) in a double-blind manner. Clinical pancreatitis developed in 6 patients (4%), in 3 patients in each group. Necrotizing pancreatitis developed in 3 patients, 2 (2%) in the nifedipine group and 1 (1%) in the placebo group. Overall 60 patients (36%) needed medication for post-ERCP +/- EST epigastric pain, 27 (33%) in the nifedipine group and 33 (39%) in the placebo group. Of the 87 patients, who did not need any pain medication before ERCP +/- EST, 34 (39%) needed pain medication after ERCP +/- EST. 14/47 (30%) in the nifedipine group and 20/40 (50%) in the placebo group (p = 0.044). Serum total amylase activity (median) increased from 189 U/l (range 39-11,950 U/l) before ERCP +/- EST to 299 U/l (range 43-11,824 U/l) at 12 h (p < 0.001) and 247 U/l (range 34-15,950 U/l) at 24 h (p < 0.001), with no differences between the two groups. Median serum C-reactive protein concentration and blood leukocyte count remained unchanged in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective randomized trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. 831 38

A patient developing acute pancreatitis with pseudocyst formation after an uncomplicated bone marrow harvest is reported. The diagnosis was confirmed by elevated serum amylase and lipase, and by CT scan. We suggest that the pancreatitis may have been precipitated by spasm of the sphincter of Oddi secondary to opiates administered as premedication and for pain relief.
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PMID:Acute pancreatitis complicating a bone marrow harvest. 905 25

In this paper a short overview is given about pathophysiology of Oddi's sphincter function and diagnosis as well as pharmacological therapy of the hypertonic dyskinesia. According to the pharmacological background of muscle relaxation in other organs, theophyllin preparations: aminophyllin and retard theophyllin were used to inhibit spasm of Oddi's sphincter provoked by morphine in 9 patients with hypertonic dyskinesia of biliary and/or pancreatic outlet. The enzyme elevations (SGOT and/or amylase) and pain response to morphine significantly diminished in all but one patient during the evocative tests and the effect seemed to be dose-dependent until about 500 mg of theophyllin. The long acting theophyllin may be useful in hypertonic Oddi's sphincter dyskinesia mainly in combination with nitrates to prevent nitrate tolerance and intolerance and for treatment of "idiopathic" pancreatitis as well as "postcholecystectomy" syndrome. It might prevent papillary stenosis and adenomyosis which seem to be precancerous states of the papillary tumors.
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PMID:[The effect of theophylline preparations on morphine-induced spasm of Oddi's sphincter in man]. 965 71

A variety of drugs have been reported to cause acute pancreatitis during the past 40 years. We report the first series of four cases of acute pancreatitis related to codeine ingestion. Four patients (three female, mean age 50.2 yr) presented with clinical, biochemical, and radiological evidence of acute pancreatitis. All four had ingested a therapeutic dose of codeine 1-3 h before the onset of abdominal symptoms. Unintentional rechallenge occurred in three cases and was followed by recurrence of acute pancreatitis in all three. All patients made a full recovery. All four patients had had a previous cholecystectomy. The likely underlying pathophysiological mechanism is codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Codeine ingestion leads to acute pancreatitis in some individuals. Previous cholecystectomy seems to predispose to codeine-induced pancreatitis.
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PMID:A new source of drug-induced acute pancreatitis: codeine. 1109 59


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