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

We investigated the intraductal pressures of the pancreatico-biliary system in dogs with acute pancreatitis. Intraductal pressures were measured by the method of perfusion manometry. After the perfusion with saline (the common bile duct (CBD: 0.8 ml/min, the pancreatic duct (PD: 0.2 ml/min], two parameters, the residual pressure (RP) and the pressure decay time (DT), were measured before and after the induction of acute pancreatitis. The RP of the PD was elevated after inducing severe pancreatitis. There were statistically significant difference of the RP of the PD between severe and moderate pancreatitis. In addition the DT of the PD was also prolonged in severe pancreatitis. There were significant difference of the DT of the PD between moderate and severe pancreatitis. On the other hand the RP of the CBD was also elevated in severe pancreatitis. There were statistically significant difference of the RP of the CBD between severe and moderate pancreatitis. However there was no significant difference between them concerning the DT of the CBD. The histological examination of periampullary area in severe pancreatitis showed measurable inflammatory changes (papillitis). However there was no such finding in moderate pancreatitis. Our results suggest that pressure measurement in the PD is useful for predicting the severity of acute pancreatitis because the pressure of both the PD and the CBD were elevated in severe pancreatitis but not in moderate pancreatitis and this difference is mainly due to the difference of the influence of pancreatitis to the periampullary region.
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PMID:Pressure measurement in pancreatic duct and biliary duct system in dogs with acute pancreatitis. 192 Dec 62

Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES) offer the ability to remove common bile duct stones (CBDS) and still use the laparoscopic technique for cholecystectomy. The accuracy of predicting choledocholithiasis has been variable in several studies. The indications and complications of perioperative ERCP and ES with laparoscopic cholecystectomy (LC) are presented here. Between 6/1/90 and 11/11/93, 484 LC were performed at Santa Barbara Cottage Hospital. A total of 38 patients underwent perioperative ERCP; 33 patients underwent preoperative ERCP with 3/33 (9%) failing to cannulate the ampulla; 15 patients had choledocholithiasis; and 14/15 (93%) were cleared by ES. Fifteen patients had a normal CBD on ERCP. There were no deaths in this group of patients, seven of 38 (18%) had complications, including bleeding and post ERCP hyperamylasemia. Patients who had a normal CBD and underwent preoperative ERCP (9/15, 60%) had a history of gallstone pancreatitis or hyperamylasemia that was resolved or resolving before ERCP. Patients without stones on ERCP or cholangiogram (11/15, 73%) had a normal bilirubin (avg. 1.0 mg/dL; Range 0.4-2.3). Patients with choledocholithiasis (8/15, 53%) had a history of jaundice or elevated bilirubin before ERCP (avg. 2.59 mg/dL; range 0.2-9.3). ERCP with ES and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic cholelithiasis with choledocholithiasis. A history of gallstone pancreatitis or hyperamylasemia that is resolving or resolved in the absence of an elevated bilirubin does not require preoperative ERCP before LC with cholangiogram.
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PMID:The role of endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy in the management of choledocholithiasis. 752 85

Since January 1990, we have treated 113 patients for gallstone pancreatitis; 59 with laparoscopic cholecystectomy (LC), 50 with open cholecystectomy, and 4 with ERCP/sphincterotomy only. In the LC group, 47 had LC during the index admission and 12 underwent delayed LC. Fifty patients had open cholecystectomy, 47 during the index admission. ERCPs were performed in 43 of the 113 patients; CBD stones were identified in 19/43 (44%) and removed endoscopically in 18 (95%). The ERCP complication rate was 6.5%. In total, CBD stones were identified in 29/113 patients (26%). Patients who had imaging of the CBD within the first 4 days from onset of symptoms were more likely to have stones identified than were those patients who were studied after 5 days. Recurrent pancreatitis occurred in in five of 11 patients (45%) who had a > or = 30-day delay to definitive treatment. We conclude that LC can be safely performed in most patients during the index admission for gallstone pancreatitis. This policy should reduce the 30-50% risk of recurrent pancreatitis associated with a delayed operation. ERCP is a helpful adjunct for CBD stones.
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PMID:Acute biliary pancreatitis. The roles of laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography. 766 Feb 60

The purpose of this study is to evaluate the operative technique, indications and results of laparoscopic management of common bile duct (CBP) stones. While laparoscopic cholecystectomy has become the procedure of choice for gallstones, the management of CBD stones remains controversial. From October 1989 to may 1993, we performed 634 cholecystectomies, 615 of them carried out by laparoscopy, (97%). We found 63 cases of CBD stones (9.9%). At the beginning, CBD stones were managed either by endoscopic sphincterotomy (12 cas) or by laparotomy (6 cas). We subsequently performed laparoscopic treatment of CBD stones. Forty-six patients have been treated in this way: 17 via a transcystic approach successfully in 14 cases (82.3%) and 29 by choledochotomy with 27 successful extractions (93.1%). There was no mortality and a morbidity of 4.3% (1 retained stone and 1 wound infection). Endoscopic sphincterotomy is indicated in high risk elderly patients and in complicated stones. (pancreatitis cholangitis), while the whereas incidence of open surgery is greatly reduced; the advantages of laparoscopic management of CD stones are its noninvasive aspect and the complete clearance of the stones in one operation.
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PMID:[Role of laparoscopy in the current treatment of lithiasis of the common bile duct. Apropos of 63 cases of lithiasis]. 781 Sep 76

Opinion is divided whether intra-operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. The aims of the present study were to assess the safety, utility and indications of intraoperative cholangiography performed during laparoscopic cholecystectomy. 11 operative cholangiograms were attempted in 63 patients who underwent laparoscopic cholecystectomy (17.4%). Duration of post-operative hospitalization and interval to return to full activity were identical in the two groups. Cholangiography increased the duration of operation (mean 20.1 min: p < 0.01) and the total charges for the operation by almost L. 200,000. Cholangiograms were performed successfully in 100% of the patients and changed operative management in 2 patients. There was not false negative or positive study. No complications or deaths occurred that were due to cholangiography. In follow-up ranging from 1-9 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. The inescapable conclusion is that an absolute indication for performing cholangiography is unclear anatomy of biliary system. Whereas to document the presence of common bile duct stones, intra-operative cholangiography, neither routine nor selective, is needed. Patients who present with clinical or biochemical signs of choledocholithiasis, a history of cholangitis, acute biliary pancreatitis, or an abnormal CBD on sonogram should have preoperative ERCP and ES before contemplated laparoscopic cholecystectomy. Further advances and confidence with laparoscopic CBD exploration may further change the approach to these patients in the future. In this case selective intra-operative cholangiography is mandatory. However, additional prospective analysis of this patient subgroup is needed.
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PMID:[Is intraoperative cholangiography always indicated during videolaparoscopic cholecystectomy?]. 788 87

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.
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PMID:[Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy]. 816 Nov 53

Sixty-two patients with acute biliary pancreatitis (ABP) were prospectively studied by early ERCP in order to evaluate the morphology of the pancreatico-choledochal junction and the pancreatic duct system (PDS) and compared with 62 control patients. Abnormalities of the ampulla of Vater were observed in 66.1% (33.5% in controls; p = 0.001). A common channel for the common bile duct and the main pancreatic duct (MPD) were found in 70.9% of ABP cases; the length of common channel was < or = 5 mm in 79.5% and > 5 mm in 20.4%; the angle between CBD and MPD was < or = 30 degrees in 88.6% and > 30 degrees in 11.4% (no difference compared to the control group). A patent Santorini's duct were found in 37% of ABP cases vs 38.7% in controls (NS); there was no significant difference in patency of the duct of Santorini between edematous and necrotizing cases of ABP. Morphological changes of the PDS were found in all patients with necrotizing (22 cases) and in 15 out of 40 patients with edematous ABP (p < 0.0001).
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PMID:Pancreatico-choledochal junction and pancreatic duct system morphology in acute biliary pancreatitis. A prospective study with early ERCP. 837 Sep 80

The authors report their experience of the use of intraoperative cholangiography in 350 operations for biliary stones. The cholangiography was performed on all 52 patients with preoperative diagnosis of stones in CBD. In the 298 patients with gallbladder stones intraoperative colangiography was performed in 32 times, on the basis of previous jaundice, pancreatitis, microlithiasis, enlarged cystic duct or choledochus, and suspected palpatory reports of hepatic duodenal ligament. Intraoperative colangiography showed stones in all the patients of the first group and in 8 (25%) of the second. No patients reported disturbances attributable to residual stone with an average follow-up of 6 months.
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PMID:[Selective use of intra-operative cholangiography in gallstone surgery]. 851 60

Choledocholithiasis is usually proven by cholangiogram during cholecystectomy, and today nearly all cholecystectomies are performed laparoscopically. Patients expect to be discharged from the hospital within 24 hours after laparoscopic surgery and return to work in 1 week. Surgeons must develop advanced laparoscopic skills to allow choledocholithiasis to be managed laparoscopically with one procedure and one anesthetic. Interventional radiologists and gastroenterologists can frequently detect and manage common duct stones that cause severe cholangitis and pancreatitis and that occur in patients too debilitated for general anesthesia. In the majority of patients, common duct stones demonstrated at laparoscopic cholecystectomy may be removed using laparoscopic transcystic techniques. Whether complicated CBD stones are optimally managed by laparoscopic choledochotomy, conversion to open common duct exploration, or left for postoperative ERC/ES is controversial and depends on the expertise of the surgeon, gastroenterologist, and wishes of the patient. Although the authors propose one algorithm for the current management of CBD stones, the superiority of the laparoscopic treatment for CBD stones is not yet proven. Multi-institutional, randomized trials comparing laparoscopic, endoscopic, and combined techniques for ductal clearance will be necessary to establish the optimal therapy of choledocholithiasis in the 1990s.
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PMID:The current management of common bile duct stones. 872 8

We report two patients who had non-surgical management of Pancreatic Pseudocyst. The first patient presented with acute pancreatitis and intestinal obstruction, had laparatomy and found to have hemorrhagic pancreatitis and impacted gallstone in terminal item which was removed. Two weeks after laparatomy U/S and CT showed a dilated CBD and two Pancreatic Pseudocysts. ERCP showed dilated CBD. Endoscopic sphincterotomy and stent insertion in CBD and Cystoduodenostomy was done. A percutaneous drainage was done for the pseudocyst involving the body of the pancreas. The second patient presented abdominal pain and clinically had an abdominal mass which was shown by CT as Pseudopancreatic cyst. This was drained percutaneously and given treatment with somatostatin with good outcome.
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PMID:Non surgical management of pancreatic pseudocyst: two case reports and review of the literature. 890 70


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