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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of severe pancreatitis and deep shock are reviewed. In the first case measures to relieve the shock state were unsuccessful. Laparatomy was, therefore, performed and revealed acute haemorrhagic pancreatitis with diffuse purulent peritonitis. After insertion of a drain and irrigation of the abdominal cavity the incision was closed. Twice-daily lavage of the pancreatic fistula via a drain was continued until, after 5 months, the fistula healed spontaneously. In the second case intensive therapy succeeded after 9 days in controlling the acute stage of the disease. Conservative treatment was continued for 6 weeks and the patient was then discharged from hospital. He was re-admitted 3 weeks later because of suspicious clinical and biochemical signs of obstructive jaundice. Laparatomy disclosed inflammatory stenosis of the distal portion of the common bile duct and Vater's papilla and also a pancreatic pseudocyst the size of a child's head. The latter was removed and a drain was inserted. There were no postoperative complications.
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PMID:[Severe acute pancreatitis; course and response to intensive therapy (author's transl)]. 7 34

Massive ascites is are complication, but not exceptional, in pancreatitis. In a series of ten personal cases and a review of one hundred cases in the world literature, the authors attempt to define the main pathological and clinical characteristics of this disease and the best treatment. Ascites may follow abdominal trauma, involving the pancreas, sometimes it occurs during known chronic pancreatitis, often it is the first sign of pancreatic disease, whether acute or chronic. High levels of pancreatic enzymes in the ascitic fluid are the main factor in diagnosis of pancreatic ascites. The mechanism of formation of the ascites is loss of pancreatic fluid into the peritoneal cavity owing to a breach in the pancreas, the presence of enzyme-rich fluid, causing secondarily "chemical" peritonitis. Paracentesis abdominis or drainage of the fluid during exploratory laparotomy, permits one to obtain in certain cases, a cure of the ascites, but surgical drainage by an anastomosis between the pancreatic cyst and the digestive tract (pancreatico-digestive anastomosis), has the advantage of ensuring treatment of the ascites and of the responsible pancreatic disease.
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PMID:[Massive ascites in pancreatitis. Review apropos of 10 personal cases]. 17 57

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

It is possible to estimate the category and volume of lost liquid in patients who have become acutely depleted of body fluids by measuring the haematocrit and plasma protein concentration in venous blood samples. Three recent examples of different categories of loss are presented: plasma loss in pancreatitis, extracellular fluid (saline) loss in paralytic ileus, and mixed plasma and extracellular fluid loss in peritonitis complicating acute appendicitis. Goood clinical results were achieved by infusion of appropriate volumes of either plasma or saline so as to restore the haematocrit and plasma protein concentration to their presumptive basal values.
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PMID:A simple clinical approach to quantifying losses from the extracellular and plasma compartments. 43 51

Seven primary carcinomas of the duodenum were observed from 1973 to 1976 at the University Hospital Hamburg; four in females and three in males with an age between 32 and 69 years of age. The interval between the first symptoms (epigastric pain, jaundice, pruritus, diarrhea, and loss of weight) and surgical therapy (duodeno-pancreatectomy) averaged four months. All carcinomas were resected radically from the macroscopic (intraoperative) aspect as well as from the histological findings. Local tumour recurrences which proved fatal occurred in five patients within nine to twenty-one months. One patient died of peritonitis and another of pancreatitis. The diagnostic mode has been changed since the introduction of endoscopy and retrograde cholangio-pancreaticography (ERCP). The consistent inclusion of the duodenum in routine gastroscopy leads to the hope that more carcinomas of the duodenum can be detected early.
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PMID:[Duodenal cancer. A clinical-pathological study]. 65 97

The case of a recipient of a kidney transplant who developed pancreatitis, complicated by pancreatic pseudocyst subsequently infected by Candidi from an infected parenteral alimentation line, is reported. The case was further complicated by rupture of the cyst leading to Candida peritonitis and development of multiple fistulous tracts between the stomach, ileum, and colon. Despite the 50% mortality of acute pancreatitis in patients with transplants and the 50% mortality reported in Candida peritonitis, the patient was successfully treated by cystogastrostomy, peritoneal lavage, and amphotericin B in association with administration of mannitol and reduction of immunosuppression to a minimal level. After eight weeks of total parenteral alimentation, the fistulous tracts spontaneously closed and the patient was discharged with normal renal function.
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PMID:Acute pancreatitis, pancreatic pseudocyst, and Candida peritonitis in recipient of a kidney transplant. 79 99

Twenty-nine patients, divided into three groups: 1) chronic obstructive pulmonary disease; 2) acute or chronic pulmonary disease with left heart failure; 3) respiratory insufficiency after peritonitis, pancreatitis, and/or sepsis, were studied during respirator treatment with regard to gas exchange, breathing mechanics and central circulation. The dead space ventilation was somewhat greater in group 1 than in the other groups. The alveolar-arterial oxygen tension difference was least in group 1, greater in group 2 and extremely high in group 3. Neither dynamic compliance of the thorax nor inspiratory resistance showed any significant differences between the groups. The cardiac output had the highest values in group 3. The venous admixture was generally small in group 1 and extremely large in group 3. The pulmonary artery pressures were highest in group 2. Three variables proved to be valuable when assessing the prognosis of a patient: a large venous admixture; a large alveolar-arterial oxygen tension difference, and a high pulmonary artery pressure indicated a less favourable prognosis.
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PMID:Studies on pulmonary function in patients during respiratory treatment. Diagnostic and prognostic evaluations. 99 53

Morphological studies of the pancreas in patients who had died of peritonitis at various periods of its development were carried out. Moreover, an experiment was fulfiled on reproducing peritonitis on 41 dogs. In the pancreas in all sectional observations there was observed a picture of acute inflammatory process of a various degree of intensity (peritonitogenic pancreatitis) depending upon the form of peritonitis. It was established that in pathogenesis of acute peritonitogenic pancreatitis an important role was played by direct transfer of the inflammatory process to the tissue of the gland on the side of the abdominal cavity. At the same time, of great importance were also regurgitation of the intestinal content into the system of the excretory ducts of the gland and hemodynamic disorders. The morphological picture of the reproduced in the experiment on dogs acute peritonitogenic pancreatitis was similar to that in the section observations. Both sectional and experimental data confirm the duct-enzymatic theory, or the theory of "common canal", of the pathogenesis of pancreatitis in general of and peritonitogenic pancreatitis in particular.
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PMID:[Morphology and pathogenesis of peritonitogenic pancreatitis]. 101 95

In a group of 260 non-selected cases of acute or subacute pancreatitis, severe complications occurred in 60 (23.1%). Long lasting shock and/or massive internal bleeding (5.4%), severe renal problems (anuria, tubular necrosis, nephrosis) (5.4%) and frank hepatic failure due to extensive liver necrosis or other severe destruction (5.0%), invariably lead to death. The clinical group of findings pointing to a fatal course usually manifested themselves during the first three days. Severe renal and hepatic lesions were in many cases secondary to shock in fulminant rapidly deteriorating cases. Preventing and efficient management of shock are thus essential prerequisites for saving the patient. Other important complications included severe intra-abdominal suppuration and abscesses, peritonitis and sepsis (3.9%), pseudocysts of the pancreas (5.4%) and biliary statis (18.4%). Severe obstruction to bile flow with associated jaundice occurred in only 4.6% of cases; unselected operative biliary decompression does not therefore appear indicated. If an early laparotomy is performed, efficient debridement and drainage are of utmost importance. Fatal panreatitis was associated with extensive necrosis of the pancreas in about 80% of cases; possibly subtotal pancreatic resection at an early laparotomy would have given better results in these most severe cases, as recently reported in the literature.
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PMID:Complications in acute pancreatitis. 103 80

In a group of 260 non-selected cases of acute or subacute pancreatitis, severe complications occurred in 60 (23.1%). Long lasting shock and/or massive internal bleeding (5.4%), severe renal problems (anuria, tubular necrosis, nephrosis) (5.4%) and frank hepatic failure due to extensive liver necrosis or other severe destruction (5.0%), invariably lead to death. The clinical group of findings pointing to a fatal course usually manifested themselves during the first three days. Severe renal and hepatic lesions were in many cases secondary to shock in fulminant rapidly deteriorating cases. Prevention and efficient management of shock are thus essential prerequisites for saving the patient. Other important complications included severe intra-abdominal suppuration and abscesses, peritonitis and sepsis (3.9%), pseudocysts of the pancreas (5.4%) and biliary stasis (18.4%). Severe obstruction to bile flow with associated jaundice occurred in only 4.6% of cases; unselected operative biliary decompression does not therefore appear indicated. If an early laparotomy is performed, efficient debridement and drainage are of utmost importance. Fatal pancreatitis was associated with extensive necrosis of the pancreas in about 80% of cases; possibly subtotal pancreatic resection at an early laparotomy would have given better results in these most severe cases, as recently reported in the literature.
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PMID:Complications in acute pancreatitis. 108 10


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