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

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

In 394 consecutive autopies, tissue from the body of the pancreas showed chronic inflammation in 52 cases (13%); 32 were mild, 11 moderate and 9 severe. Only two of these cases had the clinical diagnosis chronic pancreatitis. The incidence of inspissated plugs of protein in the ducts, dilated ducts and acinar ectasia was significantly higher when chronic inflammation was present. There was a significant higher incidence of chronic inflammation in the pancreas in patients with diabetes mellitus. No significant correlation was noted between chronic inflammation in the pancreas and cholelithiasis, previous cholecystectomy, peritonitis, gastric and duodenal ulcer, abdominal operations, ascites and liver metastases.
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PMID:The incidence and clinical relevance of chronic inflammation in the pancreas in autopsy material. 71 98

To obtain a histopathologic diagnosis at the site of a biliary obstruction, we recently have performed 24 cases of biliary biopsy using gastrofiberscopic biopsy forceps (Olympus, Tokyo, Japan) via transhepatic tracts provided in the course of the procedure of percutaneous biliary drainage. Histopathologic diagnosis was successfully made at the first attempt of biopsy procedure but a second trial was made a week later in 6 cases who were negative for malignant cells on the first attempt. The histological results from the biopsy specimens were 18 adenocarcinomas, 5 chronic inflammations and one normal epithelium. Of 6 cases who were negative for malignant cells on forceps biopsy specimen, three cases were confirmed as adenocarcinoma of the ampulla of Vater, adenocarcinoma of the pancreas and chronic pancreatitis by surgical biopsy. The latter was a true negative result, which was diagnosed as chronic inflammation on forceps biopsy and verified as chronic pancreatitis by surgery. The remaining two cases were diagnosed as malignant obstructive jaundice by clinical and radiological follow-up findings. Major complications (bile peritonitis, bleeding, and hemopneumothorax) occurred in 3 patients, which mainly arose in the earlier period of study. This procedure can be performed at the same time as percutaneous transhepatic biliary drainage with low morbidity or mortality, and although the potential for perforation of bile ducts and injury to adjacent blood vessels is considered it is a useful addition to existing biopsy techniques for yielding material sufficient for histologic analysis.
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PMID:Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps. 129 35

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patients on hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and nonphysiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50-60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.
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PMID:CAPD and pancreatitis: no connection. 138 Aug 40

We have performed 33 pylorus-preserving duodenopancreatectomies. Twenty patients presented with severe chronic pancreatitis and 13 with periampullary adenocarcinoma. We have no postoperative mortality and a 24% rate of morbidity. Complications include anastomotic leaks (2), surgical bleeding (1), anastomotic ulceration (1), and others (4). We have complete follow-up for all cases. In the tumor group, 8 (62%) patients are alive with a mean survival time of 20 months (range: 2-46). In the pancreatitis series, all patients are alive after a mean of 34 months (range: 4-66). We have observed 5 cases (15%) of anastomotic ulcerations responsible for stenosis (2) and acute perforation with peritonitis (2) occurring after a mean interval of 18 months. Four cases have been confirmed histologically after resection. The short- and long-term beneficial effects of the pylorus-preserving operation on patient well-being and nutritional status were confirmed and compared with the results achieved after a Whipple procedure performed in a series of 18 consecutive patients.
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PMID:Pylorus-preserving duodenopancreatectomy: long-term complications and comparison with the Whipple procedure. 223 66

With the help of 2 casuistics is referred to the participation of the peritoneum in chronic pancreatitis. Within the disease mentioned a chronic peritonitis with ascites was observed. Such lesions at the peritoneum are probably rare. When proving a chronic peritonitis differential-diagnostically should also be thought of the presence of a chronic pancreatitis.
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PMID:[Chronic peritonitis with ascites in chronic pancreatitis]. 617 10

Lithiasis of the terminal choledocus raises problems of pre- and intraoperative diagnosis, especially when the evolution is complicated by sclero-inflammatory of the Oddi, chronic pancreatitis, or acute pancreatitis, or with angiocholitis and hepato-renal failure. The high frequency of the lithiasis of the terminal choledocus (37.72% of all cases of biliary lithiasis) makes necessary an improvement of the methods used for the exploration, and evacuation of this type of lithiasis, and for the recovery of the biliary flow. The clinical syndrome in this biliary lithiasis was predominantly of the painful type (in 20.63% of the patients), of the icteric type (58.75%), of the angiocholitic type (8.75%), or it was dominated by pancreatitis (5.95%) or peritonitis (3.06%). In the 126 cases of lithiasis of the terminal choledocus the authors have applied the following procedures: external biliary drainage (50 cases with one death), choledochduodenostomy (42 cases with 4 deaths), papillosplincterotomy of the Oddi (34 cases with 6 deaths). The high postoperative death rate (8.75%) may be related to the fact that surgery was performed in late stages in patients aged over 50 years, with severe anatomoclinical forms (icterocholangitis), with increased anesthetic and surgical risks, as well as that of postoperative complications.
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PMID:[Details of diagnosis and surgical treatment in terminal choledochal lithiasis]. 621 97

Ultrasonically guided fine-needle aspirations were done in the liver of 42 cases of malignancy established later by autopsy and biopsy. The sensitivity was 95.3%. Only in one case, in a metastasis of renal carcinoma, precise tumour classification was not possible cytologically. Pancreatic malignancies were biopsied in 28 cases with later verified diagnoses at post mortem and biopsy; the sensitivity was 85.7%. One pancreatic head adenocarcinoma tumour classification was not possible cytologically. In 16 cases of gastrointestinal carcinoma verified by operation the sensitivity was 93.8%. In one cirrhotic gastric carcinoma only insufficient cytological material could be aspirated despite several biopsies. There were no false positive results in any puncture. The cytological results in all malignancies (n = 86) agreed in 97.7% with later established histological tumour classifications. Two clinically relevant complications were observed (biliary peritonitis, haemoperitoneum). In 15 percutaneous fine-needle pancreaticographies it has been shown to be an advantage that pancreatic juice can be aspirated prior to contrast medium filling of the pancreatic duct. Hyperinstillation into the organ can thus be prevented. In addition, the pancreatic juice aspirate can be investigated cytochemically. Only part of the patients (indurating changes of the pancreas such as chronic pancreatitis) experienced an unpleasant or painful sensation. For this reason such patients should be given analgesics.
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PMID:[Percutaneous, ultrasound-targeted fine-needle puncture biopsy (liver, pancreas, intestine) and ultrasound-targeted pancreatic duct puncture]. 661 5

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.
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PMID:[Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation]. 763 46

The role of laparoscopy in the diagnostic evaluation of ascites of unknown origin was studied in 129 patients. Laparoscopic results were as follows: (1) Carcinomatosis peritonei in 78 (60.5%). Peritoneal biopsies in 76 of these cases revealed malignancy in 67 (adenocarcinoma 62, lymphoma 4, mesothelioma 1) and tuberculosis in 5; specimens were inadequate for diagnosis in 4. (2) Tuberculous peritonitis in 26 (20.2%). Peritoneal biopsies in 24 of these cases revealed tuberculosis in 22 and non-specific chronic peritonitis in 2. (3) Cirrhosis in 7 (5.4%). (4) No gross abnormality in 18 (14.0%). Of the latter, causes of ascites had already been identified in 13 (72.2%), including chronic renal failure in 7, systemic lupus erythematosus in 2, constrictive pericarditis in 2, chronic pancreatitis with chylous ascites in 1, and retroperitoneal lymph node metastasis with chylous ascites in 1. Thus, laparoscopic observation in combination with biopsy established the cause of ascites of unknown origin in 111 (86.0%) of 129 patients. Most of the 18 patients without gross laparoscopic abnormality had underlying disease identified as a cause of ascites; laparoscopy was indicated in these cases to exclude other processes that may also cause ascites.
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PMID:The role of laparoscopy in the evaluation of ascites of unknown origin. 805 29


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