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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A novel method of pancreatic anastomosis after proximal Whipple-type resection: classical pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD), has been evaluated over a 5-year period from 1987 to 1992 in 52 patients. Indications for resection included chronic pancreatitis (n = 9) and neoplasms (n = 43). Reconstruction involved a cephalad end-to-end duodeno-/gastro-jejunal anastomosis with a biliary anastomosis 6-8 cm downstream. A separate isolated defunctioned Roux loop was used to construct a duct-to-mucosa (Wirsung-jejunal) pancreaticojejunostomy. Median postoperative stay was 18.0 days (range 11-32 days); three deaths (operative mortality 5.8%) occurred due to sepsis (subhepatic abscess), profound hypoglycaemia and necrotising pancreatitis respectively. These deaths were not related to pancreatic fistula. There were no pancreatic leaks (defined as greater than 50 ml of amylase-rich fluid for more than 7 days). Postoperative exocrine pancreatic function was good as assessed by re-establishment of preoperative weight (achieved in 35 of 40, ie 88% of surviving PPPD patients), clinical steatorrhoea (present in 10 of 41, ie 24% of surviving patients resected for neoplasm), and the need for pancreatic exocrine supplements (required in only 4 of 41, ie 9.8% of surviving patients resected for neoplasm). Twenty patients considered to have normal pancreatic remnants underwent a p-aminobenzoic acid (PABA) excretion test at 3 to 18 months after operation. Median PABA excretion index was 48% (range 24-100%). Isolated defunctioned duct-to-mucosa pancreaticojejunostomy is a safe procedure offering good functional results after Whipple's PD or PPPD resection.
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PMID:Safety and function of isolated Roux loop pancreaticojejunostomy after Whipple's pancreaticoduodenectomy. 791 89

A retrospective review of 296 patients referred for surgical management of pancreatitis from 1964 to 1992 revealed that 18 (6.1%) had colonic complications. Of seven patients with chronic pancreatitis, six developed pancreatocolonic fistulas. One had stenosis of the transverse colon, which resolved after pancreatic cystjejunostomy, three were managed with local fistula excision and simple colon closure, three had segmental colectomy, and in one the fistula closed spontaneously with expectant management. Three patients had concomitant lateral pancreaticojejunostomy, and two had a cystjejunostomy. There were two postoperative complications, but no mortality. Eleven patients had acute necrotizing pancreatitis. Seven developed segmental colonic infarction that required partial colectomy. Four had colonic fistulas, two managed with partial colectomy and colostomy, and two managed nonoperatively. Eleven patients developed major postoperative complications; four died, two from sepsis and multiorgan failure and two from recurrent hemorrhage from a necrotic pancreatic bed. Our findings indicate that the presentation, management, and outcome of colonic complications differ in chronic and acute pancreatitis. In chronic pancreatitis, pancreatocolonic fistula predominated and could be managed either with local excision or segmental resection of the colon with excellent results. Simultaneous surgical correction of associated pancreatic pathology was possible in five patients. In acute necrotizing pancreatitis, colonic infarction secondary to the necrotizing inflammatory process was frequent and required colon resection. There was substantial morbidity and mortality in spite of treatment with colectomy.
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PMID:Colonic complications of pancreatitis. 827 73

Major pancreatic resection is still accompanied by considerable morbidity (35%) and mortality (10%). Typical complications, such as pancreatic fistula and abscess, are chiefly associated with exocrine pancreatic secretion. The hormone somatostatin and its analogue octreotide are well known as potent inhibitors of exocrine pancreatic secretion. In two randomised, double-blind, placebo-controlled, multicentre trials we assessed the prophylactic effect of the perioperative inhibition of exocrine pancreatic secretion by octreotide to prevent postoperative complications. Each patient received 3 X 100 micrograms/day octreotide or placebo subcutaneously. A significant reduction in fistula, abscess, fluid collection, sepsis and postoperative pancreatitis occurred with patients undergoing pancreatic resection for cancer. Results were similar in a second study, using the same protocol but recruiting only patients with chronic pancreatitis. A new randomised, controlled multicentre trial is also described, in which 300 patients with severe acute pancreatitis are being treated with or without octreotide in double-blind fashion. The results will clarify the influence of inhibition of exocrine pancreatic secretion by octreotide on the course of acute pancreatitis, and hence its potential, through inhibition of digestive enzyme secretion, as a treatment for acute pancreatitis.
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PMID:Efficacy of somatostatin and its analogues in pancreatic surgery and pancreatic disorders. 881 84

A 40-year-old man with diabetes mellitus, congestive heart failure, alcoholic cirrhosis, and chronic pancreatitis had an exacerbation of pancreatitis due to alcohol abuse. His condition deteriorated rapidly with development of apparent sepsis; cultures were negative. He slowly improved with multiple antibiotic therapy and total parenteral nutrition. Serial imaging of the pancreas revealed edematous pancreatitis that evolved initially into a phlegmon and later into multiple pseudocysts. Intermittent fever prompted computed-tomography-directed percutaneous aspiration of the largest pancreatic fluid collection, yielding purulent material that grew only Candida albicans. Subsequently, disseminated candidiasis developed. Despite therapy with amphotericin B and aggressive supportive care, the patient died from multiple organ system failure.
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PMID:Infection of a pancreatic pseudocyst due to Candida albicans. 890 99

With the less invasive techniques for complications regarding chronic pancreatitis, such as tubular choledochostenosis, the endoscopic transpapillary bile drainage therapy by means of endoprosthesis has undergone an enlargement of its indications range. Blocked and dislocated prostheses, however, further raise the already existing possibility of septic complications. With 15 out of 43 patients undergoing medium-term endodrainage treatment, we observed different resulting conditions of chronic cholestasis, such as abscess-forming cholangitis, hepatic abscesses, retroperitoneal phlegmon and sepsis up to biliary cirrhosis. Thus, in the case of chronic pancreatitis we still regard choledochostenosis- which, due to scarring, is mostly fixed-as a primary indication for operation.
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PMID:[Distal stenosis of the choledochus in chronic pancreatitis: endoscopic drainage or operation?]. 900 99

Pancreatico-jejunal anastomosis still represents the main source of postoperative complications after pancreatoduodenectomy. In this study our experience on the occlusion of the residual pancreatic stump instead of pancreatico-jejunal anastomosis is reviewed. Between March 1981 and December 1995 we performed 223 pancreatoduodenectomies using Neoprene injection into the Wirsung duct for pancreatic carcinoma of the head (123 cases), ampullary carcinoma (36 cases), distal bile duct cancer (23 cases), islet cells carcinoma (17 cases), chronic pancreatitis (11 cases), duodenal carcinoma (5 cases), miscellaneous diseases (8 cases). Neoprene is a fluid, synthetic glue which polymerized and hardens when in contact with the pancreatic juice, inducing a fibrosis tissue which spares the endocrine component. We observed a 4.9% operative mortality (11 patients): 5 abdominal sepsis, 1 DIC, 1 aortoiliac thrombosis, 1 pulmonary embolism, 1 stroke, 1 hepatic failure, 1 cardiac failure. Overall morbidity was 44.8% (100 patients): in 25 cases (11.2%) a major complication requiring reintervention occurred. In 38 patients (17%) pancreatic fistula was detected: median duration was 43 days, with a mean output of 5.3 ml/day; in all cases a spontaneous solution of the fistula was observed. In conclusion, intraductal injection of Neoprene after pancreatoduodenectomy is a safe procedure, it represents an useful alternative to pancreatico-jejunal anastomosis.
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PMID:[Treatment of the pancreatic stump after cephalic pancreatoduodenectomy]. 957 37

Survey of basic indications of enteral nutrition in Surgery. 1. Application in preoperative preparation. 2. Postoperative preparation in malnutritive and critically-ill patients, at early stage. 3. EN applied also for accelerated motility of the stomach and bowels after major operations (in retroperitoneal operations). 4. Application in traumatology: polytraumas, burns, subsequent sepsis, multiorgan failure; also in specific therapy, e.g. traumatic fistulae of GIT. 5. Use in acute and chronic pancreatitis. 6. Use of enteral probe in special states (e.g. in treatment of fistulae in upper and lower parts of GIT (dehiscence of anastomosis, bowels ruptures). 7. Application in the syndrome of short intestine. 8. Use in reconvalescence after severe operations (sipping) 9. Application in terminal cachectic states.
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PMID:[Indications for enteral nutrition in surgery]. 962 7

Portal cavernomatosis consists in the substitution of the portal vein by many fine, twisting venules leading to the liver. This phenomenon is produced as a consequence of anterior thrombosis of the portal vein and is associated with chronic pancreatitis, cancer of the pancreas, intraabdominal sepsis and cholelithiasis. The symptomatology may be nul or present as obstructive jaundice or portal hypertension. Diagnosis is made by Doppler echography. The treatment is portal shunt when symptomatology is produced. In patients with cholelithiasis requiring surgery, the shunt is advised prior to biliary surgery since perioperative hemorrhage, if present, may be incoercible as in the case herein described. We present a 84-year-old woman with portal cavernomatosis the etiology of which was a hydatidic cyst located in the hepatic bifurcation and treated with mebendazol 10 years previously. This etiology has not been previously reported.
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PMID:[Hydatid cyst in the hepatic hilum causing a cavernous transformation in the portal vein]. 964 76

Pancreatitis is a common disorder. Numerous factors have been implicated in the pathogenesis of acute and chronic pancreatitis, but the exact mechanisms of these conditions are still poorly understood. Depending on the cause of the disorder, patients who have pancreatitis are usually not malnourished and are able to eat within 5 to 7 days of disease onset. In these patients, nutritional support is unnecessary. However, severe disease induces a catabolic state similar to that seen in trauma and sepsis, resulting in rapid weight loss and increased morbidity and mortality. Thus, vigorous nutritional support may be useful in the treatment of severe pancreatitis. Studies have shown that parenteral and enteral nutritional support are well tolerated and can maintain or improve nutritional status in patients with pancreatitis. This article reviews nutritional assessment and therapy in pancreatitis.
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PMID:Nutrition in acute pancreatitis. 1098 Sep 67

We report two patients with alcoholic pancreatic pseudocyst which communicated to the mediastinal space through the aortic hiatus, in one patient resulting in hypotensive shock due to hemothorax, and in the other, resulting in esophagobronchial fistula via the mediastinal cyst. The first patient was successfully treated by radical resection of the pancreatic body and tail, and the spleen, with an ultrasonic scalpel, although inflammatory changes caused by pancreatitis were so prominent that the splenic vein was occluded. The second patient could not be treated surgically, because the superior mesenteric vein had been occluded by chronic pancreatitis; he died of respiratory failure and sepsis due to aspiration pneumonia, despite receiving medical treatment.
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PMID:Severe complications of mediastinal pancreatic pseudocyst: report of esophagobronchial fistula and hemothorax. 1098 97


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