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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.
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PMID:Laparoscopic cholecystectomy: technical performance, safety and patient's benefit. 153 13

Of 340 patients undergoing elective cholecystectomy for gallstone disease, 41 (12%) required an abdominal drain and 22 (65%) required a nasogastric tube postoperatively to control vomiting. Eighty six percent patients were discharged on the third post-operative day; 53% were satisfied with the early discharge. In our opinion, routine use of nasogastric tube and abdominal drain is not necessary and patients can be safely discharged on the third postoperative day after an uncomplicated cholecystectomy.
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PMID:Tubeless, drainless, short-stay cholecystectomy. 155 21

A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting. Repeat gastroscopy 7 days later showed a gallstone, about 4 cm in diameter, which had perforated into the duodenal bulb and could not be removed endoscopically. Because of the serious nature of the other diseases an operation was not undertaken, but an ultrasound-guided extracorporeal shockwave lithotripsy was performed. In three sessions this succeeded without complication to break up the stone, the larger fragments of which were then removed endoscopically while the small ones passed through the gut spontaneously. Subsequent ultrasonography demonstrated a shrunk, stone-free gallbladder with a cholecystoduodenal fistula. Afterwards the patient was again able to take food by mouth without any problems.
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PMID:[Extracorporeal shockwave lithotripsy in gallstone perforation]. 155 1

A case of acute necrotizing pancreatitis in association with choledochal cyst is presented. Pancreatitis associated with choledochal cyst is probably caused by a biliary reflux into the pancreatic duct via a pancreatobiliary malunion, as the intraductal pressure of the cyst exceeds that of the pancreatic duct. Ampullar stenosis due to gallstones or inflammatory changes may increase the intraductal pressure. Bile with activated pancreatic enzymes refluxes into the pancreatic duct, and possibly results in acute pancreatitis. However, patients with choledochal cyst presenting with recurrent bouts of abdominal pain, vomiting, and fever have often been diagnosed as having acute pancreatitis because of hyperamylasemia, despite no evidence of pancreatitis at the time of surgery. At the time of bouts, they also show a slight elevation of serum bilirubin, and an increase in the degree of the choledochal dilatation that are possibly caused by biliary obstruction, not ampullar obstruction, due to suppurative cholangitis. The term "fictitious pancreatitis" or "pseudopancreatitis" in choledochal cyst appears to be appropriate. This clinical study shows that amylase in the biliary tract has ready access to the blood stream, probably through a sinusoidal pathway by cholangiovenous reflux, and a lymphatic pathway, via the Disse's space and denuded cyst wall, provided the biliary ductal pressure is increased.
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PMID:Pseudopancreatitis in choledochal cyst in children: intraoperative study of amylase levels in the serum. 169 Feb 81

Fifty children and adolescents were found to have gallstones at Children's Hospital of Buffalo (NY) during a period of 10 years. The mean (+/- SD) age was 12.2 +/- 6.2 years, with 21 boys and 29 girls. The majority of patients could be categorized into four groups: hemolytic disease (18 patients), parenteral nutrition (eight patients), adolescent pregnancy (seven patients), and idiopathic (10 patients), while seven patients had a variety of other etiologies. Right upper quadrant pain was the most common symptom (32 patients), followed by jaundice (15 patients), vomiting (13 patients), and nonspecific abdominal complaints (13 patients). Ten patients presented with jaundice and underlying hemolytic disease; seven patients were asymptomatic. Clinical presentation was found to vary with age and factors associated with the development of gallstones. Ultrasonography was the mode of diagnosis in 48 patients. Cholecystectomy was performed in 36 patients. In contrast to gallstones in adults, after exclusion of the patients with adolescent pregnancy, there was no female predominance. Pancreatitis was the most common complication, occurring in 8% of the patients; cholecystitis and cholangitis were absent.
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PMID:Gallstones in children. Characterization by age, etiology, and outcome. 173 34

Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder will relieve only these symptoms. Making this determination is a challenge, however, because the classic picture of biliary colic may be inaccurate and the connection between gallstone disease and flatulent dyspepsia is questionable at best. Descriptions of both these conditions are based on anecdotal evidence or reports of uncontrolled surgical series. A review of recent controlled trials suggests that the pain of biliary colic is constant and infrequent, comes in episodes lasting 1 to 5 hours, is located in the epigastrium or right upper quadrant of the abdomen, and characteristically occurs at night. There are few additional symptoms other than nausea or vomiting, and colic is not induced by eating fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the right upper quadrant, fatty-food intolerance, and bloating--is probably not related to the presence of gallstones in the majority of patients.
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PMID:Gallstone symptoms. Myth and reality. 192

A case of gallstone ileus in a patient with carcinoma of the ovary is presented. A 78-year-old female with stage III carcinoma of the ovary underwent optimal debulking surgery followed by six courses of chemotherapy and a microscopically positive second-look laparotomy. She was treated by whole-abdomen pelvic radiation. She then developed progressive nausea, vomiting, abdominal distension, and eventually complete small bowel obstruction. The diagnosis of gallstone ileus was made preoperatively based on the radiological findings. The pathophysiology of gallstone ileus is discussed in the differential diagnosis of patients treated for carcinoma of the ovary.
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PMID:Gallstone ileus masquerading as recurrent carcinoma of the ovary. 222 79

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
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PMID:The Bouveret syndrome: an unusual cause of hematemesis. 222 12

The case of a 74 years old woman suffered from a gallstone disease for 5 years is reported. In the background of the upper abdominal pain and vomiting, which necessitated her hospitalization, a large-size gallstone penetrated into the duodenal bulb and obstructed pyloric channel was found by endoscopic examination. The upper duodenal ileus was verified during the operation, gastroduodenotomy and cholecystectomy were performed, and the 7 x 4 cm size gallstone was removed. After a complications free period the asymptomatic patient went home. Our above reported case is a preoperatively, endoscopically diagnozed Bouveret's syndrome.
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PMID:[Bouveret syndrome diagnosed by endoscopy]. 226 63

Multiple small (2-5 mm in size) gallstones were demonstrated only by endoscopic retrograde cholangiopancreatography in eight patients who had recurrent upper abdominal pain and vomiting. Three patients had mild, rapidly resolving abnormalities of liver biochemistry and serum amylase. In the other five, both serum amylase and liver biochemistry were repeatedly normal. We conclude that endoscopic retrograde cholangiography may be useful in the detection of small gallstones in patients with symptoms suggestive of biliary tract disease, even in the presence of normal oral cholecystography, ultrasonography, serum amylase, and liver biochemistry.
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PMID:Endoscopic retrograde cholangiography in the detection of small stones in the gallbladder. 244 53


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