Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important.
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PMID:Obstructive jaundice due to internal herniation: a case report and review of the literature. 1214 94

Ultrasonography is the first line imaging investigation in patients with jaundice, right upper quadrant pain, or hepatomegaly. Most patients with jaundice have parenchymal or obstructive jaundice. A 56-year old man was admitted to the Institute of Digestive Diseases, Belgrade, with severe pains in the epigastrium, vomiting, icteric coloration of sclera, white stools and dark urine. The symptoms had developed 5 days after a Billroth II resection. The functional liver test indicated a pronounced cholestasis. Real-time ultrasonography showed in the projection of the pancreas head, a clear bordered unechogenic oval formation, with a size of 40 x 35 mm. This finding indicated a possibility of an afferent loop obstruction, accompanied by consecutive obstructive icterus due to compression on the common bile duct. Ultrasonographic examination was followed by surgical reintervention. With the development of noninvasive imaging, transcutaneous ultrasonography, computed tomography and magnetic resonance imaging, the diagnosis of pancreatic and other cysts in upper abdomen is usually straightforward. The important ultrasonographic characteristic of empty organs, compared to cysts and pseudocyts, is a change in the morphology and size of organs after a specific time interval. Air bubbles in the organs lumen are like mobile reflectors, and they are an important sign in identifying segments of the gastrointestinal tract.
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PMID:Jaundice after Billroth II resection. A case report. 1236 42

Non-parasitic liver cysts are seen in up to 5% of the population. They become symptomatic when they are large and can cause pain, nausea, vomiting, early satiety and obstructive jaundice. Treatment modalities include percutaneous drainage, open deroofing, hepatic resection and lately, laparoscopic deroofing. We assessed our management of eleven symptomatic patients over the last five years between May 1996 and August 2001. Two of these had mild symptoms and were kept under review. The remaining nine were treated surgically. Of these, eight were treated by laparotomy and open deroofing with argon laser coagulation of the cut edges while one was treated with left hepatic resection. Three of these had been previously treated with laparoscopic deroofing at other hospitals and had been referred after having developed recurrent symptomatic cysts. Two patients developed post-operative complications--bile leakage that resolved with conservative management. The patients were followed up for a median period of twelve months ranging from 3-62 months. One patient died of liver failure 12 months after surgery. There was no symptomatic recurrence. We conclude that open cyst deroofing gives marked symptomatic relief with a very low complication rate. In today's era of laparoscopic surgery, it has a definite role in the management of symptomatic liver cysts, more so in recurrent cysts following laparoscopic treatment.
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PMID:Management of symptomatic liver cysts. 1251 6

Nine children aged between 2 months and 11 years, who had congenital dilatation of extrahepatic biliary tract, with or without intrahepatic dilatation, are presented. The radiological studies performed in eight patients demonstrated abnormal choledochopancreatico ductal junction. Thus, a long common channel is formed out of the duodenal wall, leading to a continuous reflux of pancreatic juice into the biliary system, chronic inflammation of biliary tract wall, fibrosis of muscular layer and finally different types of dilatations. The main clinical findings were upper abdominal pain, vomiting, or obstructive jaundice. In only one child the dilatation was cystic type and the clinical manifestation was palpable abdominal mass. In eight patients the initial diagnosis of biliary tract dilatation was made through abdominal ultrasound and in one case by direct visualization through emergent exploratory laparotomy. The final confirmation of the presence of long common channel was made by preoperative endoscopic retrograde cholangiopancreatography or intraoperative cholangiogram. The radiologic investigation was not performed in only one case due to bad clinical conditions. The surgical treatment indicated to all cases was Roux- en- Y hepatic- jejunostomy. The late follow up demonstrated that all patients are well and assymptomatic.
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PMID:[Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children]. 1468 43

A 66-year-old patient developed episodes of severe pain due to recurrent cholangitis and pancreatitis. 2 years prior to this referral the patient had undergone an end-to-side hepaticoduodenostomy and a cholecystectomy because of choledocholithiasis and obstructive jaundice. 20 years previously a Billroth II operation had been carried out for the treatment of ulcer disease. Since the hepaticoduodenostomy the patient has suffered from recurrent epigastric pain, nausea and postprandial vomiting. An oedematous pancreatitis following a recurrent chronic cholangitis was assumed. As the intrahepatic biliary ducts appeared to be normal on radiological studies and hepatobiliary scintigraphy showed a downright transit of the tracer, recurrent cholangitis appeared at first to be a rather unlikely explanation. However, follow-up MRI and MRCP showed large calculi at the lower end of the common duct, which was also enlarged up to 1 cm. For this reason an open duodenotomy with subsequent papillosphincterotomy and retrograde choledochoscopy was carried out. The diagnosis was confirmed hereby and all calculi were removed during the operation. Since then the patient has been free of symptoms and complaints. This case shows that remaining calculi at the lower end of the common bile duct can cause severe clinical problems. Therefore the bile ducts should be inspected endoscopically and stones removed prior to, or during the primary operation.
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PMID:[Symptomatic biliary stones at the lower end of the common duct following hepaticoduodenostomy]. 1555 41

Though the high incidence of pancreatic metastasis of lung cancer has been reported in autopsy series, symptomatic cases with jaundice due to that is very rare. Dominant histological type with pancreatic metastases is small cell carcinoma and prognosis is poor. Hereby, we report a case initially presenting with gastroenterologic symptoms as jaundice, nausea, vomiting, weight loss and abdominal pain and then diagnosed as primary small cell carcinoma of the lung with metastasis to pancreas. He underwent a palliative surgery due to obstructive jaundice. This presented case is a rare one with its priority of gastroenterologic symptoms rather than pulmonary complaints.
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PMID:A case of a small cell lung carcinoma presenting with jaundice due to pancreatic metastasis. 1661 26

We report a death case of 56-year-old male with unresectable pancreatic cancer. Its diagnosis was locally-advanced cancer of pancreatic head (Stage IVa) in February 2006. However, he desired no medical treatment until obstructive jaundice (T-Bil 25 mg/dL) appeared. In September 2006, endoscopic biliary metallic stenting was performed and the obstructive jaundice had improved. In November 2006, systemic chemotherapy (S-1 +gemcitabine) was performed. After the chemotherapy, vomiting had appeared because of duodenal stenosis. In December 2006, gastrojejunostomy and intraoperative radiotherapy (IORT) were performed, and the dose of oxicodon was decreased. However, in January 2007, he was suddenly in a state of bleeding-shock and died because of intraabdominal bleeding. The autopsy demonstrated the rupture of splenic pseuoaneurysm due to necrotizing pancreatitis of pancreatic tail, and cancer of pancreatic head was almost viable and IORT was not effective.
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PMID:[A case report of intraabdominal bleeding in unresectable pancreatic cancer after intraoperative radiotherapy]. 1821 80

Sclerosing mesenteritis (SM), also known as mesenteric lipodystrophy, rarely involves the parenchyma of the pancreas. When SM does involve the pancreas, it can mimic pancreatic carcinoma both clinically and radiographically with pain, obstructive jaundice, a mass lesion, and even the appearance of vascular invasion. We report 6 patients with SM involving the pancreas (mean age 43.2 y, 5 female), and review their clinical presentation, radiographic findings, pathology, and outcome. Five of these 6 patients were originally thought to have a primary pancreatic neoplasm. Initial presenting clinical information was available for each patient: all 6 reported abdominal or epigastric pain, 3 reported weight loss, and 2 reported one or more of the following: back pain, fever, abdominal bloating/distention, nausea with/without vomiting, and anorexia. The lesions formed masses with an infiltrative pattern and all had 3 key histologic features: fibrosis, chronic inflammation, and fat necrosis-without a known etiology. The inflammatory infiltrate was composed of a mixture of lymphocytes, plasma cells, and scattered eosinophils. Of the 5 patients with post-treatment clinical information available, 4 had at least a partial response to treatment with steroids, tamoxifen, azathioprine, resection, or a combination of these, and 1 did not respond. A dramatic response to immunosuppressive therapy is illustrated by the case of a 46-year-old woman who presented with the presumptive diagnosis of an unresectable pancreatic cancer. Distinguishing SM from pancreatic carcinoma is crucial to appropriate management, as patients with SM may benefit from immunosuppressive therapy.
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PMID:Sclerosing mesenteritis involving the pancreas: a mimicker of pancreatic cancer. 2035 87

A 40-year-old man was admitted to our hospital because of epigastralgia and vomiting. His condition was diagnosed as acute pancreatitis with a pancreatic pseudocyst, obstructive jaundice, and duodenal stenosis. Because he had fever, abdominal pain, and elevated levels of C-reactive protein (CRP), endoscopic ultrasound-guided transmural cyst drainage (EUS-CD) was performed with a nasocystic tube on the 6th day. After the cyst was reduced and the patient recovered from the obstructive jaundice and duodenal stenosis, the nasal drainage tube was replaced with a plastic stent. Because a short extent of stenosis in the main pancreatic duct in the pancreatic head was found by endoscopic retrograde cholangiopancreatography (ERCP), a 5Fr pancreatic stent was placed to prevent pancreatitis. No recurrence of pancreatitis and the cyst occurred after removal of both stents 5 days later.
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PMID:[Endoscopic ultrasound-guided transmural cyst drainage (EUS-CD) was effective in a case of pancreatic pseudocyst with obstructive jaundice and duodenal stenosis]. 2082 47

Pancreatic neuroendocrine tumors (PNETs) are uncommon malignancies. The purpose of this study was to identify the prognostic factors of pancreatic neuroendocrine tumors at a single center in China. Clinical data of 27 patients with PNETs treated at the Sun Yat-sen University Cancer Center between January 1995 and December 2010 were retrospectively reviewed. Survival was estimated with the Kaplan-Meier methodology. Twenty-three patients (85.2%) had nonfunctional tumors and four patients (14.8%) had functional tumors. The majority of PNETs located in the body and/or tail of the pancreas in 20 patients (74.1%). All Patients with functional tumors cause syndromes related to hormone overproduction. Anorexia, nausea, vomiting, obstructive jaundice, weight loss, and incidental mass were more common in patients with nonfunctional tumors. The median follow-up time was 40 months. The overall 1-, 2-, and 5-year accumulative survival rates were 91%, 81%, and 81%, respectively. In univariate analysis, factors associating with significantly better survival included macroscopically radical resection of the primary tumor, tumor-node-metastasis (TNM) staging, World Health Organization (WHO) classification, and palliative chemotherapy. Macroscopically radical resection of the primary tumor, TNM staging, WHO classification, and palliative chemotherapy were prognostic variables which may emerge as a practical clinical tool to predict survival.
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PMID:Prognostic factors and survival in patients with neuroendocrine tumors of the pancreas. 2147 34


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