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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Choledochoduodenostomy was performed in 100 patients for calculus related disease of the common bile duct. There were no significant early or late complications of the anastomotic procedure. The 3 per cent mortality was related to antecedent advanced liver disease in two instances and, in one instance, to intra-abdominal sepsis. The surgical bypass has the advantage of circumventing the retained stone problem or the sequelae of benign obstructive disease in the distal part of the choledochus. It permits postoperative roentgenographic and endoscopic evaluation of the anastomotic site. Cholangitis, blind segment disability and malfunction have not been seen with these indications and this technique. When the common bile duct is at least 1.4 centimeters wide, primary or secondary choledochoduodenostomy with a wide anastomosis has significant advantages over T-tube intubation in the therapeutic and prophylactic management of choledocholithiasis.
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PMID:Choledochoduodenostomy as an adjunct to choledocholithotomy. 61 88

The bile is infected in 31% of patients undergoing an operation for biliary disease and these patients have a significantly greater risk of developing wound sepsis and septicaemia than patients with sterile bile. Prophylactic antibiotics which achieve satisfactory serum rather than high bile levels have been shown to reduce the morbidity of biliary operation. However, only patients with infected bile benefit from prophylactic chemotherapy. Patients with infected bile can be satisfactorily identified by preoperative duodenal aspiration, operative Gram staining of bile, or clinical presentation. The high-risk patients requiring preoperative antibiotic cover include anyone over 70 years of age, jaundiced patients, those requiring emergency operation, patients with recent rigors, anyone having had previous biliary operations, and patients known to have choledocholithiasis.
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PMID:Micro-organisms in the bile. A preventable cause of sepsis after biliary surgery. 87 37

A retrospective study was carried out of 74 elderly patients with obstructive jaundice undergoing percutaneous transhepatic cholangiography (PTC) and/or percutaneous biliary drainage (PBD) in order to assess the effect of prophylactic antibiotics on the incidence of fever and sepsis complicating these procedures. Seventeen patients underwent PTC alone, while 57 had both PTC and PBD. Fifty-three patients had either primary or metastatic malignancy. In the other patients with benign disease, choledocholithiasis was the most common reason for undertaking these procedures. Prophylactic antibiotics were given in 80% of cholangiographies and 93% of biliary drainage procedures. There was an overall incidence of sepsis of 13.5%. Enterobacter cloacae and Acinetobacter anitratus were the most common blood culture isolates in patients with malignant biliary obstruction. The incidence of fever was no different between patients who underwent PTC alone compared with those who had PTC and PBD. Of 24 patients who developed fever, two died secondary to sepsis. Although there was no difference in the rate of sepsis and febrile episodes between the two groups, the risk of septic episodes and mortality emphasizes the need for antibiotic prophylaxis and early therapy in elderly patients undergoing percutaneous biliary drainage procedures.
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PMID:Sepsis associated with transhepatic cholangiography. 135 87

Seventy-eight cardiac transplantations were performed between July 1982 and March 1989. The perioperative death rate was 10%. Overall survival was 86%. Among the long-term survivors, 14 patients underwent 16 noncardiac surgical procedures. Seven of them required emergency laparotomy, four for biliary tract disease, one for ruptured abdominal aortic aneurysm, one for suspected abdominal sepsis and one for enterocolitis. Elective surgical interventions included repair of symptomatic abdominal wall hernia, treatment of hemorrhoids or perianal condylomas, total hip arthroplasty, maxillary sinus drainage and resection of a duodenal villous adenoma. Preoperatively, all patients received cyclosporine orally. Ten of the 14 patients were on triple-drug immunosuppression (cyclosporine, azathioprine and low-dose prednisone [less than 0.20 mg/kg daily]). The remaining four patients took cyclosporine with either azathioprine or prednisone. There were no deaths. Complications were limited to residual choledocholithiasis treated by percutaneous removal, two cases of wound infection and an incisional hernia. The authors' experience indicates that noncardiac surgical procedures may be safely performed in patients who have received a heart transplant.
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PMID:General surgical procedures after heart transplantation. 235 Jul 41

Endoscopic sphincterotomy is the procedure of choice for choledocholithiasis in patients who have had a cholecystectomy. The bile duct is cleared of stones in about 80 to 90 percent of patients. Available data, largely retrospective, suggest that surgery and endoscopic sphincterotomy are about equal with respect to removal of stones, morbidity, and mortality. Certain technical problems are discussed, including inability to insert the papillotome, the large stone, and problems relating to anatomy such as peripapillary diverticulum and prior gastrectomy. The treatment of patients with bile duct stones who have not had a cholecystectomy, with and without cholelithiasis, is controversial. Endoscopic sphincterotomy without subsequent cholecystectomy is adequate treatment for the majority of patients who are unfit for surgery, even if there are stones in the gallbladder, provided they are asymptomatic after endoscopic removal of stones from the bile ducts. Endoscopic sphincterotomy has been performed in the treatment of gallstone-induced pancreatitis, acute obstructive cholangitis, and sump syndrome. The complication rate for endoscopic sphincterotomy ranges from 6.5 to 8.7 percent, with a mortality rate of 0 to 1.3 percent. The most common serious complications are perforation, hemorrhage, acute pancreatitis, and sepsis.
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PMID:Endoscopic management of bile duct stones. 267 45

Pylethrombosis is thrombosis of the portal vein or any of its branches. Five cases have been serendipitously detected, four by computed tomography and one by ultrasonography. Two patients had abdominal sepsis. A third patient had apparent acute cholecystitis with choledocholithiasis. The last two patients had a hypercoagulable state, mesenteric venous thrombosis, and enteric infarction that required resection. The newer diagnostic modalities of computed tomography and ultrasound may document unsuspected pylethrombosis. Surgery may be required because of signs of peritonitis, enteric ischemia, or unresolved sepsis. Anticoagulation is indicated for acute thrombosis of the portal or superior mesenteric veins to prevent further extension and enteric ischemia.
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PMID:Pylethrombosis. Serendipitous radiologic diagnosis. 331 Sep 61

Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates. Pus was released from the common bile duct by sphincterotomy within 24 hours of admission in all 13. Stones were removed endoscopically in 10 patients (77%) without complications. After endoscopic stone removal, symptoms, signs, and abnormal laboratory values returned to normal rapidly; follow-up endoscopic retrograde cholangiography did not show retained stones. Three patients whose large stones precluded endoscopic removal underwent operative choledocholithotomy. Urgent endoscopic sphincterotomy offers an important alternative in the treatment of acute suppurative obstructive cholangitis secondary to choledocholithiasis.
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PMID:Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy. 359 86

This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).
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PMID:Management of gallstones in a district general hospital. 401 6

The records of all patients undergoing hepatobiliary imaging at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.
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PMID:Etiology of the obstructive pattern in hepatobiliary imaging. 653 82

The results of autopsy carried out in 14 patients who died after undergoing papillotomy show that apart from non-method-related sepsis (4 cases) developing from a cholangitis in underlying choledocholithiasis, haemorrhage from the papillotomy wound is the most dangerous complication of this intervention. In one case the cause of bleeding was the severance of the retroduodenal artery, while in 3 cases bleeding occurred after a repapillotomy. In these patients the source of bleeding was a highly vascular granulation tissue in the early healing phase after the first papillotomy. In view of this danger, the primary papillotomy should as far as possible be a complete one, or else, no repapillotomy should be performed in the proliferation phase of wound healing.
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PMID:[Causes of death following endoscopic papillotomy]. 713 28


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