1/97. Purtscher's retinopathy in acute pancreatitis.A patient who became blind following an episode of alcohol-induced pancreatitis is described. The clinical appearance of this patient's retinal changes corresponds most closely to post-traumatic (Purtscher's) retinopathy. The etiology of the retinopathy is best explained by retinal vascular occlusion due either to fat embolism or thrombosis.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/97. nesidioblastosis in an adult man--case report.We report a case of nesidioblastosis in a 66-year-old man with chronic alcohol-induced pancreatitis manifested by attacks of hypoglycemia for several years. The state of the patient improved after subtotal pancreatectomy.- - - - - - - - - - ranking = 0.2keywords = pancreatitis (Clic here for more details about this article) |
3/97. Pancreatic injury following acute methanol poisoning.BACKGROUND: methanol ingestion is a cause of potentially life-threatening poisoning with numerous systemic manifestations. Clinicians may overlook the possibility of acute pancreatitis in this setting. The objective of this paper is to document the incidence of this complication in a series of 22 patients and to discuss the respective role of methanol and ethanol in its pathogenesis. CASE REPORT: A 54-year-old woman developed acute necrotizing pancreatitis following acute methanol poisoning. She was treated by hemodialysis, ethanol infusion, and folinic acid, but, despite maximal supportive therapy, she died from multiple organ failure 54 hours after the ingestion. CASE SERIES: In a series of 22 consecutive patients admitted with a diagnosis of acute methanol poisoning, we found evidence of pancreatic damage in 11 patients. The abnormalities were present from admission and before ethanol therapy in 7 cases and developed after ethanol therapy in 4 cases. Seven patients had a history of chronic ethanol abuse, but no patient had previously suffered from acute or chronic pancreatitis. Three patients presented moderate-to-severe acute pancreatitis according to clinical and radiological criteria and required aggressive supportive therapy including peritoneal dialysis. One patient died from the direct consequences of acute necrotizing pancreatitis and 2 fully recovered from this event. Three patients evolved to brain death; autopsy revealed hemorrhagic lesions in the pancreas in only 1 case. CONCLUSIONS: Clinical, biological, and radiographic signs of acute pancreatic injury may be more common than previously realized. Acute methanol poisoning appears to produce pancreatic injury, although antidotal treatment with ethanol or prior chronic ethanol abuse may be contributing factors. Because ethanol treatment may complicate the pancreatic injury, fomepizole (4-methylpyrazole) may be the preferable antidote in acute methanol poisoning.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
4/97. Severe complications of mediastinal pancreatic pseudocyst: report of esophagobronchial fistula and hemothorax.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.- - - - - - - - - - ranking = 0.4keywords = pancreatitis (Clic here for more details about this article) |
5/97. Acute pancreatitis with Purtscher's retinopathy: case report and review of the literature.The case is described of a 32-year-old man suffering from alcoholism who came to the Emergency Unit with vomiting, fever and sharp epigastric pain irradiating to the chest and upper abdomen. A diagnosis of acute pancreatitis was made after high amylase and lipase levels were observed and the results of computed tomography scan revealed images typical of acute pancreatitis. Findings upon admission and after the initial 48 hours did not correlate with a severe or complicated course according to Ranson's criteria. On the third day after admission he suddenly developed decreased vision. A fluorescein angiogram showed arteriolar occlusion, retinal and choriocapillary ischaemia. Purtscher's retinopathy was suspected. After 4 weeks, the patient had recovered from acute pancreatitis, ophthalmoscopic examination showed normal results, and visual acuity had almost returned to normal. Activation of complement in acute pancreatitis could account for many haematologic acute disorders due to leucocyte emboli or other complement-mediated aggregates. Coagulation abnormalities may range from isolated intravascular thrombosis to severe disseminated intravascular coagulation. Purtscher's retinopathy, due to microembolizations in the choroidal and retinal arterioles, should be included among the various systemic effects of acute pancreatitis. This visual disorder is a rare systemic manifestation of acute pancreatitis which was not correlated to a severe or complicated clinical course. Treatment of these ocular complications remains to be established and outcome, therefore, depends upon resolution of the pancreatic disease.- - - - - - - - - - ranking = 2keywords = pancreatitis (Clic here for more details about this article) |
6/97. Pancreatic pseudocysts complicated by splenic parenchymal involvement: results of operative and percutaneous management.Pancreatic pseudocysts are a common finding in acute and chronic pancreatitis, but most are small and uncomplicated, and do not require treatment. Pseudocysts with splenic parenchymal involvement are uncommon but have the potential for massive hemorrhage. Data on the clinical presentation and optimal treatment of this unusual complication of pseudocysts are lacking. The purpose of this review was to identify the clinical features of pancreatic pseudocysts complicated by splenic parenchymal involvement and to determine the outcome with nonoperative and operative therapy. methods: A retrospective review of the medical records of all patients with pancreatic pseudocysts from December 1984 to January 1999 revealed 238 patients, of whom 14 (6%) had splenic parenchymal involvement. These medical records were reviewed in detail and all pertinent radiographs were reviewed by the authors to confirm splenic parenchymal involvement by a pancreatic pseudocyst. RESULTS: Initial treatment included observation (n = 2), percutaneous drainage (n = 8), and surgery (n = 4). Of the eight patients treated by percutaneous drainage, one died, three required repeated percutaneous drainage, and three required surgical intervention. None of the patients treated primarily by surgery required additional therapy for the pseudocyst. overall, 11 patients had complications of the primary therapy, and 25% of patients treated by surgery had significant hemorrhage. Complications included infection (n = 5), pseudocyst persistence (n = 4), bleeding (n = 2), multisystem organ failure (n = 2), gastric outlet obstruction (n = 1), and splenic rupture (n = 2). CONCLUSIONS: Pancreatic pseudocysts complicated by splenic parenchymal involvement may have life-threatening clinical presentations and respond poorly to percutaneous drainage. Distal pancreatectomy and splenectomy are effective, but the complication rate is high.- - - - - - - - - - ranking = 0.2keywords = pancreatitis (Clic here for more details about this article) |
7/97. Pancreatic ascites. A case report and review of the literature.A case of pancreatic ascites is reported and compared with 55 previously reported cases. A 42-year-old black male chronic alcoholic presenting with abdominal pain was found at operation to have chronic pancreatitis with no pseudocyst formation or overt duct disruption, in contrast to the majority of cases reported. The diagnosis and differentiation from cirrhosis of the liver were based on the operative findings, elevated serum amylase level, ascitic fluid amylase value, and protein content. Surgical exploration alone has proven beneficial--the patient has done well in the past 2 years with no recurrence of the ascites and continued weight gain. The clinical course was compatible with pancreatitis although the radiographic and angiographic studies were not diagnostic. It is suggested that the clinical entity of pancreatic ascites occurs more often than reported and a workup for it should be done even in the face of unconvincing radiographic and angiographic evidence.- - - - - - - - - - ranking = 0.4keywords = pancreatitis (Clic here for more details about this article) |
8/97. Acute pancreatitis-induced hypomagnesemia.We describe the case of an alcoholic patient admitted to our hospital with alcohol-induced acute pancreatitis who developed severe hypomagnesemia (serum magnesium 0.36 mmol/l) during hospitalization. The underlying pathogenetic mechanisms of hypomagnesemia are discussed.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
9/97. Pseudoaneurysm of the gastroduodenal artery ruptured into the superior mesenteric vein in a patient with chronic pancreatitis.We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.- - - - - - - - - - ranking = 1.2keywords = pancreatitis (Clic here for more details about this article) |
10/97. Intrasplenic pancreatic pseudocyst: a case report.An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts.- - - - - - - - - - ranking = 0.2keywords = pancreatitis (Clic here for more details about this article) |
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