1/31. Obstructive jaundice and acute cholangitis due to papillary stenosis.Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/31. Hydatid liver disease as a cause of recurrent pancreatitis.Intrabiliary rupture of a hydatid liver cyst is infrequently reported, but may present with symptoms of choledocholethiasis or cholangitis. We report a case of hydatid liver disease presenting as recurrent pancreatitis, and discuss its clinical, radiological and surgical treatments. Hydatid liver disease has a diverse clinical spectrum, and a diagnosis of acute pancreatitis should be considered in patients with hydatid liver disease presenting with unexplained abdominal pain.- - - - - - - - - - ranking = 3keywords = pancreatitis (Clic here for more details about this article) |
3/31. Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography.Magnetic resonance cholangiopancreatography (MRCP) has received much attention as a non-invasive alternative to endoscopic retrograde cholangiopancreatography, primarily for investigation of choledocholithiasis, but also for evaluation of less common biliary anomalies. We present a case of haemobilia causing acute pancreatitis after percutaneous liver biopsy in which the diagnosis could be made clearly by MRCP, thus avoiding endoscopic retrograde cholangiopancreatography and sphincterotomy.- - - - - - - - - - ranking = 2.5keywords = pancreatitis (Clic here for more details about this article) |
4/31. Endoscopic removal of ascaris lumbricoides from the biliary tract as emergency treatment for acute suppurative cholangitis.ascariasis is the most common intestinal helminthiasis worldwide. Heavily infected individuals are prone to develop bowel obstruction or perforation as well as biliary disease. Nevertheless, the presence of roundworms in the biliary tree outside endemic areas is very uncommon. The migration of these worms to the biliary system can cause biliary colic, pancreatitis, or even acute suppurative cholangitis with hepatic abscesses and septicemia.We report here on 2 infants with 14 and 15 months and a 9-year-old boy who suffered from massive biliary ascariasis and who presented with acute suppurative cholangitis. All cases were successfully treated by endoscopic retrograde cholangiopancreatography with worm extraction and adjuvant medical therapy.physicians should be aware of ascariasis in patients with pancreatobiliary symptoms who have traveled to endemic areas or in immigrants from these areas.- - - - - - - - - - ranking = 0.5keywords = pancreatitis (Clic here for more details about this article) |
5/31. Extraordinarily elevated CA19-9 in benign conditions: a case report and review of the literature.Carbohydrate antigen CA19-9 is commonly used in the diagnosis of pancreatic and biliary malignancies. However, increases in its level in benign conditions such as acute cholangitis or pancreatitis have also been reported. A 79-year-old woman presented with cholangitis and a pancreatic pseudocyst while showing elevation of CA19-9 up to 35,500 U/mL. The patient was adequately treated and at two months' follow-up the CA19-9 level had returned to normal.- - - - - - - - - - ranking = 0.5keywords = pancreatitis (Clic here for more details about this article) |
6/31. Bacterial cholangitis causing secondary sclerosing cholangitis: a case report.BACKGROUND: Although bacterial cholangitis is frequently mentioned as a cause of secondary sclerosing cholangitis, it appears to be extremely rare, with only one documented case ever reported. CASE PRESENTATION: A 48-year-old woman presented with an episode of acute biliary pancreatitis that was complicated by pancreatic abcess formation. After 3 months she had an episode of severe pyogenic (E. Coli) cholangitis that recurred over the subsequent 7 months on a further two occasions. Initially, cholangiography suggested the presence of extra-biliary intrahepatic abcesses while repeated investigations demonstrated development of multiple segmental biliary duct strictures. After maintenance antibiotic treatment was started, no episodes of cholangitis occurred over a 14-month period. CONCLUSIONS: Sclerosing cholangitis can rapidly develop after an episode of bacterial cholangitis. Extra-biliary involvement of the hepatic parenchyma with abcess formation may be a risk factor for developing this rare but particularly severe complication.- - - - - - - - - - ranking = 0.5keywords = pancreatitis (Clic here for more details about this article) |
7/31. Biliary emergencies: pancreatitis, cholangitis, and more.The most common cause of acute pancreatitis is gallstones, although many other etiological factors have been identified. The management of the initial episode depends on the severity of the attack and the etiology. In most patients, acute pancreatitis has a benign, self-limited course. However, in the minority who develop infected pancreatic necrosis the mortality can reach 25%. The early assessment of severity and aggressive management of these patients is critical. The roles of endoscopic retrograde cholangiopancreatography, surgical intervention, enteral feeding and use of antibiotics in acute pancreatitis are discussed in this article. Finally, the origin of recurrent acute pancreatitis is discussed, with particular reference to conditions such as pancreas divisum and sphincter of oddi dysfunction whose role in the development of acute pancreatitis is controversial, and to hereditary or familial pancreatitis.- - - - - - - - - - ranking = 5keywords = pancreatitis (Clic here for more details about this article) |
8/31. Acute biliary pancreatitis in a 9-year-old child treated with endoscopic sphincterotomy.Acute biliary pancreatitis is a well recognized complication of gallstone disease in adults. Acute pancreatitis in childhood is usually caused by congenital anomalies of the pancreatico-biliary ducts, viral infections, drug toxicity or abdominal trauma. We report the case of a 9-year-old girl with acute biliary pancreatitis and cholangitis. On urgent endoscopic retrograde cholangiopancreatography a bulging papilla with impacted stone was seen. She was treated with endoscopic sphincterotomy without complications. The disease resolved rapidly and uneventfully after the endoscopic treatment.- - - - - - - - - - ranking = 3.5keywords = pancreatitis (Clic here for more details about this article) |
9/31. Overlap syndrome of autoimmune pancreatitis and cholangitis associated with secondary sjogren's syndrome.In approximately 25% of patients with acute or chronic pancreatitis the cause remains unclear. Despite progress in understanding so-called idiopathic pancreatitis, more diagnostic criteria are needed. We report on a patient who presented with jaundice, but without pain or fever. Under the assumption of pancreatic cancer the patient underwent hemipancreatoduodenectomy. Histological examination showed chronic sclerosing inflammation of the pancreas and bile ducts without any signs of malignancy. Ten weeks later he developed bilateral parotid swelling and recurrent bouts of fever. Again liver enzymes were elevated and unsuccessfully treated with antibiotics for bacterial cholangitis. Further biopsies from submandibular gland, lymph nodes and liver again showed chronic sclerosing inflammation with lymphoplasmacytic infiltration. For sicca symptoms the diagnosis of a primary sjogren's syndrome was proposed. However, with corticosteroid treatment the patient improved remarkably but after tapering he relapsed. On the basis of established criteria, we diagnosed autoimmune pancreatitis with (1) diffuse swelling of the pancreas, (2) irregularities of the pancreatic duct, (3) lymphoplasmacytic infiltration, (4) response to corticosteroids, (5) hypergammaglobulinaemia, and (6) disproportionately raised IgG4. In addition, the patient fulfilled the criteria for secondary sjogren's syndrome. Autoimmune pancreatitis may present as an isolated or syndromic disease. It is an autoimmune disorder of unknown cause and should be included in the differential diagnosis of pancreatic disorders.- - - - - - - - - - ranking = 4keywords = pancreatitis (Clic here for more details about this article) |
10/31. Autoimmune pancreatitis with evolution to cholangitis: a case report.We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic resonance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholangitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancreatitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. Also, our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment.- - - - - - - - - - ranking = 5keywords = pancreatitis (Clic here for more details about this article) |
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