1/88. Experience with duodenal necrosis. A rare complication of acute necrotizing pancreatitis.Duodenal necrosis is a rare, but very serious complication of acute necrotizing pancreatitis that most likely is the result of vascular compromise and ischemia of the peri-Vaterian aspect of the duodenal wall. In this article, we present three patients with duodenal necrosis complicating acute necrotizing pancreatitis. The diagnosis was made at the time of necrosectomy. Management options of this challenging complication of necrotizing pancreatitis are discussed.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/88. The application of immobilized polymyxin b fiber in the treatment of septic shock associated with severe acute pancreatitis: report of two cases.The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin b fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.- - - - - - - - - - ranking = 0.71428571428571keywords = pancreatitis (Clic here for more details about this article) |
3/88. Extra-hepatic biliary-ductal necrosis in acute pancreatitis: a rare complication.An 8-year-old male presented with an acute abdomen. Exploration revealed bilious ascites, oedematous pancreatitis with areas of necrosis, and omentum showing patches of fat necrosis. The common bile duct and almost all of the common hepatic duct were gangrenous and had sloughed, with bile leaking from the junctional stump of the right and left hepatic ducts. The patient was managed successfully by Roux-en-Y hepaticojejunostomy. This is a rare case showing necrosis and sloughing of the extrahepatic bile ducts in acute pancreatitis.- - - - - - - - - - ranking = 0.85714285714286keywords = pancreatitis (Clic here for more details about this article) |
4/88. Development of colonic necrosis following severe acute pancreatitis.We herein describe a 70-year-old male patient who developed colonic necrosis following severe acute pancreatitis. He was referred to our hospital with a diagnosis of acute pancreatitis. In the course of the disease, he developed sudden and massive hematochezia and died. The autopsy findings revealed large bowel ischemia with transmural infarction. The possible pathogenic mechanisms of colonic ischemia are also discussed.- - - - - - - - - - ranking = 0.85714285714286keywords = pancreatitis (Clic here for more details about this article) |
5/88. A fatal case of pancreatic panniculitis presenting in a young patient with systemic lupus.BACKGROUND: subcutaneous fat necrosis associated with pancreatic disease is a rare event. The clinical cutaneous findings are non-specific erythematous nodules with central softening located predominantly on the lower extremities. The histopathologic features of these lesions are very characteristic and diagnostic. methods: We present an unusual case of pancreatic panniculitis associated with lupus pancreatitis in a 21-year-old African American female. The patient presented with lower extremity skin nodules, arthralgia, and serositis prior to the diagnosis of systemic lupus and pancreatitis. The skin lesions progressed despite normalization of serum pancreatic enzymes. Following femoral vein catheterization for renal dialysis, she developed a large indurated area over the left lower quadrant, flank, groin, and upper thigh measuring 25 cm. She was treated with repeated debridement, tissue grafts, and hyperbaric oxygen because of a clinical suspicion of necrotizing fasciitis. RESULTS: Examination of skin biopsies and debrided tissue revealed the pathognomonic features of pancreatic panniculitis without any evidence of necrotizing fasciitis. Organisms were not detected by tissue examination or microbiologic cultures. CONCLUSIONS: This case illustrates the potential role of vascular trauma in the pathogenesis of pancreatic panniculitis.- - - - - - - - - - ranking = 0.28571428571429keywords = pancreatitis (Clic here for more details about this article) |
6/88. Ultrathin cutting needle biopsy histology in the tissue diagnosis of acute pancreatitis--experimental study and application in a human case.BACKGROUND AND AIMS: This study was to assess whether the tissue obtained with an ultrathin cutting needle, that is as thin as used for aspiration cytology and bacteriology, can give enough material to diagnose acute pancreatitis in rat model and in a human case. methods: Wistar rats were randomly allocated into control group (n = 6), cerulein group (n = 6), ligation group (n = 6) and bile salt group (n = 6). In the cerulein, ligation and bile salt groups acute pancreatitis was induced by cerulein intraperitoneal injections, low ligation of common biliopancreatic duct and sodium taurodeoxycholate intraductal injection, respectively. serum amylase activity was measured and a large cut specimen and two ultrathin needle biopsy specimens were obtained from the pancreas for light microscopic histology. Oedema, acinar cell necrosis, haemorrhage or fat necrosis, and leukocyte infiltration were evaluated semiquantitatively and compared with large cut specimens. RESULTS: The pancreatitis groups revealed different severity in oedema, acinar cell necrosis, haemorrhage or fat necrosis, and leukocyte infiltration. The needle biopsy showed 100% sensitivity and 100% specificity in the diagnosis of acute pancreatitis. The histopathologic scores showed a good and significant correlation between ultrathin biopsy and large cut specimens in all the four histologic parameters, especially in oedema and acinar cell necrosis. A human case is presented, whose percutaneous ultrathin needle biopsy histology was successfully applied for diagnosing acute pancreatitis. CONCLUSIONS: The ultrathin needle biopsy histology can give enough material for the diagnosis of acute pancreatitis. Further studies with ultrasonography guided percutanous or endosonography guided transduodenal technique will be needed to assess the role of tissue sampling in acute pancreatitis.- - - - - - - - - - ranking = 1.5714285714286keywords = pancreatitis (Clic here for more details about this article) |
7/88. Pancreatic pseudocystportal vein fistula manifests as residivating oligoarthritis, subcutaneous, bursal and osseal necrosis: a case report and review of literature.Pseudocyst is a common complication of pancreatitis. Pseudocyst may rupture into the surrounding organs. rupture into the portomesenteric vein is extremely rare with only seven cases being described in the English literature. pancreatic portal vein fistula is very difficult to verify. The aim of this study was to view the diagnostic methods of pancreatic portal vein fistula and to describe the results of high-dose corticosteroid treatment to our knowledge for the first time. We report here a case of pancreatic portomesenteric vein fistula that was manifest as subcutaneous fat necrosis, bursal necrosis, intramedullary aseptic bone necrosis and recidivating oligoarthritis. The literature of this unusual complication is reviewed. The results of high-dose corticosteroid treatment are also described. In patients with recidivating oligoarthritis, subcutaneous, bursal or osseal necrosis a pancreatic process should be included in the differential diagnosis even in cases of no abdominal signs or symptoms or previous abdominal history. Operative exploration of the pancreas should be performed in the early phase of the disease. To diminish the ongoing extrapancreatic manifestations after the closure of the fistula massive corticosteroid treatment may be attempted although the role of this therapy remains controversial.- - - - - - - - - - ranking = 0.14285714285714keywords = pancreatitis (Clic here for more details about this article) |
8/88. Intraductal papillary mucinous neoplasm of the pancreas presenting as acute pancreatitis.Intraductal papillary mucinous neoplasms are rare pancreatic exocrine tumors with distinct clinicopathologic features. They usually present with a long history of chronic pancreatitis-like symptoms, which are often associated with weight loss, diarrhea, and malabsorption. We report a case of benign intraductal papillary mucinous neoplasm with focal squamous metaplasia presenting as acute necrotizing pancreatitis. The clinicopathologic features are discussed in a brief review of the literature.- - - - - - - - - - ranking = 0.85714285714286keywords = pancreatitis (Clic here for more details about this article) |
9/88. Pathological case of the month: sudden death in a child as a result of pancreatitis during valproic acid therapy.valproic acid is a widely used drug in the treatment of epilepsy and, compared to other anticonvulsant drugs, is considered safe. The most common side effects of valproic acid ingestion or therapy are transient nausea, vomiting, abdominal cramps, and diarrhea. Most of these complaints are mild. However, more serious adverse reactions can occur such as hepatotoxicity and pancreatitis. It has been proposed that, whenever possible, valproic acid not be used in the younger child, the child with a severe seizure disorder or other neurological disorders, mental retardation, developmental delay, organic brain disease, congenital abnormalities, or the child who is taking multiple anticonvulsant drugs, as these factors may increase the likelihood of hepatotoxicity and/or pancreatitis. In the present report, we describe a fatal case of acute hemorrhagic pancreatitis in a four and a half-year-old Hispanic female child who was receiving valproic acid in combination with another anticonvulsant drug for control of focal seizures. The patient also received the macrolide antibiotic azithromycin. For pediatricians and forensic pathologists valproic acid-induced pancreatitis can be a challenging diagnosis which must not be mistaken for abdominal trauma. We discuss the workup of the patient and differential diagnosis.- - - - - - - - - - ranking = 1.1428571428571keywords = pancreatitis (Clic here for more details about this article) |
10/88. Pancreatico-mediastinal fistula with a mediastinal mass lesion demonstrated by MR imaging.Internal pancreatic fistulas are uncommon but well-recognized complications of inflammatory pancreatic disease. A case of a pancreatico-mediastinal fistula with a mediastinal mass lesion in a patient with a documented history of chronic alcohol consumption and previous episodes of acute pancreatitis is described. Since the clinical symptomatology was dominated by pulmonary complaints, magnetic resonance (MR) imaging using a breathhold coronal T2-weighted sequence with spectral fat saturation was essential in clarifying this difficult and rare pathology. Furthermore, the depiction of a fistulous tract between a mediastinal mass lesion and the retroperitoneum posterior to the pancreas, i.e., a pancreatico-mediastinal fistula by MR imaging has not been previously reported, to the best of our knowledge.- - - - - - - - - - ranking = 0.14285714285714keywords = pancreatitis (Clic here for more details about this article) |
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