| Three patients with relapsing gallstone pancreatitis and normal routine biliary radiology are reported and discussed. It is emphasized that when dealing with recurrent pancreatitis for which no cause is evident, normal conventional biliary radiology (oral cholecystogram and intravenous cholangiogram) should not necessarily be accepted as conclusive. The use of endoscopic cholangiography in such a situation is encouraging. ( info) |
2/2147. Haemosuccus pancreaticus: a clinical challenge. BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss. ( info) |
3/2147. Lessons from an unusual case: malignancy associated hypercalcemia, pancreatitis and respiratory failure due to ARDS. A 37-year old woman, presenting with severe hypercalcaemia-associated pancreatitis with pseudocyst formation, was admitted to intensive care because she developed ARDS with respiratory failure. Skeletal metastasis from non-small cell bronchial carcinoma were subsequently diagnosed. After she developed arterial occlusion in the lower limb, supportive treatment was withdrawn. Severe pancreatitis is an exceedingly unusual presentation of non-small cell bronchial carcinoma. Concepts of diagnostic and therapeutic strategies in the context of suspected unusual pathology, and the concept of futility are briefly discussed. ( info) |
| A case of infrapapillary duodenal obstruction secondary to the superior mesenteric artery syndrome is reported. The clinical picture and laboratory data simulated acute pancreatitis but no evidence of pancreatic disease was noted at surgical exploration. A review of the causative factors and treatment of the superior mesenteric artery syndrome is presented along with the differential diagnosis of infrapapillary duodenal obstruction. ( info) |
5/2147. CT demonstration of fibrous stroma in chronic pancreatitis: pathologic correlation. Fibrous stroma found in two patients with chronic pancreatitis was investigated. The helical CT-pathologic correlation confirmed that fibrous stroma found in the subcapsular zone of the pancreatic parenchyma corresponded to the area that was identified as a hypodense zone in the early phase by spiral CT and became isodense with the internal parenchyma in the delayed phase. These CT findings have an important implication for the diagnosis of chronic pancreatitis. ( info) |
6/2147. On the toxicity of valproic-acid. pancreatitis is a serious adverse effect of valproic acid (VPA). We report a case of VPA-induced pancreatitis in a dialysis patient. A brief review concerning VPA toxicity and acute pancreatitis in chronic renal patients is presented. We suggest that end-stage renal disease (ESRD) should be considered another risk factor for VPA-induced pancreatitis. ( info) |
7/2147. Metastasis-induced acute pancreatitis in a patient with small cell carcinoma of the lung. Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma. ( info) |
8/2147. 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. ( info) |
9/2147. Prevention of recurrent pancreatitis in familial lipoprotein lipase deficiency with high-dose antioxidant therapy. We describe a dramatic response to antioxidant therapy in three patients with familial lipoprotein lipase deficiency complicated by frequent severe episodes of pancreatitis who had failed to respond to other dietary and pharmacological measures. Antioxidant therapy may be an important advance in the management of this type of patient. ( info) |
10/2147. Ventral pancreatitis defined on MRI. Ventral pancreatitis, pancreatitis localized in the embryologic ventral pancreas, is rare. To date, only three well documented reports of ventral pancreatitis have been reported in the English-language literature. All three were associated with pancreas divisum. This report presents a patient suspected to have ventral pancreatitis on endoscopic retrograde cholangiopancreatography, confirmed by magnetic resonance imaging. ( info) |