Cases reported "Necrosis"

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21/88. Progression of imaging in pancreatitis panniculitis polyarthritis (PPP) syndrome.

    Lobular panniculitis, together with a polyarthritis may complicate pancreatic disease. Abdominal symptoms are frequently absent and mis-diagnosis of the joint-skin complex can lead to inappropriate treatment in a condition with an already high mortality. We report a case of the pancreatitis panniculitis polyarthritis (PPP) syndrome, complicated by metastatic fat necrosis, with bone marrow involvement and characteristic magnetic resonance imaging (MRI) and describe the clinical characteristics, therapy and outcome of patients affected by the syndrome.
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ranking = 1
keywords = pancreatitis
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22/88. Ansa pancreatica type of ductal anatomy in a patient with idiopathic acute pancreatitis.

    CONTEXT: Ansa pancreatica is a type of pancreatic ductal variation. The exact clinical significance of this ductal variation is not clear. CASE REPORT: We report the case of a 21-year-old male with acute idiopathic severe pancreatitis and extensive parenchymal necrosis who later developed a large pancreatic abscess. Subsequently, transpapillary drainage of the pancreatic abscess was attempted and on endoscopic retrograde pancreatography, disruption in the mid-body of the pancreas and the ansa pancreatica type of ductal anatomy was noted. A 7 Fr nasopancreatic catheter was placed across the disruption. However, due to the development of a new abscess, surgical drainage was performed. The patient has since been asymptomatic over a one-year follow up period. CONCLUSION: A pancreatic ductal variation such as ansa pancreatica may be a finding in severe acute pancreatitis; it is not clear if the presence of these two conditions is co-incidental or if ansa pancreatica causes acute pancreatitis. Further studies are needed to clarify these points.
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ranking = 1.4
keywords = pancreatitis
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23/88. Endoscopic transgastric debridement and drainage for splenic necrosis following an acute episode in chronic alcoholic pancreatitis.

    Management of the complications and sequelae of acute and chronic pancreatitis is a clinical challenge. We report a case of successful transgastric drainage of splenic necrosis after occlusion of the splenic vessels during an acute episode in chronic pancreatitis.
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ranking = 1.2
keywords = pancreatitis
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24/88. Acute portal vein thrombosis and massive necrosis of the liver. An unusual complication after stenting for chronic pancreatitis.

    CONTEXT: ERCP can provide information which is invaluable in managing chronic pancreatitis but it is associated with infrequent, although significant, complications and rare mortality. The complications uniquely associated with diagnostic ERCP include pancreatitis and sepsis (primary cholangitis). CASE REPORT: A 32-year-old man presented with severe upper abdominal pain radiating to the back, associated with vomiting and abdominal distension. The patient was diagnosed as having had chronic calcific pancreatitis recently and had undergone ERCP with pancreatic duct stenting elsewhere. Two days after the procedure, the patient developed severe abdominal pain, vomiting and abdominal distention, and patient was referred to our hospital 7 days after the procedure. Investigation revealed massive liver necrosis and portal vein thrombosis. This patient had a life-threatening complication following pancreatic duct stenting for chronic pancreatitis and was managed medically. CONCLUSION: Therapeutic pancreatic endoscopy procedures are technically demanding and should be restricted to high volume centers. There is a continuing need for evaluation and comparison with alternative strategies. In a good surgical candidate, it is better to avoid stenting.
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ranking = 1.6
keywords = pancreatitis
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25/88. Pancreaticobiliary tuberculosis diagnosed by endoscopic brushings.

    CONTEXT: Isolated pancreaticobiliary involvement with tuberculosis is extremely unusual. Clinical manifestations include abdominal discomfort, weight loss, obstructive jaundice or pancreatitis. Mass/cystic lesions are seen on imaging studies and are often mistaken for pancreatic malignancy. diagnosis is by demonstration of caseation necrosis or the presence of acid-fast bacilli on Ziehl Neelson staining in the aspirated or biopsied specimen. CASE REPORT: A 35-year-old man presented with pain in the upper abdomen of two-month duration associated with significant weight loss. Investigation showed elevated alkaline phosphatase. Imaging studies revealed a mass in the region of the head of the pancreas with dilated intra-hepatic biliary radicles. The diagnosis of pancreaticobiliary tuberculosis was confirmed by cytology from biliary brushing. Biliary brushings taken during endoscopic retrograde cholangiopancreatography have never previously confirmed the diagnosis of pancreaticobiliary tuberculosis. CONCLUSIONS: To the best of our knowledge, this is the first case report where the diagnosis was made on the basis of biliary brushings.
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ranking = 0.2
keywords = pancreatitis
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26/88. Clinical regression of infected pancreatic necrosis. Case report.

    Infected pancreatic necrosis was diagnosed clinically and radiologically in a patient admitted for acute pancreatitis. As free gas in the pancreatic area was recognized, antibiotic therapy (ceftriaxone) was empirically introduced, while surgical drainage was being planned. After the second week, the patient rapidly started to improve, to the point that he could be discharged home without operation. Control CT-scans and general laboratory tests, at this phase and later on, confirmed a still enlarged gland but free of infection or ongoing inflammation. cholelithiasis, which had been identified in an early ultrasound scan, was electively treated by cholecystectomy 2 mo after the onset of pancreatitis, in the absence of sepsis, and with uneventful recovery. This case illustrates the rare possibility of spontaneous regression of infected necrotic pancreatitis, without any type of operation or nonoperative drainage.
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ranking = 0.6
keywords = pancreatitis
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27/88. Roux-en-Y loop jejunal necrosis: another pancreatitis associated enteropathy.

    Severe acute pancreatitis is frequently associated with systemic and local complications. Local sequelae include disorders of the stomach, duodenum, small and large bowel, collectively termed pancreatic enteropathies. We describe a patient with post-gastrectomy acute haemorrhagic pancreatitis which was complicated by necrosis and perforation of an intra-thoracic Roux-en-Y jejunal loop. This does not appear to have been previously reported.
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ranking = 1.2
keywords = pancreatitis
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28/88. Isolation of agent associated with cat scratch disease bacillus from pretibial biopsy.

    We describe the isolation and cultural characteristics of a Gram-negative bacillus that is very similar to the presumed etiologic agent of cat scratch disease. The organism was isolated from a tibial lesion of a male patient who had been hospitalized for severe necrotizing pancreatitis. The significance of the isolate in this patient remains uncertain.
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ranking = 0.2
keywords = pancreatitis
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29/88. Duodenal necrosis and intramural haematoma complicating acute pancreatitis.

    Although segmental bowel necrosis is a recognized complication of pancreatitis, the duodenum is rarely involved. We report a unique case of acute duodenal obstruction characterized by transmural necrosis and intramural duodenal haematoma in a young man with acute alcohol-induced pancreatitis. The patient recovered following pancreaticoduodenectomy.
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ranking = 1.2
keywords = pancreatitis
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30/88. Infected pancreatic necrosis possibly due to combined percutaneous aspiration, cystogastric pseudocyst drainage and injection of a sclerosant.

    This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.
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ranking = 0.4
keywords = pancreatitis
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