ABSTRACT
Stool screening for gallstones and ultrasound monitoring of diameter changes of the biliary and pancreatic duct were performed in 129 patients with choledocholithiasis. Gallstone migration was found in 44 patients, all of whom were operated on electively. At surgery, acute pancreatic lesions were found in 16 patients; in the remaining 28 there was no evidence of pancreatic inflammation. There were no significant differences among patients in both groups regarding sex, age, stone size, shape or number found in stools, interval between admission and migration, or the presence of a dilated pancreatic duct before migration. Pancreatic duct reflux, however, was significantly more frequent in cholangiograms of patients with acute pancreatitis, implying that a common channel may be a major factor relating to acute pancreatitis in patients with migrating gallstones.
Subject(s)
Cholelithiasis/complications , Pancreatitis/etiology , Acute Disease , Adult , Bile Reflux/epidemiology , Cholelithiasis/analysis , Cholelithiasis/physiopathology , Cholelithiasis/surgery , Feces/analysis , Female , Humans , Male , Prospective Studies , Risk FactorsABSTRACT
1) Acute suppurative cholangitis is the most severe clinical form of bacterial biliary infection. 2) During a 14 year period, 29 patients were treated at the General Surgery Division A, of the Cosme Argerich General Hospital. 3) Patients were divided in two groups; a) acute suppurative cholangitis with (n:100 or b) without (n:19) evidence of biliary obstruction. In the former group, in addition to Charcot's triad, we found mental confusion and septic shock among clinical signs. 4) Gall stones were the most common cause of obstruction, followed by pancreatic and biliary carcinoma. 5) Diagnosis on admission was correct in 40% of patients. Charcot's triad was present in 19 of the 29 patients. 6) All 22 operated patients survived whereas 7 non operated patients died. 7) The high mortality observed was similar to that reported in other publications and could be partly due to delayed diagnosis, and the high frequency of multiple liver abscesses found at autopsy. 8) Newer diagnostic procedures have improved the differential diagnosis of obstructive jaundice. It is hoped that they will help in the earlier recognition of acute suppurative cholangitis and decrease the incidence of severe complications.
Subject(s)
Bacterial Infections/etiology , Cholangitis/microbiology , Cholestasis/etiology , Adult , Aged , Bacterial Infections/epidemiology , Bile Ducts/microbiology , Cholangiography , Cholangitis/pathology , Cholangitis/surgery , Female , Humans , Male , Middle Aged , Suppuration , UltrasonicsSubject(s)
Hospitals, Religious/organization & administration , Leadership , Administrative Personnel , Catholicism , Decision Making , Forecasting , Hospitals, Religious/trends , Humans , Multi-Institutional Systems/organization & administration , Multi-Institutional Systems/trends , Personnel Selection , United StatesSubject(s)
Colonic Diseases/surgery , Gastric Fistula/surgery , Intestinal Fistula/surgery , Jejunum/surgery , Adult , Humans , Male , Middle AgedABSTRACT
A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were admitted to the hospital. Ultrasonography performed in all patients at admission demonstrated a distal bile duct measuring 7 mm or more in 39 patients, who were monitored for diameter changes of the biliary and pancreatic duct every 24 h and their stools screened for gallstones. Patients underwent surgery at least 8 days after admission. Gallstone migration was found preoperatively in 10 patients, of whom 6 had total serum bilirubin values lower than 2 mg/100 ml. Migration time was accurately determined by the sudden decrease in bile duct caliber. Simultaneous dilatation of biliary and pancreatic duct was found in 4 out of 10 patients with migrating gallstones and in 7 out of 23 patients without gallstone migration, though differences proved non-significant. Acute pancreatitis developed in 2 patients with lithiasis of the distal bile duct who ingested a fatty meal against medical advice. Gallstone migration, even of small stones, was preceded by a period of biliary obstruction. Pain and jaundice before migration were not as frequent as expected.
Subject(s)
Cholelithiasis/complications , Cholestasis/etiology , Pancreatitis/etiology , Ultrasonography , Acute Disease , Adult , Cholestasis/diagnosis , Female , Humans , Middle Aged , Pancreatic Ducts , Pancreatitis/diagnosis , Prospective StudiesABSTRACT
Se presenta un enfermo de 37 anos de edad, con una fistula arterioportal congenita, que desarrollo un cuadro septico luego de un estudio angiografico e intento de embolizacion transarterial. Dicha fistula comprendia la arteria gastroduodenal, y un aneurisma venoso que comunicaba con la vena porta. La evaluacion clinica y hemodinamica del paciente descarto la existencia de hipertension portal, y de otros sindromes vasculares esplacnicos o sistemicos. La extirpacion quirurgica de la malformacion controlo la sepsis, y el enfermo ha permanecido asintomatico en los 12 meses que lleva de seguimiento. Este caso demuestra que la presencia de una fistula arteriovenosa celiaca no necesariamente produce hipertension portal. Se necesita la asociacion con un bloqueo venoso intra o extrahepatico capaz de aumentar la resistencia vascular. La embolizacion es un tratamiento inadecuado, que resulta por lo general insuficiente, y no exento de peligros. La reparacion debe ser quirurgica adaptando la tactica a las caracteristicas y localizacion de la fistula
Subject(s)
Adult , Humans , Male , Arteriovenous Fistula , Portal System , Portal VeinABSTRACT
Se estudiaron los signos pronosticos de Ranson en una serie de 25 pancreatitis agudas. Se diagnosticaron 22 pancreatitis leves y la evolucion demostro en todos los casos la certeza del pronostico inicial.Dos de la pancreatitis leves eran hemorrate correlacion entre los signos clinicos y la anatomia patologica. En 3 pancreatitis biliares leves operadas electivamente se hallo un calculo alojado en la papila lo que demuestra que no todo calculo papilar persistente es causa de necrosis pancreaticas progresiva. De 3 pancreatitis clasificadas como graves, 2 fueron necroticas y una hemorragica. Los signos pronosticos son utiles para comparar serie y realizar estudios prospectivos. No creemos que sean de utilidad para indicar o evitar la cirugia en el periodo inicial de la pancreatitis de acuerdo el numero de signos positivos. En esta serie, todos los enfermos fueron tratados medicamente durante la primera semana, y solo hemos operado precozmente cuando existia duda diagnostica
Subject(s)
Humans , Male , Female , Pancreatitis , PrognosisABSTRACT
Se presenta un caso de absceso piogaseoso intraabdominal postraumatico. Se comenta lo infrecuente de esta observacion, de acuerdo a la bibliografia consultada, haciendo consideraciones clinico-diagnosticas y etiopatogenicas. Se comentan aspectos salientes en cuanto a la oportunidad diagnostica y el tratamiento a realizarse
Subject(s)
Adult , Humans , Male , Abdominal Injuries , Abscess , Postoperative ComplicationsABSTRACT
Se presentan 3 casos del sindrome de reflujo enterogastrico postoperatorio;en todos se habia realizado una gastrectomia de tipo Billroth II. El diagnostico se realizo por exclusion, ya que la endoscopia y la biopsia gastrica son de poca utilidad en estos casos. Se obtuvieron buenos resultados con la interposicion yeyunal isoperistaltica en 2 casos y con la Y en 19 de Tanner en el restante. En la actualidad no existe ningun metodo diagnostico diferencial con otras patologias y una rigurosa seleccion de los enfermos evitan operaciones innecesarias
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Biliary Tract Diseases , Gastrectomy , Postoperative ComplicationsABSTRACT
El estudio necropsico de 12 enfermos fallecidos por pancreatitis aguda necrohemorragica, revelo que solo uno de ellos presentaba una necrosis de coagulacion masiva del parenquima. En los 11 restantes, existia una necrosis hemorragica intersticial y capsular, con el parenquima pancreatico relativamente indemne. En estos casos el parenquima funcionante asociado a la necrosis capsular determinaron una grave retroperitonitis disecante y sepsis generalizada. La pancreatectomia estaria indicada en la necrosis masiva del parenquima.En la necrosis hemorragica intersticial,la pancreatectomia no seria indispensable, si se pudiera evitar la digestion enzimatica retro e intraperitoneal mediante la colocacion oportuna de multiples drenajes y el tratamiento simultaneo de la enfermedad biliar