Management of biliary acute pancreatitis

Publication date: Available online 30 October 2018Source: Journal of Visceral SurgeryAuthor(s): M. Bougard, L. Barbier, B. Godart, A.-G. Le Bayon-Bréard, F. Marques, E. SalaméSummaryAcute pancreatitis is a frequent pathology with 11,000 to 13,000 new cases per year in France. A biliary origin (30 to 70% of the cases) should be suspected when alanine amino-transferases are elevated during the first 48 hours, and it is confirmed by the presence of gallstones at trans abdominal ultrasound. Abdominal computed-tomography scan is performed around the fifth day, and is repeated according to clinical and biological evolution. Management of acute biliary pancreatitis varies according to its severity, which should be assessed according to systemic inflammatory response syndrome and organ failures. For mild acute pancreatitis, cholecystectomy should be performed during in-hospital stay, before oral feeding. For moderately severe and severe acute pancreatitis, treatment is based on resuscitation, early enteral continuous feeding, and management of complications. Interval cholecystectomy is performed at a later stage. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be performed in emergency when angiocholitis is associated, and in delayed emergency before oral feeding for persistent common bile duct stone. A common bile duct stone should be searched for during cholecystectomy and can be treated during the same surgical procedure if local conditions ...
Source: Journal of Visceral Surgery - Category: Surgery Source Type: research

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CONCLUSION: Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester. PMID: 31135938 [PubMed - in process]
Source: Turkish Journal of Trauma and Emergency Surgery : TJTES - Category: Emergency Medicine Authors: Tags: Ulus Travma Acil Cerrahi Derg Source Type: research
This article discusses the work-up, diagnosis, and management of the varying pathologies that make up biliary disease including cholelithiasis, cholecystitis, biliary dyskinesia, choledocholithiasis, cholangitis, gallstone pancreatitis, and gallstone ileus. Also addressed are more challenging and rare presentations including pregnancy and bariatric anatomy.
Source: Surgical Clinics of North America - Category: Surgery Authors: Source Type: research
We present a case of acute non-gallstone pancreatitis in a patient with acute and severe pre-eclampsia.A 39-year-old primigravida woman at 33 + 4 weeks' dichorionic diamniotic gestation presented with severe bilateral lower-limb oedema and underwent an emergency caesarean section due to the development of acute severe pre-eclampsia. Postpartum, the woman developed out-of-proportion generalised upper abdominal tenderness with worsening liver function and markedly raised lipase and amylase levels. Imaging confirmed oedema and inflammatory changes in keeping with acute non-gallstone pancreatitis. The patient improved wi...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
Abstract OBJECTIVE: To evaluate the cumulative hospitalization cost differences between routine cholecystectomy and an observational approach during index hospitalization for pregnant patients. METHODS: A retrospective cohort study of 1,245 pregnant women with biliary pancreatitis across the United States between 2010 and 2014 was performed using the Nationwide Readmissions Database. Cumulative costs and complications were compared between patients with and without cholecystectomy during both initial and subsequent hospitalizations. RESULTS: Cholecystectomy was performed at index hospitalization in 374 p...
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
We present a case of acute non-gallstone pancreatitis in a patient with acute and severe pre-eclampsia.A 39-year-old primigravida woman at 33 + 4 weeks' dichorionic diamniotic gestation presented with severe bilateral lower-limb oedema and underwent an emergency caesarean section due to the development of acute severe pre-eclampsia. Postpartum, the woman developed out-of-proportion generalised upper abdominal tenderness with worsening liver function and markedly raised lipase and amylase levels. Imaging confirmed oedema and inflammatory changes in keeping with acute non-gallstone pancreatitis. The patient improved wi...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
Gallstones are common during pregnancy, and acute biliary pancreatitis (ABP) is associated with increased rates of morbidity and mortality. There is a paucity of population-based data for ABP in pregnancy. Thus, we sought to investigate national outcomes of ABP in this group of patients
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Tuesday abstract Source Type: research
We present a case of acute non-gallstone pancreatitis in a patient with acute and severe pre-eclampsia. A 39-year-old primigravida woman at 33 + 4 weeks' dichorionic diamniotic gestation presented with severe bilateral lower-limb oedema and underwent an emergency caesarean section due to the development of acute severe pre-eclampsia. Postpartum, the woman developed out-of-proportion generalised upper abdominal tenderness with worsening liver function and markedly raised lipase and amylase levels. Imaging confirmed oedema and inflammatory changes in keeping with acute non-gallstone pancreatitis. The patient improved w...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
This study aimed to describe the types, clinical characteristics, mortality, and the safety and necessity of gestation termination of acute pancreatitis in pregnancy (APIP).MethodsWe retrospectively reviewed 121 APIP cases in the Gastroenterology Department of The First Affiliated Hospital of Nanchang University. APIP diagnosis were based on 2012 Atlanta Criteria. The correlation between APIP types, severity, biochemical parameters and mortality was analyzed.ResultsThe most common symptoms for APIP were abdominal pain (86.8%) and vomiting (73.6%). The most common causes for APIP were gallstone (36.4%) and hypertriglyceride...
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
We report a case of HTGP in a male with hyperlipoproteinemia type III who was treated successfully with insulin and apheresis on the initial inpatient presentation followed by bi-monthly outpatient maintenance apheresis sessions for the prevention of recurrent HTGP. We also reviewed the literature for the different inpatient and outpatient management modalities of HTGP. Given that there are no guidelines or randomized clinical trials that evaluate the outpatient management of HTGP, this case report may provide insight into a possible role for outpatient apheresis maintenance therapy. PMID: 29142480 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
ConclusionsGallstone disease during pregnancy was associated with adverse maternal and neonatal outcomes. Most women with gallstone disease during pregnancy are managed conservatively. Surgical management was associated with decreased risk of readmission.
Source: Paediatric and Perinatal Epidemiology - Category: Perinatology & Neonatology Authors: Tags: Original Article Source Type: research
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