scholarly journals Acute Recurrent Pancreatitis

2003 ◽  
Vol 17 (6) ◽  
pp. 381-383 ◽  
Author(s):  
Glen A Lehman
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Sphincterotomy ◽  
Microscopic Analysis ◽  
Sphincter Of Oddi ◽  
Recurrent Pancreatitis ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis ◽  
Idiopathic Pancreatitis ◽  
Minor Papilla ◽  
The Common

History, physical examination, simple laboratory and radiological tests, and endoscopic retrograde cholangiopancreatography (ERCP) are able to establish the cause of recurrent acute pancreatitis in 70% to 90% of patients. Dysfunction of the biliary and/or pancreatic sphincter, as identified by sphincter of Oddi manometry, accounts for the majority of the remaining cases. The diagnosis may be missed if the pancreatic sphincter is not evaluated. Pancreas divisum is a prevalent congenital abnormality that is usually innocuous but can lead to recurrent attacks of acute pancreatitis or abdominal pain. In select cases, endoscopic sphincterotomy of the minor papilla can provide relief of symptoms and prevent further attacks. A small proportion of patients with idiopathic pancreatitis have tiny stones in the common bile duct (microlithiasis). Crystals can be visualized during microscopic analysis of bile that is aspirated at the time of ERCP. Neoplasia is a rare cause of pancreatitis, and the diagnosis can usually be established by computerized tomography or ERCP. A wide variety of medications can also cause recurrent pancreatitis. ERCP, sphincter of Oddi manometry, and microscopy of aspirated bile should be undertaken in patients with recurrent pancreatitis in whom the diagnosis is not obvious.

scholarly journals Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

2014 ◽  
Vol 7 ◽  
pp. CGast.S13531 ◽  
Author(s):  
Vincenzo Neri ◽  
Francesco Lapolla ◽  
Alessandra Di Lascia ◽  
Libero Luca Giambavicchio
Keyword(s):  
Acute Pancreatitis ◽  
Sphincter Of Oddi ◽  
Diagnostic Process ◽  
Unknown Etiology ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis ◽  
Therapeutic Program ◽  
Oddi Dysfunction

Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

scholarly journals Ansa Pancreatica, an Uncommon Cause of Acute, Recurrent Pancreatitis

2021 ◽  
pp. 587-593
Author(s):  
Danial H. Shaikh ◽  
Ahmed Alemam ◽  
Jennifer von Ende ◽  
Haider Ghazanfar ◽  
Anil Dev ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Main Pancreatic Duct ◽  
Recurrent Pancreatitis ◽  
Recurrent Acute Pancreatitis ◽  
Developmental Anomalies ◽  
Anatomic Variant ◽  
Minor Papilla ◽  
Ansa Pancreatica

The pancreatic duct is vulnerable to developmental anomalies which may produce variations in its course and/or its configuration. Ansa pancreatica is the least common anatomic variant. It is characterized by the formation of an “S-shaped loop” from the main pancreatic duct to the minor papilla. Ansa pancreatica has been implicated as a cause of recurrent acute pancreatitis. We review existing literature on pancreatitis secondary to the ansa deformity and present a case of recurrent acute pancreatitis in a patient who was ultimately found to have the ansa deformity on endoscopic ultrasound.

scholarly journals Are complications of endoscopic sphincterotomy age related?

Gut ◽  
1997 ◽  
Vol 41 (4) ◽  
pp. 545-548 ◽  
Author(s):  
G T Deans ◽  
P Sedman ◽  
D F Martin ◽  
C M S Royston ◽  
C K Leow ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Endoscopic Sphincterotomy ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Younger Patients ◽  
Age Related ◽  
Increased Risk ◽  
Ascending Cholangitis ◽  
Retroperitoneal Perforation ◽  
The Common

Background—Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endo- scopic sphincterotomy in this age group, relative to that in older patients, is unknown.Aim—To determine whether the development of short term complications following endoscopic sphincterotomy is age related.Patients and methods—A prospective multicentre audit of 958 patients (mean age 73, range 14–97, years) undergoing a total of 1000 endoscopic sphincterotomies.Results—Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41–1.67, p=0.74).Conclusion—Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.

scholarly journals Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Mouhanna Abu Ghanimeh ◽  
Omar Abughanimeh ◽  
Khalil Abuamr ◽  
Osama Yousef ◽  
Esmat Sadeddin
Keyword(s):  
Acute Pancreatitis ◽  
Alcohol Intake ◽  
Definitive Treatment ◽  
Watery Diarrhea ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis ◽  
History Of ◽  
Acute And Chronic Pancreatitis ◽  
Heavy Alcohol Intake ◽  
Uncommon Complication

Colonic complications, including colopancreatic fistulas (CPFs), are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

Endoscopic sphincterotomy (ES) may not alter the natural history of idiopathic recurrent acute pancreatitis (IRAP)

Pancreatology ◽  
2016 ◽  
Vol 16 (5) ◽  
pp. 770-777 ◽  
Author(s):  
Rohit Das ◽  
Bridger Clarke ◽  
Gong Tang ◽  
Georgios I. Papachristou ◽  
David C. Whitcomb ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Natural History ◽  
Endoscopic Sphincterotomy ◽  
Recurrent Acute Pancreatitis ◽  
History Of
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