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Article
The Safety of Endoscopic Retrograde Cholangio Pancreatography (ERCP) in Elderly (over 80), Patients: Single Centre Experience

Authors: P Harte --- K Walsh --- Ali Alshareefy
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2012 Volume: 9 Issue: 3 Pages: 716-720
Publisher: Babylon University جامعة بابل

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Abstract

AbstractBackground: ERCP is an invasive procedure which combines the use of x ray and endoscopy to provide a reliable way for diagnosis and treatment of hepatobiliary diseases. The diagnostic role of ERCP has largely been replaced by MRCP (Magnetic Resonance cholangiopancreatography). The valuable use of ERCP has, however, been associated with significant morbidity and mortality. Aims: 1) determine the safety of ERCP procedure in elderly patients. 2) compare the local complication rates with international standards using international large scale studies and British Society of Gastroenterology audit rates as standards. Patients and Methods: 1) Retrospective study on 106 elderly patients (over 80) 2)Cases were identified using local register and profoma used to collect data. 3)Completed data were submitted for collation and statistical analysis. Results: The research revealed the following rates for local complications. 1) acute pancreatitis: 5%. 2) Hemorrhage: 0%. 3) Acute cholangitis: 1%. 4) Dudenal perforation: 0%. 5) Death: 1%. Conclusions: 1) Elderly patients tolerate ERCP as good as young patients despite their advanced age and co-morbidities. 2) The local complication rates fall within the international ranges

Keywords

ERCP --- Pancreatitis --- cholangitis --- Perforation


Article
Pancreatic Fistula Following Surgery of Primary Pancreatic Hydatid Cyst Causing Pancreatitis

Author: Ghassan A .A .Nasir
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 3 Pages: 359-362
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Primary pancreatic hydatid cyst is rarely encountered and difficult to differentiate from pancreatic cystic neoplasm.THE AIM:Of this case report is to discus the mode of presentation and best management of this condition.CASE REPORT:A twenty-eight years old male, presented with recurrent upper abdominal pain of three years duration. The pain was radiating to the back and associated with vomiting and low-grade fever.The ultrasound as well as CT scan with oral and I.V. contrast revealed that there was a solid-cystic mass in the tail of the pancreas suggesting of pancreatic cystic tumors. Laparotomy revealed pancreatic hydatid cyst, which was communicating with pancreatic duct. The patient treated by endocystectomy, which was complicated by pancreatic fistula.CONCLUSION:Pancreatic hydatid cyst should be kept in mind in any cystic lesion of pancreas.This disease could be treated by endocystectomy or partial pancreatectomy.


Article
Levels of Zinc & Copper in Acute Pancreatitis Patients

Author: Sundus Khawam. Al-Khazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 3 Pages: 203-205
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute pancreatitis has traditionally been defined as an acute inflammatory process of the pancreas that (1) is associated with abdominal pain and elevations in serum levels of pancreatic enzymes and, (2) disrupts normal pancreatic architecture and function.AIM OF THE STUDY:To assess the serum level of zinc and copper in patients with acute pancreatitis.METHOD:A study conducted in Gastrointestinal Teaching Hospital in Baghdad, from first May 2005 to first March 2006, twelve patients were eligible in this study, and they were 4 females & 8 males. Zinc & Copper were measured for every patient by Perkin-Elmer (USA) atomic absorption spectrophotometer model 305B fitted with nitrous oxide acetylene burner head.RESULTS:Zinc & Copper concentrations were significantly decreased (p <0.001 and p<0.0001 respectively) in the serum of acute pancreatitc patients.CONCLUSION:These findings of Zinc & Copper levels suggest that altered minerals metabolism in serum may have contributed to the pathophysiology of acute pancreaitits

Keywords

Acute pancreatitis --- Zinc --- Copper --- Serum level


Article
Explorative Laparotomy Versus Conservative Management In Acute Pancreatitis
مقارنة بين العلاج التحفظي وبين فتح البطن في التهاب البنكرياس الحاد

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Abstract

BACKGROUND Acute pancreatitis is common disease, the two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis .Patients and methods This study was done in the emergency department (ED) in AL- Hussein. teaching- hospital ( Al Nassyria ) during 2 years (between 1st junuary 2009 to 31st December 2010) about 39 patients presented as acute abdomen proved later on as acute pancreatitis , all patients were presented to the emergency department with acut abdominal pain .19 patients had reports suggested that they had features suspected perforated viscus[a history of more than 72 hours of sever abdominal pain with abdominal distention,free fluid in the peritoneal cavity] so their conditions were mandated exploratory laparotomy . While the other ( 20 patient ) had less feature of abdominal distention, not dehydrated and near normal vital sign so they were postponed to the early morning and re-evaluated by C.T scan of the abdomen and complete evaluation of Ransons criteria which confirm that they had a cute pancreatitis and treated conservatively.Aim of study Comparison between conservative versus operative management in acut pancreatitis.Results Patients in group 1 (Conservatively managed patient ) required relatively less hospital stay than the patient in group 2 (explored patient),but complications like pseudo cyst of pancreas,bilateral pleural effusion occurs mores in group 1.Conclusion Early washout of abdominal cavity by explorotive surgery or other minimal access pruceduers was advocated in management of acute pancreatitis.

دراسة أجريت على 39 مريضا خلال سنتين 2009 و 2010 في طوارئ مستشفى الحسين التعليمي في الناصرية كحاله بطن حاد أثبتت فيما بعد التهاب البنكرياس الحاد تحدث حالات التهاب البنكرياس الحاد لأسباب متعددة مثل التهاب البنكرياس بسبب وجود حصى القناة الصفراويه او نتيجة الاصابه بالتهاب فيروس أو بكتيري كما تحدث الالتهابات في البنكرياس بعد التعرض للحوادث والإصابات المباشرة على العمود الفقري او الغير المباشر وقد يحدث التهاب البنكرياس في المرضى بعد عمليات جراحيه كبرى ومرضى الإنعاش الجراحي لأسباب مجهولة تعالج معظم حالات التهاب البنكرياس بعد تشخيصها بالعلاج التخطيطي غير الجراحي باستخدام المغذيات غن طريق الوريد وإعطاء المضادات الحيوية لمنع تحول الالتهاب الى موت في جزء من البنكرياس وتحوله الى خراج خاصة ذيل البنكرياس 19 مريضا راجع ردهة الطوارئ يشكو من الم البطن الحاد وقسم من المرضى يراجعون ولديهم تقارير فحص السونار التي يذكر فيه سوائل داخل التجويف البطني مما يؤدي يزيد الشكوك باحتمال وجود ثقب في المعده او الاثني عشر او الأمعاء الدقيقه الاخرى مما تتطلب اجراء عملية فتح البطن استكشافيه وفي اثناء العمليه اكتشف بانها التهاب البنكرياس الحاد 20 مريضا راجع ردهة الطوارئ وتم اكتشاف التهاب البنكرياس من خلال مايلي : 1.وجود احتقان وتورم حول البنكرياس وفي البنكرياس تغير في ملمس سطح البنكرياس 2.وجود بقع بيضاء مصفره متعدده في مساريق الامعاء والثرب وهي من اهم العلامات الداله على تسرب الانزيمات البنكرياس للتجويف البطني وعمل هذه الانزيمات على تحلل الدهون في مساريق الامعاء 3.في قسم من المرضى وجد تجمع سوائل نزفيه داخل التجويف البطني وهذه احد حالات التهاب البنكرياس النزفي .معظم الحالات التي اجريت لها العمليات الجراحيه تماثلوا الى الشفاء وبمضاعفات اقل وفترة بقاء اقل في المستشفى من اولاءك الذين تم علاجهم بدون عمليه حيث تطلب بقاءهم فتره اطول واجراء فحوصات متقدمه مثل المفراس واعادة فحص السونار واشعة البطن لاثبات حالتهم المرضيه وبعد الاستطلاع على الدراسات المماثله والمذكوره في نهاية البحث بانه اجريت حالات سحب السوائل المتجمعه في البطن لتقليل كمية انزيمات البنكرياس في السوائل الموجود في التجويف البطني ونتائجها غير مثبته لحد الان كما ان اجراء عملية فتح البطن وتوقيت هذه العمليه في حالات الاتهاب البنكرياس يبقى موضوع تحدده الظروف السريريه وتطورات المرض وقرار الطبيب المعالج ووصف ما يراه مناسب . لذا فاننا ننصح لعلاج حالات التهاب البنكرياس الحاد ( بعمليه تنظيف التجويف البطني من السوائل البنكرياسيه الناجمه من المرض) اما بعمليه جراحيه اوناظوريه .


Article
Pancreatic pseudocyst in a 4-year old boy: case report

Authors: Ali Egab Joda --- Alaa Yaser
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 3 Pages: 16-22
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Pancreatic pseudocyst is an uncommon condition in childhood and is almost always associated with pancreatitis which may result from trauma or other rare diseases like biliary tract disease, viral illness & drugs or may be related to complications of metabolic diseases. However, unlike adult experience, trauma is the most common cause of pancreatic pseudocysts in children. Most pseudocysts are uncomplicated with few nonspecific symptoms, so they are challenging lesions to diagnose and to treat except when they are large. Therefore, a high index of clinical suspicion is necessary to make an early diagnosis & this require integration of careful medical history, clinical examination and laboratory investigations, but imaging studies such as ultrasound, computed tomography scan & magnetic resonance imaging are very helpful in establishing the diagnosis. Its management is markedly different depending on the cause and size of the cystic lesion of the pancreas. Initially the conservative approach for asymptomatic patients is preferable, on the basis that an appreciable percent of pseudocysts will resolve spontaneously, otherwise different surgical options may be implemented for symptomatic patients or when there are complications. We report a case of a large pancreatic pseudocyst in a four-year-old boy following pancreatitis due to blunt abdominal trauma by a bike injury. The child was treated conservatively for 4 weeks after the development of pancreatic pseudocyst then he underwent an open trans-gastric cystogastrostomy which was very effective and free of complication postoperatively. The presentation, diagnosis and surgical intervention are discussed.


Article
Management of patients with acute pancreatitis In Al- Karama Teaching Hospital
ادارة المرضى الذين يعانون من التهاب البنكرياس الحاد في مستشفى الكرامة التعليمي

Authors: Amine M. Bakkour الدكتور أمين محمد بكور --- Ahmed N. Hassan د. احمد نافع حسن --- Mohammed H. Surriah الدكتور محمد حلو سريح
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2018 Volume: 60 Issue: 3 Pages: 131-136
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Acute pancreatitis is an acute inflammatory condition. It's not an uncommon disease, inboth the developed and developing countries, causes high morbidity and mortality, and inflicts aheavy economic burden. Severe acute pancreatitis is present in up to 25% of patients with acutepancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2decades contributed to reduce the mortality.Objective: was to review the diagnosis and management and outcomes of patients with acutepancreatitis of patients with acute pancreatitis in Al- Karama teaching hospital.Patients and Methods: This prospective study included 63 patients with acute pancreatitis in surgicaland medical wards in Al- Karma teaching hospital from the 1st October 2014 to 30th September 2017.Results: 63 patients with acute pancreatitis were included 35 male and 28 female patients with upperabdominal pain in which the diagnosis was not confirmed by CT or serum amylase or by CRP are notincluded in this study. Age and gender had no significant relations to outcome. Medical therapy is themainstay, with supportive therapy consisting of controlled volume resuscitation and enteral feeding.Minimally invasive drainage and debridement play a role in managing infective pancreatic necrosisbut in general should not be used until at least 4weeks after the acute illness.Conclusions: Acute pancreatitis is a benign abdominal disorder in up to 85% of cases. In theremaining 10%-15% of cases the disorder is life threatening with management of the disorderrequiring admission to an intensive care unit with cardiovascular, respiratory, and renal monitoringand support.

خلفية البحث: التهاب البنكرياس الحاد هو حالة التهابية حادة. إنه ليس مرضا غير شائع ، في كل من البلدان المتقدمة والنامية ، يسبب ارتفاعمعدلات المراضة والوفيات ، وينطوي على عبء اقتصادي ثقيل. التهاب البنكرياس الحاد الشديد موجود في 25 ٪ من مرضى التهاب البنكرياسالحاد ، مع وفيات كبيرة. ساهمت التغييرات في علاج التهاب البنكرياس الحاد في العقدين الماضيين في خفض معدل الوفيات. هدفت هذه الدراسةإلى مراجعة تشخيص ونتائج مرضى التهاب البنكرياس الحاد لدى مرضى التهاب البنكرياس الحاد في مستشفى الكرامة التعليمي.المرضى والطرق: شملت هذه الدراسة المستقبلية 63 مريضاً يعانون من التهاب البنكرياس الحاد في الأجنحة الجراحية والباطنية في مستشفى. الكرمة التعليمي من 1 أكتوبر 2014 إلى 30 سبتمبر 2017النتائج: تم إدراج 63 مريضا يعانون من التهاب البنكرياس الحاد 35 الذكور و 28 من الاناث المرضى الذين يعانون من آلام في الجزء العلوي منلم يتم تضمينها في هذه الدراسة. لم يكن للعمر والجنس أي علاقة CRP في الدم أو amylase أو CT البطن والتي لم يتم تأكيد التشخيص من قبلمهمة بالنتيجة. العلاج الطبي هو الدعامة الأساسية ، مع العلاج الداعم الذي يتكون من إنعاش الحجم المتحكم فيه والتغذية المعوية. يلعب الصرفوالصرف الأقل بضعاً دورًا في تدبير نخر البنكرياس المعدني ولكن بشكل عام يجب عدم استخدامه حتى 4 أسابيع على الأقل بعد الإصابة بمرضحاد.15 ٪ من - ٪ الاستنتاجات: التهاب البنكرياس الحاد هو اضطراب في البطن حميدة في ما يصل إلى 85 ٪ من الحالات. في ما تبقى من 10الحالات ، هذا الاضطراب يهدد الحياة مع إدارة الاضطرابات التي تتطلب القبول في وحدة العناية المركزة مع مراقبة القلب والأوعية الدمويةوالجهاز التنفسي ، والكلى .


Article
Management of Obstractive Jaundice Due to Common Bile Duct Stone in Baghdad Teaching Hospital
علاج اليرقان الانسدادي الناتج عن حصاة القناة الصفراوية المشتركة في مستشفى بغداد التعليمي

Authors: Akram A. Almosswi اكرم الموسوي --- Hussain A. Turky حسين علي تركي --- Tharwat I. Sulaiman ثروت ادريس --- Adel H. Jabur عادل هاشم جبر
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2014 Volume: 56 Issue: 3 Pages: 283-286
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm) Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.Key wards: CBD stones, endoscopic management, surgical intervention

خلفيه الموضوع: اكثر اسباب اليرقان الانسدادي هو حصا القناه الصفراء,وهذا يمكن ان يولد مضاعفاه ووفياه مهمه.معالجه اليرقان الانسدادي الناتج من حصاه ه قناه الصفراء في تطور,عده طرق تشخيصيه وعلاجيه ادخلت في هذا الموضوع وكل منها له فوائده ومضاره.هدف الدراسه:لغرض دراسه وتقييم معالجه اليرقان الانسدادي الناتج عن حصاه القناه الصفراء في مستشفى بغداد التعليمي.المرضى والوسائط :دراسه مستقبليه مكونه من 111 مريض لديهم اعراض سريريه ونتائج مختبريه وصوريه تقترح وجود يرقان انسدادي ناتج عن حصاه القناه الصفراء عولجو في مستشفى بغداد التعليمي في الفتره من كانون الثاني 2011 الى تشرين الثاني 2011 14 مريض اخر ابعدو من الدراسه بسبب ثبوت ان سبب اليرقان الانسدادي لديهم كان باسباب اخرى.العمل المبذول لكل مريض كان اخذ تاريخ المرض والفحص السريري وفحوصات مختبريه فحص الامواج فوق الصوتيه (السونار) للبطن.نفس المرضى تعرضوا لعمليه تنظير القناه الصفراء لسببين لغرض التشخيص واستخراج حصاه قناه الصفراء .مريضين فقط ارسلوا مباشره الى العلاج الجراحي كان لديهم (متلازمه ميريزي).كذالك اجريت العمليات الجراحيه للمرضى الذين فشلت لديهم المعالجه الناظوريه.النتائج:من ال125 مريض الذين لديهم يرقان انسدادي والذين انضموا لهذه الدراسه ,14مريض لديهم اسباب غير حصاه القناه الصفراء ابعدوا من هذه الدراسه, فاصبح العدد الكلي للمرضى 111 مريض46 ذكر و65 انثى .جميع المرضى ليهم اعراض سريريه ولديهم نتائج تحاليل وظائف كبد غير طبيعيه , اجري الفحص السوناري لجميع المرضى ,وفحص الرنين المغناطيسي للقنوات الصفراء والبنكرياس اجري ل26 مريض وفحص السونار عن طريق ناظور المعده والاثني عشر ل9 مرضى ,4 مرضى كان لديهم حصاه القناه الصفراء الاوليه, 95 مريض كان لديهم حصاه القناه الصفراء الثانويه , 9 مرضى كان لديهم حصاه القناه الصفراء المحفوظه , و3 مرضى لديهم (متلازمه ميريزي ).المعالجه المنظاريه اجريت ل 108 مريض نجحت في 90% من المرضى.العلاج الجراحي اجري ل 13 مريض 10 منهم بعد فشل العلاج المنظاري و3 مرضى كان لديهم (متلازمه ميريزي) .الاستنتاجات:العلاج الناظوري لاستخراج حصاه القناه الصفراء المتبوع برفع المراره ما زال الطريقه الرشيده في علاج حصاه القناه الصفراء . حصاه القناه الصفراء الكبيره وتعددها ما زالا الاسباب الاكثر شيوعا لفشل العلاج المنظاري لاستخراج حصاه القناه الصفراء والعلاج الجراحي ,في هذه الدراسه كان هنالك نسبه حصاه محفوظه في القناه الصفراء اعلى من الدراسات المذكوره في الدول الغربيه,بسبب عدم وجود فحوصات خلال العمليه تجرى لغرض تشخيص حصاه القناه الصفراء لغرض تلافي ترك حصا في القناه الصفراء في مستشفانا مفتاح الكلمات: حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

Keywords

Background: the most common cause of obstructive jaundice is CBD stones --- and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution --- several methods of investigations and treatment have been introduced --- and each one has its own advantages and disadvantages. Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital. Patients and methods: a prospective study of 111 patients with clinical --- laboratory --- and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011 --- other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them --- MRCP for 26 patients --- and EUS for 9 patients. Four patients had primary stones --- 95 patients had secondary stones --- 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions --- and they were excluded from the study --- so the total number of the patients was 111 --- 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients --- 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone --- more than 15mm Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries --- because there is no intraoperative screening to avoid missing CBD stones in our hospital. Key wards: CBD stones --- endoscopic management --- surgical intervention --- حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

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