Major Duodenal Papilla Stone and Acute Pancreatitis
https://doi.org/10.16931/1995-5464.2015190-95
Abstract
The aim is to study the incidence of acute pancreatitis on background of major duodenal papilla stone and to evaluate its
clinical course. Material and Methods. Signs of major duodenal papilla stone have been found in 189 patients aged 22–94 years.
Incarcerated calculus was diagnosed in 121 patients. 14 patients suffered from icterus previously. Also 14 patients were treated at the hospital for acute pancreatitis (2 of them were treated for pancreatonecrosis). Pain syndrome was present in each case. Contact ultrasonic and duodenoscopy were obligatory stages of patient’s examination. Results. Major duodenal papilla stone was successfully visualized using contact ultrasound only in 58.4% of cases, two or more pathological features of the papilla and para-ampullar area were endoscopically confirmed in 92.6% of patients.
The course of disease was complicated by acute pancreatitis in 112 cases (59.3%), by pancreatonecrosis – in 33 cases, by confirmed clinical and instrumental signs of biliary stasis – in 133 (70.4%) observations, by cholangitis – in 62 (32.8%) cases. Acute pancreatitis developed due to incarcerated calculus in 79 patients. In 21 of 33 cases of pancreatitis (63.6%) subtotal and total lesion of pancreatic gland was found. Suppurative complications and signs of multiple organ failure were diagnosed in 13 (39.4%) and 21 (63.6%) of 33 patients respectively. Overall mortality from pancreatonecrosis on background of major duodenal papilla stone was 36.4%. Conclusion. Major duodenal papilla stone is complicated by acute pancreatitis in more than half of cases and nearly one of five patients had pancreatonecrosis. More than half of patients suffered from severe course of disease. In view of this it is necessary to improve the quality of diagnosis and to carry out immediate resolution of acute block of major duodenal papilla
About the Authors
S. V. Mikhaylusov
State Educational Institution of Higher Professional Education N.I. Pirogov Russian National Research Medical University of Health Ministry of the Russian Federation
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor at the Chair of Hospital Surgery № 1 of Medical Faculty, State Educational Institution of Higher Professional Education “N.I. Pirogov Russian National Research Medical University” of Health Ministry of the Russian Federation
E. V. Moiseenkova
O.M. Filatov City Clinical Hospital № 15, the Health Department of Moscow
Russian Federation
Russian Federation
Cand. of Med. Sci., Surgeon of the O.M. Filatov City Clinical Hospital № 15, Moscow
M. M. Misrokov
City Clinical Hospital № 2, Nalchik
Russian Federation
Surgeon of the City Clinical Hospital № 2, Nalchik
Russian Federation
Surgeon of the City Clinical Hospital № 2, Nalchik
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For citations:
Mikhaylusov S.V., Moiseenkova E.V., Misrokov M.M. Major Duodenal Papilla Stone and Acute Pancreatitis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015;20(1):90-95. (In Russ.) https://doi.org/10.16931/1995-5464.2015190-95
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