ABSTRACT
Duodenal loop obstruction is an unusual cause of acute pancreatitis. Increased intraluminal pressure hinders pancreatic flow, causing dilatation of the pancreatic duct and inducing acute pancreatitis. We experienced three cases of acute pancreatitis that resulted from duodenal loop obstruction after (1) an esophagectomy with gastric pull-up procedure for esophageal cancer, (2) a gastrectomy with Billroth I reconstruction for gastric cancer, and (3) a gastrojejunostomy for abdominal trauma. An abdominal CT scan revealed a distended duodenal loop, dilated pancreatic duct, and inflamed pancreas with fluid collection. Acute pancreatitis with duodenal loop obstruction was diagnosed by abdominal pain, elevated serum amylase/lipase, and abdominal CT findings. Immediate decompression with a nasogastric tube was performed, and all patients showed improvement within one week after admission. Each patient was followed up for more than two years without recurrence. Our findings suggest the usefulness of nasogastric tube decompression as the first line of treatment for acute pancreatitis related to duodenal loop obstruction.
Subject(s)
Humans , Abdominal Pain , Decompression , Dilatation , Duodenal Obstruction , Esophageal Neoplasms , Esophagectomy , Gastrectomy , Gastric Bypass , Gastroenterostomy , Pancreas , Pancreatic Ducts , Pancreatitis , Recurrence , Stomach Neoplasms , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The incidence of upper gastrointestinal bleeding has decreased in the general population but has increased in geriatric patients worldwide. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with upper gastrointestinal bleeding and to compare them with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 288 patients with upper gastrointestinal bleeding from January 2007 to August 2010. We compared the clinical characteristics and outcomes of geriatric patients (n=148, 51.4%) with those of non-geriatric patients (n=140, 48.6%). RESULTS: Cardiovascular disease, hypertension, and cerebrovascular accidents were more prevalent in the geriatric group, compared with those in the non-geriatric group (p<0.05). Vital signs were more unstable in the geriatric group than those in the non-geriatric group (p<0.05). The geriatric group had taken more ulcerogenic drugs than those in the non-geriatric group (p<0.05). The most common cause of upper gastrointestinal bleeding was peptic ulcer (72.3%) in the geriatric group, whereas it was variceal bleeding (41.4%) in the non-geriatric group. Treatment methods, transfusion volume, operation rate, and mortality were not different between the two groups. The length of hospital stay and length of intensive care unit (ICU) stay were significantly longer in geriatric patients than those in the non-geriatric group (p<0.05). CONCLUSION: Geriatric patients with upper gastrointestinal bleeding had longer ICU and hospital stays than those of non-geriatric patients. Important emerging etiologies such as ulcerogenic drugs and associated chronic illness should be monitored and treated early in these patients.