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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective study 152 consecutive patients presenting with acute abdominal pain were assessed clinically and an ultrasonographic examination was performed immediately. Of these, 16 (11 per cent) patients would normally have had an immediate ultrasonographic scan requested; routine (within 24 h of admission) ultrasonographic examination would have been requested in a further 66 (43 per cent) patients. In 70 (46 per cent) patients an ultrasonographic examination would not have been requested. Ultrasonography altered the diagnosis in one patient from probable appendicitis to cholecystitis. Ultrasonography missed one abdominal aortic aneurysm and one empyema of the gallbladder. Ultrasonography had a sensitivity of 96 per cent, a specificity of 94 per cent, a positive predictive value of 96 per cent, a negative predictive value of 94 per cent and an accuracy of 95 per cent in diagnosing appendicitis. Exactly the same values were found for the clinical diagnosis of appendicitis. The study shows that routine immediate ultrasonographic examination of the acute abdomen is rarely helpful, with the possible exception of appendicitis. Where an urgent ultrasonographic scan is necessary on clinical grounds the expertise of a radiologist is probably required, whereas in specific areas, for example in the diagnosis of right iliac fossa pain, there may be a place for training the surgical trainee.
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PMID:Ultrasonography in the acute abdomen. 195 78

We report an evaluation of the MANTRELS clinical score in predicting appendicitis in a prospectively studied pediatric population presenting with abdominal pain. One hundred eighty-nine independent episodes from 187 children 2 to 17 years old were studied. For the groups as a whole and for the individual groups less than 16 years old, the score failed to satisfactorily discriminate those with appendicitis from those without. Had the MANTRELS score been used to determine observation and laparotomy in our patients, 21 additional patients would have been unnecessarily hospitalized, and 16 would have been subjected to unnecessary laparotomies. One patient would have received appropriate intervention earlier. In the 40 children 16 and 17 years old, the MANTRELS score adequately distinguished the two groups. A seven-variable discriminant function, derived from stepwise discriminant analysis, performed slightly better but showed essentially the same findings as the MANTRELS score. We believe the MANTRELS score failed to predict appendicitis in younger children because it does not contain variables that allow for separation of appendicitis from the numerous other conditions mimicking it in the pediatric population. The clinician remains the best judge of the acute abdomen in the pediatric age group.
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PMID:Use of the MANTRELS score in childhood appendicitis: a prospective study of 187 children with abdominal pain. 203 19

A prospective study has been undertaken of 321 patients with acute abdominal pain admitted to hospital under one surgical firm over a period of 21 months. During the first 10 months patients were classified on admission according to the perceived need for operation, with laparoscopy being performed on all those in whom the need for operation was uncertain. In addition, all women with suspected appendicitis underwent laparoscopy because previous studies by us and others have demonstrated a high error rate in this group. During the second 11 months of the study a similar system of classification and procedure was used but the patient's initial assessment was entered on a structured data sheet. After the patient had been discharged home this information was entered into a computer-aided diagnosis program. Hypothetical retrospective computer-aided decisions were then made about patient management. The final management error rate (correct decision to operate or not) was compared with the actual error rate using the clinical system. The final overall error rate in the first 10 months was 11 out of 163 patients and this was improved to 3 out of 158 in the second 11 months of the study by the addition of the structured data sheet to selective laparoscopy. A management policy based entirely on diagnostic probabilities taken from the computer-aided diagnosis program would have produced an error rate of 26 out of 158. We conclude that in the management of the acute abdomen a policy based on clinical decision combined with selective laparoscopy may be superior to one based on diagnostic probabilities alone. Further improvement in results follows the introduction of a structured data sheet for initial data collection.
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PMID:Clinical decision making and laparoscopy versus computer prediction in the management of the acute abdomen. 253 48

Anisakiasis is a zoonotic disease caused by the ingestion of larval nematodes in raw seafood dishes such as sushi, sashimi, ceviche, and pickled herring. Symptoms of anisakiasis include abdominal pain, nausea, vomiting, and diarrhea. Because symptoms are vague, this disease is often misdiagnosed as appendicitis, acute abdomen, stomach ulcers, or ileitis. Endoscopic examination with biopsy forceps has facilitated the diagnosis of gastric anisakiasis. Worms can be removed and identified, and a definitive diagnosis can be made. Patients generally recover with no further evidence of disease. Worms can become invasive, however, and migrate beyond the stomach, penetrating the intestine, omentum, liver, pancreas, and probably the lungs. Surgery is often necessary for treatment of invasive anisakiasis. With the increase in popularity of eating lightly cooked or raw fish dishes, the number of cases of anisakiasis may be expected to increase.
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PMID:Anisakiasis. 267 Jan 91

During the 5-year period 1976-1980, seven cases of emergent surgical disease of the adnexae during pregnancy were encountered. The incidence of 1:1832 deliveries approximated that of appendicitis (1:1603 deliveries) during the same period. There were three cases of adnexal torsion, two ruptured ovarian cysts with hemorrhage, one heterotopic pregnancy, and one ruptured endometrioma. The right side was more commonly the site of the pathology, and abdominal pain the only consistent presenting symptom. Fever, tachycardia, and leukocytosis were inconsistent findings. Culdocentesis was positive in two cases. Four desired pregnancies were carried successfully to term postoperatively. Surgical emergencies of the adnexae will be encountered during pregnancy more commonly than is generally recognized. Aspects of obstetric management are described. If prompt surgical intervention is undertaken in pregnancy when the clinical picture suggests an acute abdomen, a satisfactory outcome can be expected.
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PMID:Surgical emergencies of the uterine adnexae during pregnancy. 288 Jul 65

In our Country through the acquired experience, we have reached the 10 more frequent diagnostics in laparoscopies of urgency. 1) Our 10 more frequent diagnosis in laparoscopy were: Salpingitis 27.5%; Appendicitis 18%; Ovarian cyst 18%; Inflammatory localized processes 8.5%; Ectopic pregnancy 4.5%; Peritonitis 4%; Piosalpinx 3.5%; Cholecystitis 3%; Hemoperitoneum 3%; Metritis 2%. 2) That acute abdomen conditions should be diagnosed as early as possible. 3) That the maximum time employed to this diagnostic must not depass of six hours from the onset of the symptomatology. 4) That if at that time a diagnostic has not been established by all resources at the hands of the physician, an emergency laparoscopy shall be indicated. 5) That, this laparoscopy of urgency ought to be performed immediately at an Specialized Service and by a qualified endoscopist. 6) That, a qualified endoscopist shall be able to issue a laparoscopic diagnostic of the pathologies of the different abdominal organs, digestives and gynecological, in adults and children.
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PMID:[Emergency laparoscopy in the diagnosis of acute abdomen]. 295 85

The clinical features of 81 cases of abdominal tuberculosis (TB) are presented. The peritoneum was involved in 41 patients, the ileocecal area in 17, the anorectal area in 16, and mesenteric glands in 8. There was one case each involving the liver and sigmoid colon. Most patients were young women. The tuberculin reaction was significant in 83% of patients tested, and 54% had evidence of TB elsewhere. Tuberculous peritonitis was more common in native North American Indians and presented as an acute abdomen, abdominal tumor, or cirrhosis. Asians developed the majority of ileocecal and mesenteric lymph node disease and were frequently diagnosed as having Crohn's disease, appendicitis, or cancer. Anorectal cases presented with fistulae or abscesses and usually had concomitant pulmonary TB. The disease was fatal in five patients (6%), four of whom were diagnosed only after death. One noncompliant patient had a relapse. All other patients were cured after receiving treatment.
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PMID:Clinical features of abdominal tuberculosis. 276 Apr 89

Over a 6-year period at the University Hospital in London, Ont., 101 patients underwent heart transplantation and 5 heart-lung transplantation. The authors review the general surgical problems identified from the charts of 13 of these patients. In the early postoperative period (within 30 days), laparotomy was required for pancreatitis (one), perforated peptic ulcer (two), cholecystectomy (one), pancreatic cyst (one) and appendicitis (one). In addition, a spontaneous colocutaneous fistula and spontaneous pneumoperitoneum occurred; both were managed conservatively. Later, three patients required cholecystectomy; one underwent a below-knee and a Symes amputation for dry gangrene and one surgical correction of a lymphocele. The incidence of surgical problems (13%) indicates an increased susceptibility in this group of patients. Four of the 13 patients died. Pancreatitis is a well-recognized complication of cardiac surgery; it is frequently associated with a normal or only slightly elevated serum amylase level, making a definitive diagnosis without laparotomy almost impossible. Persistence of abdominal signs should signal the need for exploratory surgery. During the early postoperative period and in the absence of multiorgan failure, immediate operation for an acute abdomen is usually successful. Despite the additional risk, cardiac transplantation does not preclude later surgery, but immunosuppression must be continued and carefully monitored.
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PMID:Management of general surgical problems after cardiac transplantation. 329 32

A retrospective review of cecal and appendiceal complications occurring in young patients with acute leukemia since 1969 was performed. The objective of this study was to determine the relative incidence of appendicitis and typhlitis among patients with acute leukemia who had operation or autopsy in this institution as well as to determine the risks of operative intervention. Fifteen patients with these complications were identified among the 400 patients with acute leukemia seen during this time period. Signs and symptoms of an acute abdomen were present despite immunosuppression. The incidence of sepsis at the time of presentation was 53%. Preoperative risk factors identified most frequently were coagulopathy and organ failure resulting from sepsis. Postoperative morbidity (25%) and mortality rates (8%) were related to the development of infectious complications. Appendicitis occurred in eight of the 15 patients studied, whereas typhlitis or its complications was found in seven patients. No preoperative factors could be found to differentiate typhlitis from appendicitis on clinical examination. It is suggested that operation can be safely performed in neutropenic patients who have acute right lower quadrant pain and signs of peritoneal irritation and may be the only effective way of differentiating appendicitis from typhlitis.
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PMID:Right lower quadrant pain in young patients with leukemia. A surgical perspective. 331 27

The case of a man with situs inversus who presented with acute abdomen is reported. Acute left-sided appendicitis was considered before operation, but at laparotomy an omental abscess of unknown aetiology was drained. The appendix, localized in the left iliac fossa, was removed but was normal on histological examination.
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PMID:Acute abdomen in a patient with situs inversus. A case report. 394 78


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