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

The acute abdomen continues to be a large part of the general surgeon's workload. The continuing advances in laparoscopic surgery have already permitted many emergency procedures to be performed by this route. Since 1993 the Authors perform an explorative laparoscopy in patients with acute abdomen. Once the diagnosis is verified, the endoscopic view suggests to continue the intervention laparoscopically or to convert the procedure. 70 acute cholecystitis, 57 acute appendicitis, 15 perforated peptic ulcers, 6 gynaecological emergencies, 8 intestinal occlusions and 2 splenic traumas were treated according to this approach. The results obtained testify that laparoscopy is a valuable diagnostic tool for the surgeon in case of acute abdomen and an interesting therapeutic alternative in selected cases. However, it requires extensive experience in laparoscopic techniques.
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PMID:[Emergency laparoscopic surgery]. 875 32

Acute appendicitis is one of the most frequent causes of an acute abdomen. The clinical diagnosis is based on the case history and the physical examination which plays a major role in clinical diagnosis. However, in some cases the typical clinical symptoms are equivocal or misleading. Without using the opportunities of diagnostic imaging the accuracy of preoperative appendix diagnosis ranged between 70 and 78%. Consequently the rate of unnecessary laporotomies ranged between 22 and 28%. Since 1986, 13 studies including more than 5,000 patients have been published showing a sensitivity of 85% and a specificity of 96% if the sonographic examination was performed by an experienced examiner. The rate of negative laparotomies could be decreased to 7%, and possible differential diagnoses could be either confirmed or ruled out by using ultrasound technique. Based on the current literature, real-time sonography plays a major part in the diagnosis of acute appendicitis.
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PMID:[Value of ultrasound in diagnosis of acute appendicitis]. 875 48

The high diagnostic ability of sonography for the solid organs of the upper abdomen and the biliary and genitourinary tract is well established. The gut on the other hand has been more or less ignored by many sonographers in routine abdominal screening and evaluation of the acute abdomen. This is regrettable because sonography, like CT, is an excellent modality for assessing mural abnormalities of various origin (i.e. neoplastic, inflammatory, ischemic or hemorrhagic), as well as possible involvement of the adjacent soft tissues and solid organs. Considerable sonographic skill and "tenacity" and an adequate equipment are however indispensable to achieve high diagnostic reliability in the detection and interpretation of abnormalities of the G-I tract. Our own and other's experience suggest that the time devoted to sonographic screening of the gut is very worthwhile especially in acute clinical conditions. Acute appendicitis is one of the typical examples where sonography has found widespread acceptance. This article reviews the application of graded compression sonography in the evaluation of appendicitis, for using on technique, diagnostic criteria, and differential diagnosis.
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PMID:Sonography of appendicitis and acute diseases of the lower abdomen. 890 64

A case of primary acute appendiceal torsion in a 6-year-old boy with symptoms suggestive of acute appendicitis is presented. The appendix was abnormally long, measuring 13.5 cm in length. Although appendicitis is the most common intra-abdominal surgical emergency, there are few descriptions of primary acute appendiceal torsion, a rare cause of an acute abdomen. A review of the English language literature disclosed 19 reports, including the present, with 11 pediatric cases. The site of torsion occurs most frequently 1 cm or more from the appendiceal base. Rotation varies from 270 degrees to 1080 degrees with a mean of 580 degrees. The direction of the rotation is more frequently anticlockwise. Appendix is most commonly described as lying free or pelvic. In children the mean age is 9.1 years, the range 3-16 years, and the male-to-female ratio 4.5:1.
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PMID:Primary acute torsion of the vermiform appendix. 902 62

The primary torsion of the omentum is a rare cause of acute abdomen. The clinic features may mimic closely acute appendicitis, with acute onset of right lower quadrant pain. The Authors, after reporting two cases recently observed, discuss the aetiopathogenetic aspects, point out the problems of diagnosis and finally suggest the most correct surgical approach.
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PMID:[Primary omental torsion in children: report of 2 cases and review of the literature]. 906 74

From the surgical point of view acute abdominal pain is the cardinal symptom of acute abdomen. Additional leading symptoms of acute abdomen are tension of the abdominal wall, peristaltic disorders and, in rare cases, shock symptoms. Acute abdomen is an operational diagnosis for painful, in part life threatening diseases of various etiologies. The most frequent cause is acute appendicitis, followed by cholecystitis and by diverse forms of ileus. These three diseases together are the cause of acute abdomen in more than 80% of cases. Over 90% of cases with acute abdomen are treated surgically. The decision in favour of a surgical intervention must be determined within minutes to hours depending on the etiology. A delay may lead to further, partly most serious sequelae.
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PMID:[Acute abdominal pain. Surgeon's viewpoint]. 908 28

When to operate immediately, when to observe, and when not to operate at all represent major challenges in the management of a child with an acute abdomen. This article is an overview of the subject from symptom to diagnosis, evaluation, and preparation for the surgical intervention. Tables provide examples of conditions requiring prompt surgical intervention and relative surgical urgency; pathologies suitable for (initial) nonsurgical management; and clinical pictures where surgical intervention is not indicated. Factors that influence the timing of operation are provided, as is the differential diagnosis between intestinal strangulation and obstruction. Brief notes highlight four important causes of acute abdomen in children acute appendicitis, malrotation with volvulus, Meckel's diverticulum, and intussusception. These as well as other intraabdominal pathologies are illustrated by means of surgical photographs. The acute abdomen is a clinical diagnosis. Other diagnostic modalities have merely supporting roles. The decision to operate is based primarily on the results of a good history and thorough physical examination(s).
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PMID:Acute abdomen. When to operate immediately and when to observe. 915 57

The aim of the study was to review the literature on the accuracy of C-reactive protein (CRP) in diagnosing acute appendicitis. All the relevant articles found by searching Medline and the Science Citation Index were reviewed. We used summary receiver operating characteristic (SROC) curve analysis to describe the central tendency of the studies and to assess potential sources of variability. We included 22 articles with a total number of 3436 patients. The sensitivity ranged from 0.40 to 0.99, and the specificity from 0.27 to 0.90. The cut-off values for a positive test varied from 5 to 25 mg l-1. SROC curve analysis showed that CRP performed significantly better in acute abdomen populations (11 studies) than in populations already selected for appendectomy (11 studies). The diagnostic accuracy of CRP tended to be a little inferior to that of total leukocyte count (13 studies). CRP is a test of medium accuracy in diagnosing acute appendicitis. The formerly distractingly wide range of sensitivity and specificity is at least partly due to variations in cut-off values and to differences in study populations. However, definitive conclusions on the clinical usefulness of the test could not be drawn.
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PMID:The accuracy of C-reactive protein in diagnosing acute appendicitis--a meta-analysis. 927 62

Endometriosis is rarely found by the general surgeon and sometimes it may seem a surgical disease. Two cases with abdominal pain, requiring surgical treatment, are presented. The first case gave history of dysmenorrhea and dyspareunia, she was admitted with acute abdomen due to acute appendicitis, and laparoscopic appendectomy was performed without complications; she had slight endometriosis at left utero-sacrum ligament and histopathological report showed endometriosis at the appendix. The second patient presented with incomplete obstruction related to ileocecal damage that it was resected with an histopathological report of endometriosis at cecum, ileon and appendix. The patient presented with endometriosis, degree IV, and had medical treatment with gestrinohn, during six months; latter on, HTA+SOB, was done, she received hormonal therapy. Endometriosis may be a cause for acute abdomen in women, and it should be considered in the differential diagnosis.
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PMID:[Intestinal endometriosis as an acute surgical emergency]. 931 16

From 1989 to 1995 high-resolution ultrasonography (US) was performed in 3,546 children (age: 1-17 years) with clinically suspected appendicitis. A total of 518 patients underwent laparotomy; 420 had histologically proven acute or perforated appendicitis (prevalence 11.8%). In these children, the sensitivity, specificity and overall accuracy of US examination were 90%, 97% and 96% respectively. The use of US in clinically doubtful acute abdomen may allow earlier diagnosis of acute appendicitis; in 1995 the rate of unnecessary appendectomy was reduced to 13%.
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PMID:[Appendicitis in childhood]. 934 Jun 74


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