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

Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.
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PMID:Modern aids to clinical decision-making in the acute abdomen. 238 63

On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.
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PMID:[Diverticula of the cecum. Our experience]. 222 11

An atypical presentation of ileal diverticulosis definitively diagnosed and treated with laparoscopy is presented. While jejunoileal diverticula are often asymptomatic, they may lead to chronic or acute symptoms. The large majority of complications secondary to small-bowel diverticulitis present with an acute abdomen similar to appendicitis but they also may appear with atypical symptoms. As a result, identification of jejunoileal diverticulosis can be quite difficult and surgery is often required in order to reach an absolute diagnosis. Surgical exploration, resection of the involved segment, and primary reanastomosis may be indicated in instances of symptomatic diverticular disease of the small bowel. Current laparoscopic techniques make this procedure well suited for both diagnosis and treatment of jejunoileal diverticula. In this report, the surgical incision was directed and limited under laparoscopic guidance while still allowing the benefit of thorough examination of the abdominal contents.
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PMID:Perforated ileal diverticulitis. An atypical presentation with definitive diagnosis by laparoscopy. 767 77

While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.
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PMID:[Value of laparoscopy in diagnosis and therapy of the acute abdomen]. 814 45

Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.
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PMID:[Diverticulitis of the appendix: a rare cause of acute abdomen]. 839 20

Thirteen (13) patients with proven diverticulitis are presented with the aim of demonstrating the current evaluation and management. Radiological evaluation were obtained with plain abdominal x-rays and computed tomography (CT) in all cases, abdominal ultrasonography (US) in 8 cases and contrast enema in 5 patients. Radiological percutaneous abscess drainage (PAD) were performed in 5 cases, two of which preceded surgery. A clinical suspicion of diverticulitis was made in only 3 of the 13 cases. CT provided the diagnosis in all cases and helped in directing the appropriate management. Ultrasound was also useful but to a lesser extent. CT or US guided PAD reduced the surgical operation to a single stage procedure instead of the former 2- to 3-stage surgical management. Plain abdominal x-ray were only useful for the diagnosis in intestinal obstruction and vesical fistula. Contrast enema provided supporting information when necessary. CT clearly diagnosed both suspected and totally unsuspected cases of diverticulitis and provides guidance for the appropriate management. When CT is unavailable US with accurate colonic imaging and abscesses identification can also be useful in diagnosing and guiding drainage. Plain abdominal x-rays are less helpful but mandatory since the presentation is usually that of acute abdomen. Water soluble contrast enema also provides supportive features when necessary. In areas where diverticular disease is uncommon, diverticulitis should be suspected in cases with left iliac fossa or pelvic pain with mass and tenderness.
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PMID:Radiological diagnosis and management of diverticulitis. 992 Oct 96

A staging classification is proposed by CT findings in 27 patients with acute abdomen, caused by inflammatory colonic non-parasitic pathology. Of the 17 patients with diverticular disease, 4 were stage A (edema/ischemia on thickness of the abdominal wall), 2 were stage B (partial intramural infarction on the abdominal wall) and 3 were stage C (abscess/peritonitis and obstruction/vascular strangulation). None of the patients in the series were stage D (ischemia/infarction of the colonic wall with dilatation). Of the 4 patients with ulcerative colitis, 3 were stage A and 1 in stage C. Of the 3 patients with Crohn's disease, 2 were stage A and 1 was in stage C. Classified as stage D were 1 pseudomembranous colitis, 1 volvulus and 1 idiopathic megacolon. Clinical severity was in parallel with CT stages that gave better information on the progression of the pathology. Staging by CT in acute abdomen caused by inflammatory colonic non-parasitic pathology could be useful in therapeutics.
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PMID:Acute abdomen caused by inflammatory colonic non-parasitic pathology: staging by CT. 1042 Oct 16

The authors describe the case of a 86-year-old female patient admitted to hospital with acute abdomen of the inflammatory type. The condition developed in the course of cca three days with sudden deterioration on the day of admission to hospital. Contrast X-ray examination revealed perforation of the distended jejunum and surgery revealed diffuse peritonitis the source of which was the mentioned perforation associated with mechanical ileus caused by malrotation and adhesions of the small intestine. An additional finding which, however, dominated on X-ray examination of the gastrointestinal tract when using contrast material and on revision of the peritoneal cavity was multiple diverticulosis of the small intestine. The uncommon finding on the small intestine and the relatively sparse data in the literature on diverticulosis of the jejunum and ileum made us submit the case-history for publication.
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PMID:[Diverticulosis of the small intestine--case report]. 1091 42

Diverticulosis of the colon is a very frequent pathology in the western word and is characterised by a high percentage of dangerous complications (10-25%). The most accurate method of staging diverticular disease is by CT scan. The aim of our study was to evaluate the sensitivity of ultrasonography in the evaluation and management of diverticular disease of the colon. We studied 51 patients: the parameters used to assess complicated diverticulosis of the colon were: 1) wall thickness; 2) presence of fluid collections and pericolic abscesses; 3) free liquid collections in the peritoneal cavity; 4) subdiaphragmatic free air; 5) presence of fistula tracts. Ultrasonography showed 66% sensitivity in the assessment of wall thickness and in detecting the presence of diverticula. The sensitivity rate was 100% in the detection of abscess complications, pericolic collections, free air and fistula tracts. False-negatives (5 patients) were all recorded in Hinchey stage I. The overall sensitivity amounted to 91%. In our experience the method is a first level examination in the approach to patients suffering from diverticular disease of the colon and presents high sensitivity and diagnostic accuracy. The method, in expert hands, is suggested as a first step in the clinical-diagnostic approach to patients suffering from acute abdomen due to diverticulitis of the colon.
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PMID:[Role of ultrasonographic imaging in the surgical management of acute diverticulitis of the colon]. 1194 14

The diverticular disease is rarely located in the small intestine (0.1-1.4%). The most important feature is due to the lack of a typical symptomatology which may appear only on the occasion of the complications it may incur (perforation, haemorrhage and so on). It isn't also infrequent that the surgeon may observe intestinal diverticula accidentally, on the occasion of laparotomies carried out in emergency or for other pathologies. The literature on intestinal diverticula is reviewed and personal experience in a clinical case presenting as acute abdomen is described.
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PMID:[Jeiuno-ileal diverticula complicated by perforation. Clinical case]. 1269 6


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