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

The diagnosis and management of the patient with an acute abdomen remains one of the most difficult challenges for the surgeon. A thorough understanding of the anatomy and physiology of the abdomen are essential to properly generate a differential diagnosis and to formulate a treatment plan. While recent advances in technology can be extremely helpful in certain situations, they cannot replace a physician's clinical judgment based upon a good history and physical examination. This article provides a general overview of the evaluation of the patient with an acute abdomen. It will also suggest algorithms to consider in the diagnosis and treatment of these patients.
Surg Clin North Am 1997 Dec
PMID:The acute abdomen. An overview and algorithms. 943 37

Over the last 10 years, the most significant advancement in imaging of the acute abdomen has been the development of helical CT imaging. Rapid breath-hold imaging and improved intravascular opacification have enabled radiologists to obtain volumetric data that can be viewed in smaller slice increments. Helical data can also be analyzed utilizing multiplanar and three-dimensional techniques. With its proven ability to diagnose a wide variety of conditions, CT remains the diagnostic modality of choice for imaging the surgical abdomen. There have been considerable improvements in image resolution in US with improvements in transducer technology. Ultrasonography often serves as the first study in evaluating the pediatric or female patient with right lower quadrant or pelvic pain. Computed tomography may be necessary if US is not diagnostic. Despite these technical advances, plain film radiography should be the first imaging study for suspected cases of bowel perforation or obstruction. Magnetic resonance imaging continues to evolve, with improvements in hardware and software design that allow for faster imaging, but current levels of availability in the acute setting preclude its wider use. Whereas further imaging is not necessary for patients presenting with classic signs and symptoms of various acute abdominal diseases, the atypical patient often requires careful diagnostic imaging. Close consultation between the radiologist and surgeon leads to studies appropriately tailored to meet the diagnostic challenge at hand.
Surg Clin North Am 1997 Dec
PMID:Advances in imaging of the acute abdomen. 943 38

Evaluation of a female patient who presents with an acute abdomen must always consider surgical and gynecologic disorders. Laparoscopy and pelviscopy have had a major impact on the surgical approach in gynecology. Most acute abdomens can now be approached laparoscopically. Certain conditions that are discussed require the traditional laparotomy. Preservation of reproductive capability has a major impact on the wellness of a woman.
Surg Clin North Am 1997 Dec
PMID:Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy. 943 45

Antibiotics are only an adjunct to proper surgical therapy for the treatment of the acute abdomen associated with bacterial secondary peritonitis. Upon presentation, all patients require a preoperative dose of antibiotics for prophylaxis against infection of remaining sterile tissues. Patients found intraoperatively to have an established peritoneal infection benefit from an immediate postoperative course of therapeutic antibiotics. A regimen that adequately covers facultative and aerobic gram-negative bacilli and anaerobic organisms is essential. The duration of therapeutic antibiotics is probably best decided on an individual patient basis. The goal of antibiotics is to reduce the concentration of bacteria invading tissues. The pathogens of bacterial peritonitis are influenced by such factors as the patient's pre-existing chronic diseases, state of acute physiologic debilitation, immunocompetence, recent antibiotic use, recent hospitalization, and neutralization of gastric acidity. Intraoperative peritoneal cultures are most useful in patients suspected of having impaired local host defenses. In these patients, all identified organisms, such as Enterococcus or Candida, may be potential pathogens. The common practice of administering empiric and prolonged courses of broad-spectrum antibiotics in patients who manifest persistent signs of inflammation may be more harmful than beneficial. These patients warrant an exhaustive search for extra-abdominal and intraperitoneal sources of new infection. Otherwise, such use of antibiotics may continue to promote the selection of bacteria that are highly resistant to conventional antibiotics and permit the overgrowth of organisms commonly seen with tertiary peritonitis. The best chance of resolving bacterial peritonitis is through early, aggressive surgical management complemented by short courses of potent antibiotics and appropriate physiologic support. Through these efforts, the clinician tries to help the systemic inflammatory response to benefit the host and not become unregulated, result in MOFS, and produce a high mortality.
Surg Clin North Am 1997 Dec
PMID:Antibiotics for the acute abdomen. 943 46

The critically ill patient with an acute abdomen represents a great challenge for the surgeon. The physiologic derangement that is associated with the critically ill state both fuels and is fueled by acute abdominal processes. Improvements in critical care and cardiopulmonary bypass technique have allowed for a group of patients to evolve that are susceptible to the complications of prolonged flow states. This article focuses on the abdominal consequences of support of the critically ill patient, as well as, the diagnostic and therapeutic options that are available to treat these patients.
Surg Clin North Am 1997 Dec
PMID:The acute abdomen in the critically ill patient. 943 49

Cystic lymphangioma of the pancreas is a rare tumour. The authors report on a case of cystic lymphangioma of the pancreas in a 6-year-old boy, presenting an acute abdomen. These tumours are benign and must be differentiated from other cystic abdominal lesions. Histological diagnosis is required in all cases. Treatment consists in a complete resection of the tumour. In most cases a tumorectomy is sufficient, although sometimes pancreatic resection might be necessary.
Acta Chir Belg 1997 Dec
PMID:Cystic lymphangioma of the pancreas: an unusual cause of the acute surgical abdomen. 945 21

Benign ulceration of the cecum is an uncommon lesion that was originally described by Cruveilhier in 1832. Etiology is unknown and symptomatology not pathognomonic. Pre-operative and intraoperative diagnosis is rare and difficult. Definitive diagnosis is usually obtained by histologic evaluation of the surgical specimen after a right hemicolectomy performed for a suspect of a neoplasm of the cecum. The authors present 7 cases of cecal ulcers and suggest that preoperative diagnosis may be due after a colonoscopy with biopsy. This examination may be performed only in that cases that appear without symptoms of acute abdomen. The authors suggest also to perform right hemicolectomy.
Minerva Chir 1997 Dec
PMID:[Benign ulcers of the cecum]. 955 58

The presence at the same time of intrauterine and ectopic (heterotopic) pregnancy is unusual. A case of acute abdomen by tubaric haemorrage in a patient with ectopic pregnancy and evolutive intrauterine pregnancy during first trimester is reported. After surgical therapy, the intrauterine pregnancy had a good evolution.
Minerva Ginecol 1997 Dec
PMID:[Simultaneous intrauterine and tubal pregnancy. A clinical case]. 955 85

The authors report two case stories of visceral aneurysm: a 54 year-old man presenting recurrent gastrointestinal bleeding caused by a splenic artery aneurysm, and a 57 year-old man presenting with acute abdomen due to rupture of a hepatic artery aneurysm. Visceral aneurysms often present with classical gastrointestinal symptoms. They are connected with considerable mortality. Rupture requires instant surgery. In the elective phase the literature recommends embolization or resection.
Ugeskr Laeger 1998 Dec 07
PMID:[Visceral aneurysms. Two case reports]. 985 28

Patients with intra-abdominal processes that require prompt surgical intervention, including appendicitis, perforated viscus, ischemic bowel, volvulus, and bowel obstruction, often present with signs and symptoms of an acute abdomen. Several medical problems can mimic an acute abdomen. Overwhelming postsplenectomy infection is a life-threatening condition that can present with acute abdominal symptoms. The incidence of overwhelming postsplenectomy infection ranges from 1% to 25%, and is caused by Streptococcus pneumoniae in 50% of cases. Capnocytophaga canimorsus, a bacteria commonly found in dog saliva, accounts for less than 1% of cases. Overwhelming postsplenectomy infection has a rapidly deteriorating course that progresses to respiratory and renal failure, cardiovascular collapse, and death. The mortality associated with overwhelming postsplenectomy infection is 60% to 80%. Early diagnosis and institution of appropriate antibiotic therapy and supportive care is essential to improve patient outcome. A previously healthy woman who had undergone splenectomy secondary to trauma 11 years earlier presented with symptoms of an acute abdomen. A diagnosis of overwhelming postsplenectomy infection due to C canimorsus was made based on her peripheral blood smear and blood culture findings. Early aggressive care and antibiotic treatment resulted in a successful outcome for this patient with no long-term morbidity. This patient's clinical course demonstrates the importance of early diagnosis and treatment of overwhelming postsplenectomy infection.
Arch Surg 1998 Dec
PMID:Postsplenectomy Capnocytophaga canimorsus sepsis presenting as an acute abdomen. 986 57


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