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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Small intestinal tumors are relatively rare, notoriously difficult to diagnose, and often advanced at the time of definitive treatment. The purpose of this study is to compare the differences between benign and malignant tumors of the small intestine and between symptomatic and asymptomatic tumors with respect to their clinical presentation, efficacy of diagnostic procedures, and surgical management with correlation to pathologic findings. Forty-nine patients with primary small intestinal tumors between 1981-1993 had 17 benign and 32 malignant tumors. Benign tumors more commonly presented with acute gastrointestinal hemorrhage (29% versus 6%, P < 0.05), and were often asymptomatic (47% versus 6%, P < 0.05). Malignant tumors more commonly presented with abdominal pain (63% versus 24%, P < 0.05) and weight loss (38% versus 0%, P < 0.05). The total number of diagnostic tests/patient averaged 2.3 +/- 0.3, and the average time from onset of symptoms to resection was 30.2 +/- 6.6 weeks. Upper endoscopy, angiography, and upper gastrointestinal contrast studies had the most useful sensitivity rates. Surgical treatment of tumors included biopsy/excision, limited bowel resection, segmental resection with regional lymphadenectomy, or a bypass procedure. The most common types of benign and malignant tumors were leiomyoma (41%) and adenocarcinoma (53%), respectively. Histologically, tumors were evenly distributed throughout the small intestine. Small intestinal tumors remain difficult to diagnose because of an atypical presentation and renew the need for appropriate suspicion when treating patients with vague abdominal symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The continuing clinical dilemma of primary tumors of the small intestine. 761 9

A case of amyloid tumour of the colon and the first in association with a carcinoma is reported. A previously healthy 65 year old man presented with non-specific symptoms of lower abdominal pain and flatulence without rectal bleeding. A clinical diagnosis of diverticular disease was made and colonoscopy performed. Two lesions (one at 15 cm and the other at 30 cm from the anal margin) were found on endoscopy and removed. On histology, the lesion at 15 cm was a moderately differentiated adenocarcinoma and that at 30 cm contained amyloid. Further tests (standard tinctorial methods and immunohistochemistry) revealed the 30 cm lesion to be an amyloid tumour of the colon of AL (lambda) type. When biopsy of an atypical, large, solitary colorectal lesion reveals amyloid deposition, the possibility of an amyloid tumour should be considered and the lesion resected.
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PMID:Amyloid tumour of the colon. 766 12

Mucinous pancreatic neoplasms present diagnostic and therapeutic challenges. These tumors behave in an indolent nature, with frequent overlap of symptoms and radiographic appearance with other forms of pancreatic cysts, pseudocysts, and malignancy. Some authors propose that all mucin-producing tumors of the pancreas are variants of the same basic entity and have subclassified them on the basis of their predominant location within the pancreas. These disorders must be considered in the evaluation of chronic abdominal pain, particularly in the presence of a cystic pancreatic lesion or when associated with idiopathic chronic or acute recurrent pancreatitis. The clinicopathologic features of IMHN overlap to a great extent with classic mucinous cystic neoplasms but are different significantly enough to be distinct clinical entities. These tumors originate from the pancreatic duct epithelium, produce mucin, demonstrate a papillary growth pattern, and are considered premalignant or frankly malignant at the time of diagnosis. Both lesions biologically are much less aggressive than that of pancreatic ductal adenocarcinoma and appear to infiltrate peripancreatic tissue and to metastasize to lymph nodes or other adjacent structures late in the course of disease. Nevertheless, IMHNs are located primarily in the head of the pancreas, commonly affect elderly men, and present clinically with obstructive pancreatitis, often leading to pancreatic insufficiency, whereas mucinous cystic neoplasms are more likely to develop in the pancreatic body or tail, predominate in young women, and present with symptoms referable to tumor compression of adjacent structures. The location of the lesion is the primary differentiating feature because the lining epithelium of the two tumor types is indistinguishable pathologically. In mucinous cystic tumors, the mucus is secreted and retained within the cyst lumen because of the absence of communication between the cyst and the main pancreatic duct. In contrast, mucus produced in MDE flows into the main pancreatic duct, resulting in obstructive pancreatitis and, ultimately, dilatation of the pancreatic duct. Intraductal mucus provides an important clue to the diagnosis of intraductal pancreatic neoplasms and, whenever present, should prompt an aggressive diagnostic evaluation. Both lesions are managed by resectional surgery because the opportunity for cure is high in the absence of metastatic disease.
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PMID:Mucin-secreting tumors of the pancreas. 772 46

In emergency, the most commonly used examination, other than plain radiographs of the abdomen, is the water-soluble contrast enema (Gastrografin). It demonstrates three different pictures, which may be more or less associated one to the other: "peridiverticulitis", featuring serrate lesions, abnormal stiffness and fixity and, in some cases, a long narrowing or stricture of the colon; diverticula, mainly in the sigmoid colon, becoming sharp-pointed or spark-liked; spillage of contrast material out of the colic lumen or into a neighbouring organ (fistula). Ultrasonography may be a useful emergency procedure to secure a hesitating diagnosis in a patient with a febrile abdominal pain or with a abdominal-pelvic mass, especially in women. Colonoscopy and barium enema are both usually contra-indicated in the acute setting of diverticulitis because of their potential hazards. On the other hand, after resolution of the acute event, these tests may allow to rule out carcinoma or associated adenomas (which coexist in more than 15% of the patients). Endoscopic control appears more especially important as initial accurate diagnosis in sometimes impossible to assess between adenocarcinoma and diverticulitis. CT scan has found an increasing place in both diagnosis and evaluation of infectious complications of diverticular disease. It is most recommended to assess the diagnosis of severe episodes, failing to clearly improve after medical treatment, and most particularly when an abscess in suspected. CT scan may demonstrate a thickening of the colic wall, high densities of pericolic fat and a tissular mass which may enclose gas bubbles.
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PMID:[Radiological and endoscopic diagnosis of sigmoid diverticulitis]. 776 82

A 72-year-old woman was admitted to our hospital complaining of loss of weight, general fatigue, and upper abdominal pain. Barium studies suggested that a fistula was present between the proximal transverse colon and the stomach which originated from a carcinoma of the colon. A plain computed tomography (CT) scan confirmed the presence of a gastrocolic fistula. A two-thirds distal gastrectomy and right hemicolectomy with a resection of a bulky tumor in the mesocolon were performed en bloc. Histological examination revealed a well-differentiated adenocarcinoma of the transverse colon which was involved with the wall of the stomach. We were able to obtain information on 14 previous cases of gastrocolic fistula originating from transverse colon cancer in the Japanese literature, including the present case. The most common symptom was abdominal pain (64%). A preoperative diagnosis of fistula was confirmed in 10 of the 11 cases examined by barium studies. A plain CT and a CT scan after the barium studies may also be helpful in detecting fistula formation. A fistula between the carcinoma of the middle or distal transverse colon and the stomach was found in 13 of 14 cases, but not in our case. Only one case lived longer than 9 years, even though a surgical resection was possible in 9 of 11 cases.
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PMID:Gastrocolic fistula originating from transverse colon cancer: report of a case and review of the Japanese literature. 778 Feb 32

The extent to which the different resections relieve the symptoms of gastric cancer is poorly defined. The symptoms of 57 consecutive patients undergoing standard resection of gastric adenocarcinoma by oesophagogastrectomy (n = 19), total gastrectomy [16] or partial gastrectomy [22] were studied prospectively. Common symptoms were relieved in 80% of cases and this was independent of tumour stage. Symptoms were significantly more frequent after total gastrectomy than after partial gastrectomy or oesophagogastrectomy, the difference being attributable principally to the development of new symptoms after total gastrectomy. While abdominal pain, nausea and vomiting were largely relieved by resection, dyspepsia or dysphagia worsened in 31% of patients following surgery, especially total gastrectomy (P < 0.05). Resection relieves the symptoms of gastric cancer adequately but outcome is influenced by operation type. As total gastrectomy gives a poorer symptomatic outcome, it should be avoided when the performance of an alternative procedure does not compromise established principles of resection.
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PMID:Symptomatic outcome following resection of gastric cancer. 778 Jun 11

Although clear cell carcinomas have been described in numerous anatomic sites, their occurrence in the gallbladder and extrahepatic bile ducts (EHBD) is practically unknown. We report 10 such cases. Seven arose in the gallbladder and three in the EHBD; all patients with gallbladder tumors were females with cholelithiasis whose ages ranged from 56 to 68 years. Patients with EHBD tumors were younger (38 and 40 years of age) and had extrahepatic biliary obstruction and abdominal pain. Two patients with gallbladder carcinomas had elevated serum carcinoembryonic antigen (CEA) levels, and another without hepatic involvement had markedly elevated circulating levels of alpha-fetoprotein (AFP). Histologically, nine tumors were adenocarcinomas and one was a squamous cell carcinoma. Seven adenocarcinomas consisted of cords, sheets, nests, papillae, and trabeculae of clear cells with well-defined cytoplasmic borders. Two were composed predominantly of glands and papillary structures. The cells contained PAS-positive diastase-labile granules and were cytokeratin- and EMA-positive and immunoreactive for erythropoiesis-associated antigen. One gallbladder tumor contained areas of hepatoid differentiation, a feature described in gallbladder neoplasms only once before. These areas were AFP-positive and immunoreactive for CEA. By electron microscopy, they showed hepatoid differentiation with formation of bile canaliculi. In two gallbladder tumors, neoplastic cells contained subnuclear vacuoles reminiscent of early secretory endometrium. Foci of conventional adenocarcinoma or mucinous carcinoma were recognized in all nine tumors. The squamous cell carcinoma showed only foci of squamous differentiation with keratinization. The clear cells of this neoplasm had a trabecular and solid growth pattern. These clear cell neoplasms of the gallbladder and EHBD must be differentiated from metastatic renal cell carcinoma, based upon the presence of areas of conventional adenocarcinoma or foci of squamous differentiation since results of special stains and immunohistochemistry are similar in both neoplasms. One of the patients with EHBD carcinoma is alive and symptom-free 6 years following right hepatic lobectomy. Five patients with gallbladder tumors had direct extension into the liver and died with metastases. Two are living with metastases.
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PMID:Clear cell carcinomas of the gallbladder and extrahepatic bile ducts. 780 41

Thirty-seven cases of colorectal cancer in patients aged 30 years or younger have been treated at the University of Virginia Health Sciences Center from 1957 through 1992. The present series, comprising patients treated from 1978 through 1992, updates a series presented from our institution comprising patients treated from 1957 through 1977. For the 36-year series, 24 patients (65%) were female, and 13 (35%) were male. Sixteen patients (43%) were black, and 21 patients (57%) were white. Sites of tumor and their frequency were rectosigmoid, 14 (38%), left colon, five (14%), splenic flexure, two (5%), transverse colon, three (9%), hepatic flexure, two (5%), right colon, two (5%), and cecum, six (16%). Twenty-two patients (59%) presented with abdominal pain, whereas 15 (41%) presented with hematochezia or hemoccult positive stools. The average time of onset of symptoms to diagnosis was 2.3 months. Thirty-four of 37 patients (92%) presented with advanced stage disease. Only four patients had precancerous conditions: one each with Gardner's Syndrome, Turcot's Syndrome, ulcerative colitis, and villous adenoma. Twenty-five patients (68%) underwent surgery for cure, and ten (27%) received palliative procedures. Nothing could be done for two patients (5%). Twenty-one patients (57%) had mucinous histology, 13 (35%) had typical adenocarcinoma, one (3%) had small cell carcinoma, and histology was unavailable in two (6%). Nodes were negative in only 10 (27%) patients, of which only three had mucinous histology. There have been five 5-year survivors and three patients alive and disease free at last follow up, ranging from 30 months to 48 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Colorectal carcinoma in patients 30 years of age and younger. 783 88

The authors present a case of appendiceal intussusception, a rare finding that can be associated with appendiceal neoplasms. A 74-year-old woman with right lower quadrant abdominal pain was found to have an appendiceal intussusception associated with a villous adenocarcinoma and was managed with a laparoscopic assisted right hemicolectomy. This case is presented along with a review of the symptoms, diagnosis, classification, and appropriate management of this entity via laparoscopy.
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PMID:Laparoscopic management of appendiceal intussusception associated with villous adenocarcinoma. 783 25

Spontaneous rupture of the right upper ureter caused by metastatic ureteric tumor in an 80-year-old man is reported. He was admitted to our hospital with right lower abdominal pain. Ultrasonography showed mild right hydronephrosis and a low echogenicity mass under the right kidney. Drip infusion pyelography and abdominal computerized tomography showed extravasation of contrast medium around the right upper ureter. Retrograde pyelography was unsuccessful because of edema of the bladder wall. Right ureterocutaneostomy was performed under the diagnosis of spontaneous rupture of the right ureter. The right ureter was completely obstructed 3 cm below the point where it crossed the common iliac artery. At this site, the ureteric wall was hard, thickened, and adherent to the surrounding tissue. The lesion was a metastatic adenocarcinoma. The origin of the tumor could not be found, but pancreatic cancer was suspected on the basis of elevated CEA and PSTI levels. He died of peritonitis carcinomatosis at 8 months after surgery. Thirty three cases of spontaneous rupture of the ureter and 60 cases of metastatic ureteric tumor have been reported in Japan. However, our patient is the first reported case of spontaneous rupture of the ureter caused by a metastatic ureteric tumor in the Japanese literature.
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PMID:[Spontaneous rupture of the ureter caused by metastatic ureteric tumor: a case report]. 790 May 70


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