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

The incidence of cryptic mycotic abdominal aortic aneurysms has relatively increased since antibiotic therapy has become available. The causative organism is the salmonella group in about 50 per cent of cases. This diagnosis should be strongly entertained in patients with fever of unknown origin, vague abdominal pain, and progressive appearance of a pulsatile abdominal mass. Aortography may be helpful in establishing the diagnosis. Some postoperative graft infections may be due to unrecognized cryptic mycotic infection of the aorta and not from external contamination, as previously supposed. Construction of an axillofemoral bypass graft through clean tissue is advised for the successful treatment of the grossly infected infrarenal aortic aneurysm. Three surviving patients with cryptic mycotic abdominal aortic aneurysms are added to the sixteen surviving patients already reported in the literature.
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PMID:Cryptic mycotic abdominal aortic aneurysms: diagnosis and management. 58 Oct 39

A patient with an unusual unilateral ureteral obstruction secondary to mechanical obstruction by a common iliac artery aneurysm in association with an abdominal-aortic aneurysm is presented. A diagnosis of ureteral obstruction should be suspected in a patient with flank or abdominal pain and an infra-umbilical (iliac) aneurysm. Treatment is directed toward the aneurysm. The aneurysmal wall attachments to the ureter should be left undisturbed.
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PMID:Ureteral obstruction secondary to iliac artery aneurysm. 114 37

18 patients were admitted from 1969 to 1973 to the Surgical and Urological University Clinic in Mainz with ruptured infrarenal aortic aneurysms. Three patients died immediately following the operation and three during surgery from internal hemorrhage. Eight patients died later following prolonged shock. Four patients survived surgery. The classical symptoms of shock, abdominal pain and pulsating tumor was only present in three patients. The diagnosis was only made in seven patients at admission, from the clinical findings. Urological symptoms were also prominent such as unilateral flank pain, colic, dysuria, anuria and tenderness over the kidney. There is no typical clinical picture of ruptured aortic aneurysm. Acute urological symptomatology in cases of acute abdomen with unclear etiology and in connection with shock could indicate a ruptured aortic aneurysm. There is absolute indication for immediate operative intervention. The aneurysm is removed and replaced by a vascular prosthesis. Early diagnosis is important since prolonged shock and anuria will result in a poor postoperative prognosis. Abdominal exploration is therefore also indicated when a ruptured aortic aneurysm is only suspected.
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PMID:[Urinary tract manifestations of ruptured infrarenal aortic aneurysms (author's transl)]. 120 8

A 66-year-old man suffering from high fever and abdominal pain was diagnosed as abdominal aortic pseudoaneurysm due to Salmonella enteritidis septicemia. After complete remission of infection with the antibiotic therapy, we performed a replacement of abdominal aorta with a prosthetic graft. Infection parameters are normal 5 months postoperatively. Although Salmonella septicemia is a serious disorder, it is not a rare infection recently as compromised host increases more. Rapid diagnosis, adequate antibiotic therapy and surgical treatment are essential for successful result of Salmonella aortic aneurysm.
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PMID:[A case of abdominal aortic pseudoaneurysm due to Salmonella enteritidis septicemia]. 155 94

We report the second case of a primary aortoenteric fistula resulting from septic aortitis with a contained aortic leak into the retroperitoneum and finally erosion into the duodenum. An emergency laparotomy revealed a fistula between the third part of the duodenum and a decompressed sac (false aneurysm) arising from a nonaneurysmal, grossly infected pararenal aorta. The purpose of this report is to present this rare case in detail and to review primary aortoenteric fistulas reported in the English language literature. Most fistulas form in association with an abdominal aortic aneurysm and rarely are due to infection. Only 6% of patients presented with the classic triad of abdominal pain, a palpable mass, and gastrointestinal bleeding. Although 29% of patients presented with massive hemorrhage, adequate time usually existed for surgical treatment of these complications. A patient with ill-defined abdominal pain and fever who suddenly develops a palpable abdominal mass should have an emergency ultrasound or CT scan to exclude the possibility of an infected aortic aneurysm or a contained rupture of an infected nonaneurysmal aorta. If the symptoms are associated with bleeding and the patient is hemodynamically stable, emergent endoscopy should also be performed. If a primary aortoenteric fistula or an aortic pseudoaneurysm is confirmed, emergent surgery should be undertaken to avoid rupture into the bowel or retroperitoneum.
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PMID:Primary aortoduodenal fistula due to septic aortitis. 157 77

A 54-year-old man suddenly developed a transverse spinal cord syndrome with paralysis of both legs and diffuse abdominal pain. Spinal compression was excluded by myelography. Subsequent computed tomography, however, revealed an aortic aneurysm of 7 cm diameter. At laparotomy extensive mesenteric ischaemia with necrosis of the entire colon and massive peritonitis were noted. It was not possible, because of the peritonitis, to bypass the aneurysm with a graft and only a colectomy was performed. The patient died 48 hours after admission of prolonged cardiocirculatory failure. Autopsy revealed further multiple organ damage in addition to the ischaemic myelomalacia. The common cause of the findings was probably a sudden drop in blood pressure in the presence of severe generalized arteriosclerosis.
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PMID:[Acute ischemic myelomalacia and colon necrosis in infrarenal aortic aneurysm]. 229 3

We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. One hundred eighty-four of these cases were included in the following eight diagnostic categories: chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, aortic aneurysm, central nervous system bleeding, and epiglottitis. These eight categories accounted for 66.44% of the total dollars spent for the 262 claims. Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.
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PMID:Preventability of malpractice claims in emergency medicine: a closed claims study. 237 83

A 53-year-old man was hospitalized with chronic abdominal pain. A CT scan was performed and demonstrated an aortic aneurysm surrounded by a soft tissue mantle. In the laparotomy, extensive fibrotic adhesions between the aneurysm and the duodenum were discovered. This made mobilization of the duodenum and the left renal vein difficult. The aortic wall was white, thickened, and surrounded with dense fibrous tissue. The aneurysm was replaced by a Dacron graft. Histology of the fibrous tissue showed the features of chronic inflammation. He had no abdominal pain after the operation, and he was discharged in good health. In the preoperative diagnosis of inflammatory aneurysms, the CT scan is useful. We are of the opinion that the preferred treatment for inflammatory aneurysm is aneurysmectomy (or aneurysmorrhaphy) plus grafting.
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PMID:[Surgical treatment of inflammatory abdominal aortic aneurysm]. 240 76

In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17 per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10-29 years (31 per cent) and 60-79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20-29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4.4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged greater than or equal to 60 years, and patients aged 80-89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.
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PMID:Abdominal pain: a surgical audit of 1190 emergency admissions. 259 64

Two patients with duodenal obstruction as the presenting symptom of an abdominal aortic aneurysm are reported. The increasing frequency of aortic aneurysm in an ageing population may make this rare cause of duodenal obstruction more common. Vomiting, abdominal pain, and weight loss are the common presenting, symptoms. This report includes only the third successful aortic replacement in these patients. Upper gastrointestinal examination with contrast and endoscopy and computerized tomography scan of the abdomen are considered the most relevant investigations.
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PMID:Duodenal obstruction as the presenting symptom of aortic aneurysm. 325 Apr 28


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