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

We retrospectively reviewed 54 consecutive children (mean age, 12 years) evaluated for possible appendicitis to determine the efficacy of laboratory and radiologic procedures in establishing the diagnosis. The final diagnosis was appendicitis in 24 and abdominal pain not necessitating operation in the remaining 30. Two hundred two laboratory tests were obtained (average 3.7 tests per patient). The mean white blood cell count on initial CBC was 13,930/cu mm overall with a higher mean in the appendicitis group (16,704 vs 11,057/cu mm). Of the 148 tests besides CBC, only 12 (8%) yielded abnormal results; all of these were present on urinalysis and were nondiagnostic. A total of 117 roentgenograms were obtained on initial evaluation (average 2.2 x-ray films per patient). Films were considered abnormal by the ordering physician in 12 cases (24%). When reviewed by the radiologist, 17 abnormalities (33%) were detected. In only seven instances was there agreement in interpretation of abnormality between the ordering physician and the radiologist. This review indicates little usefulness of nonspecific laboratory and radiologic evaluation of possible appendicitis in children. Appendicitis remains a diagnosis of physical examination, and early referral with thorough evaluation by an experienced examiner may result not only in improved accuracy, but in less delay in appropriate therapy, with greater cost effectiveness.
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PMID:Pediatric appendicitis: efficacy of laboratory and radiologic evaluation. 320 Dec 95

Appendicitis is the first 3 years of life is uncommon and most cases are perforated at laparotomy. Case records at the Adelaide Children's Hospital were reviewed over a 12-year period. The findings were that acute appendicitis in this age group is commonly associated with respiratory symptoms and diarrhoea, the appendix was gangrenous or perforated in 92% of cases, and there was a significant delay in diagnosis. It is concluded that full evaluation of any child of this age with fever, vomiting, abdominal pain and tenderness is mandatory, and should include rectal examination, abdominal radiographs, differential white cell count and urinary examination. Examination under sedation may be necessary.
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PMID:Appendicitis in the first three years of life. 327 Mar 21

Yersinia enterocolitica was isolated from the feces of 29 patients over a three-year period following the introduction of a selective culture medium. Y. enterocolitica was the third most common enteric pathogen after Campylobacter jejuni and Salmonella in this series of 3795 specimens from a predominantly adult population. The isolation rate of Y. enterocolitica was 0.9% and this represented 15.8% of positive cultures. The usual symptoms of Yersinia infection were diarrhea (93%) and abdominal pain (72%), often associated with tenderness in the right iliac fossa and fever. Fourteen patients required admission to hospital and four came to surgery for possible appendicitis. Acute terminal ileitis and mesenteric lymphadenitis were noted in each case. Two patients who were HLA-B27 positive had a reactive arthritis as their dominant complaint. In conclusion, Y. enterocolitica has emerged as a common cause of diarrhea in adults. It is an important cause of symptoms resembling those of acute appendicitis and is occasionally complicated by reactive arthritis.
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PMID:Clinical aspects of infection with Yersinia enterocolitica in adults. 330 48

Whether barium retained in the appendix can be a cause of acute appendicitis is debatable. We describe a 40-year-old man who developed nonspecific right abdominal pain 7 weeks after a barium enema, which proved to be normal. On abdominal film a distended appendix containing barium was seen, and at laparotomy acute appendicitis was present. Thus far, 26 cases of "barium appendicitis" have been reported. On the basis of the relevant literature and the cases collected, it is appropriate to draw the following conclusions: 1) With present knowledge it is not possible to state whether retained barium plays any etiologic role in the development of subsequent uncomplicated acute appendicitis. 2) If a later appendicitis does supervene, it carries a high risk of being complicated; barium seems to be responsible for the complication. 3) The longer the interval between the barium study and the subsequent appearance of acute appendicitis, the higher will be the risk of complications.
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PMID:Barium appendicitis: fact or fancy? Report of a case and review of the literature. 330 23

A clinical study of 22 cases of ovarian hemorrhage suggests that intraabdominal hemorrhage of 100 ml and above should be surgically treated. The study also found polycystic tendency and increased peripheral blood white blood cell count. 13 cases which were pathologically treated were diagnosed to be corpus luteum hemorrhage. Out of 26 cases with ovarian hemorrhage seen at Almeida Hospital in Oita, Japan, between 1976 and 1987, 4 cases were eliminated from the study because of pregnancy. No significant difference was found in terms of number of pregnancies or number of child births. 19 of 22 cases belonged to the age group 20-34. Hemorrhage occurred in 9 cases during the premenstrual period, from the 22nd day to the 28th day. It occurred after induced abortion in 5 cases. All 22 women complained of lower abdominal pain. 15 were diagnosed to have puncture of Douglas pouch. In 16 out 22 cases hemorrhage occurred in the left ovary. This is due to the fact what many with right side abdominal pain had already been operated elsewhere because of suspected appendicitis. No fever over 38 degrees celsius was found, but 8 cases had a slight temperature. 5 of 22 cases showed a peripheral blood white blood cell count over 10,000. This combination of two factors proved to be not so reliable in distinguishing between acute appendicitis and ovarian hemorrhage. 9 out of 11 cases which were diagnosed to have intraabdominal hemorrhage of 100 ml and above were still hemorrhaging at the time of operation. Therefore, hemorrhage of 100 ml, not 200 ml and above as in the past, should be surgically treated.
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PMID:[Idiopathic ovarian hemorrhage]. 336 Nov 83

The records of all (5080) patients presenting to a district general hospital with acute abdominal pain over a 4-year period were examined. The contribution of abdominal radiographs to the assessment of patients with suspected appendicitis, urinary tract infection, and non-specific abdominal pain was evaluated, these conditions accounting for 48 per cent of patients with abdominal pain and 32 per cent of those with abdominal radiographs. Any positive information from these radiographs was less likely to be helpful than incidental or inconsistent (and hence potentially misleading). Because of this high 'false positive' rate it is suggested that if the initial diagnosis is suspected appendicitis, urinary tract infection, or non-specific abdominal pain, there is little value in the routine use of abdominal radiographs.
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PMID:Plain abdominal radiographs and acute abdominal pain. 339 21

The complete blood count (CBC) is the laboratory test most frequently ordered by emergency physicians. This is often not cost effective because of the relative inaccuracy of the white blood cell (WBC) and differential cell counts. The WBC and differential counts do not reliably distinguish between bacterial and viral infections because they lack specificity in many patients, nor do they reliably correlate with the severity of disease because they lack sensitivity in some patients. This article briefly summarizes the laboratory, physiologic, and pathophysiologic causes of variations in the WBC and differential counts; reviews some of the literature on pediatric patients with fever and appendicitis and on adult patients with appendicitis and abdominal pain; and presents suggestions for future research into the reliability and cost effectiveness of the CBC.
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PMID:CBC or not CBC? That is the question. 351 1

Ultrasonography demonstrated thrombus within the portal venous system in a child who presented with abdominal pain and a fever. This helped lead to a diagnosis of appendicitis complicated by ascending septic thrombophlebitis. Ultrasound of the portal vein may be of value when investigating such children with atyptical abdominal pain.
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PMID:Case report: ultrasonographic demonstration of portal vein thrombosis in the acute abdomen. 351 73

A 43-year-old man, with a chief complaint of abdominal pain and a palpable mass in the lower abdomen, was admitted to this hospital. He had 2-3 episodes of diarrhea monthly for several years. Laparotomy revealed the mass resembling sarcoma, invaded the ileum and bladder and also it had disseminated lesions in the other intraabdominal organs. Resected tissues showed actinomycotic abscess. AB-PC was administered post-operatively, with a satisfactory prognosis. On the 71 patients with abdominal actinomycosis who underwent laparotomy during the past 32 years in Japan, 42 were males and 28 females. Many of them were in their forties or fifties. Some literatures mention the ileocecal region as the usual site of following perforated appendicitis. As far as this review is concerned, however, the transverse colon was as frequently affected as the ileocecal region and it was only in 13 patients that acute appendicitis preceded the infection. Abdominal actinomycosis is not an uncommon disease and should be taken into consideration in the differential diagnosis of the abdominal mass.
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PMID:[A case of abdominal actinomycosis]. 360 May 98

776 patients seen in our emergency ward with abdominal pain for less than one week duration were prospectively analysed. In 49% of these patients no cause was found and 19% had acute appendicitis. Among 180 appendectomized patients, 147 (82%) had acute appendicitis whereas 33 (18%) had no inflammation of the appendix. Clinical presentation with a pain duration of less than 36 hours, steady abdominal pain, guarding in the right iliac fossa and a white cell count above 12,000/mm3 (12 g/l) were the best criteria for prediction of acute appendicitis versus a normal appendix. Perforated appendicitis was found in 18% of the patients with acute appendicitis but in only one patient for whom appendectomy had been deferred on the grounds of atypical presentation. Thus, in most cases, the perforation was preexistent to admission. We therefore recommended a 24-48-hour observation period for patients with uncertain diagnosis. Rates of normal appendices and perforated appendices of about 20% seem to be difficult to improve upon.
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PMID:[A prospective study of 776 cases of acute non-traumatic abdominal pain. Acute appendicitis and its diagnosis]. 367 66


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