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

A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.
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PMID:An unusual clinical presentation of pancreatic carcinoma: Duodenal obstruction in the absence of jaundice. 100 50

Of one hundred and forty-nine patients (101 male and 48 female) 4-67 years of age, 117 were alcoholics and underwent pancreatectomy because of episodic or continuous abdominal pain or complications or chronic pancreatitis. Nineteen patients underwent pancreaticoduodenectomy, seventy-seven 80-95% distal resection, anf fifty-three 40-80% distal pancreatic resection. There were 3 operative death and 30 late deaths 6 months to 11 years post pancreatectomy. Twenty-one patients were lost to followup, 1 to 11 years post pancreatectomy. Ninety-five patients are known to be alive, 4 of whom are institutionalized. Indications for pancreatectomy in addition to abdominal pain include recurrent or multiple pseudocysts, failure to relieve pain after decompression of a pseudocyst, pseudoaneurysm of the visceral arteries associated with a pseudocyst, recurrent attacks of pancreatitis unrelived by non-resective operations, duodenal stenosis and left side portal hypertension. The choice between pancreaticoduodenectomy or distal resection of 40-80% or 80-95% of the pancreas should be based on the principle site of inflammation whether proximal or distal in the gland, the size of the common bile duct, the ability to rule out carcinoma, and the anticipated deficits in exocrine and endocrine function. The risk of diabetes is very significant after 80-95% distal resection and of steatorrhea after pancreaticoduodenectomy. When the disease process can be encompassed by 40-80% distal pancreatectomy this is the procedure of choice.
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PMID:Pancreatectomy for chronic pancreatitis. 101 87

Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastric biopsies showed diffuse chronic inflammation in the lamina propria, a decrease in the number of parietal cells, and "intestinalization" of gastric mucosa. Total achlorhydria was demonstrated after a maximal histalog stimulus; however, serum levels of vitamin B12 and Schilling test values were normal in all three patients. Parietal cell antibodies were found in the serum in all patients in a dilution of 1:20 to 1:80. These cases represent autoimmune (type A) chronic atrophic gastritis and should be distinguished from chronic simple (type B) gastritis, in which serum gastrin levels are normal and no parietal cell antibodies are found in the serum. Patients with autoimmune gastritis should be observed at frequent intervals for the occurrence of pernicious anemia or gastric carcinoma.
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PMID:Autoimmune atrophic gastritis with hypergastrinemia. 101 70

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

From 1948 through 1970, 108 causes of primary carcinoma of the gallbladder were recorded out of a total of 17 698 cases of cancer exclusive of skin cancer (incidence, 0.6%). This review indicated that the following are the chief features of this condition: Primary gallbladder carcinoma is mainly a disease of women older than 60 years; abdominal pain occurs in most patients and jaundice in more than half, and weight loss is also common; laboratory and radiographic features are nonspecific; the diagnosis is made or strongly suspected in only one-quarter and, moreover, in many patients the disease may not be discovered until pathologic examination is conducted postoperatively. Resection was possible in 41 of the 93 patients who underwent operation but treatment was conservative because it was palliative in 20, and in 20 of the other underwent cholecystectomy the disease was not recognized at operation. Overall, the 5-year survival rate was 6.4%; for those who underwent curative resection it was 33%; and for patients without visible metastases at operation the mean survival was 3 years. Improvement in survival will come from more frequent recognition of the cancer at operation so that an operation so that an operation more adequate than cholecystectomy may be performed; that is, cholecystectomy, wedge resection of liver and resection of regional lymph nodes.
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PMID:Primary carcinoma of the gallbladder: study of 108 cases. 124 5

Study of hospital records of 146 patients with carcinoma of the pancreas from 1952 to 1971 revealed that 74 per cent had had abdominal pain and 65 per cent jaundice. Abdominal pain was the commonest symptom of carcinoma of the head as well as of the body and tail. Diabetes mellitus was four times as common among the patients with carcinoma of the pancreas as among the population in general. The interval between the onset of symptoms and diagnosis of the disease was the same in both decades of the 20-year period, but the survival time after operation was longer in the second 10-year period. Pancreatoduodenectomy was possible in only four of the 138 patients operated on, and one of them died postoperatively. The three patients who survived the operation survived significantly longer than the 87 in whom an anastomosis had been established between the bile ducts and the intestine. Forty-one patients were subjected to surgical exploration only. No difference in survival time was found between the two last-mentioned groups.
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PMID:Carcinoma of the pancreas. 125 48

A report from a medium-sized community hospital of 4 additional cases of hepatocellular adenoma is presented. Of these, 3 were pedunculated tumors. A 29-year-old woman, gravida 7, had been taking Enovid-E for 8 years. After 3 attacks of epigastric pain a mass was detected in her right upper abdomen. Surgical exploration revealed the mass pedunculated from the right hepatic lobe. The mass was excised. 3 years later a liver scan was normal. The histological appearance of the tissue resembled mature hepatic architecture without protal areas or bile ducts. A 34-year-old woman, gravida 4, para 2, had been taking Enovid-E for 6 years. She previously had had a partial thyroidectomy for carcinoma of the thyroid and later radical neck dissection for metastatic thyroid carcinoma. A mass was detected in the right abdomen. At operation, a pedunculated mass was found attached to the right hepatic lobe with 2 smaller nodules. All lesions were excised. The microscopic picture was similar to that of the other patient. A 24-year-old woman, gravida 4, para 3, had been taking Oracon for 1 year. Upper abdominal pain, vomiting, and diarrhea were complained of. An upper abdominal mass was present. At operation, a 9 cm mass was excised. The histology was the same as in the previous cases. A 28-year-old woman, gravida 2, para 1, had been taking Ovulen for 5 years. An abdominal mass was present. Surgical exploration revealed a nodular mass pedunculated from the left lobe of the liver. The mass was excised. Histological appearance was similar to the other 3 tumors. Of 42 other reported cases of similar tumors, the mean age was 27.3 years. About 40% had been admitted as emergency cases with hemoperitoneum. Almost 20% had complained of upper abdominal pain. A palpable mass was usually present. Multiple nodules were found in 13% of cases. For nonemergency cases, selective hepatic angiography has been a reliable method of diagnosis. The treatment has been resection of the tumor when feasible. However, regression of tumors has occurred when exogenous hormone influence ceased. The outcome has been fatal in 8 cases. The low incidence of this tumor is not considered sufficient cause to justify discontinuing use of oral contraceptives.
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PMID:Hepatocellular adenoma and oral contraceptives. 127 46

A 36-year-old male with a history of immature teratoma and embryonal carcinoma of the testis was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha-fetoprotein (AFP) was 46.8 ng/ml (reference < 25 ng/ml). Fine-needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear vacuolization. Intracytoplasmic PAS-positive, diastase-resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al.: Am J Surg Pathol 1987; 11(10):767-778). We believe this is the first reported case of an endometrioid-like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant.
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PMID:Fine-needle aspiration cytology of an endometrioid-like variant of yolk sac tumor. 128 67

Intestinal localization of rhabdomyosarcoma is exceptional, this case is the first to be published in the world literature. A 35-year-old patient with abdominal pain, fever, was found to have an infiltrative white-grey tumour, involving 20 cm the jejunoileal wall and also the surrounding mesenterium up to the origin of upper mesenterical vessels and lymph nodes. Histologic examination showed an alveolar type of rhabdomyosarcoma intricated with solid undifferentiated tumoral cells. The presence of multinucleated giant cells and the positivity of protein S 100 reaction was important for differential diagnosis, given the alveolar soft part sarcoma, malignant mesothelioma, malignant melanoma or papillary carcinoma.
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PMID:Jejunoileal alveolar rhabdomyosarcoma. A case report. 134 1

A 59-year-old woman who had undergone a Whipple's operation for carcinoma of the head of the pancreas, developed septic fever of up to 40 degrees C on the fourth postoperative day, accompanied by severe upper abdominal pain and local guarding on palpation over the liver. Her general condition markedly and quickly deteriorated. Liver abscess was suspected. Computed tomography demonstrated a hypodense, wedge-shaped lesion in the right lobe of the liver without any abscess capsule. Liver infarction was diagnosed when injection of contrast medium failed to show any increase in density. Magnetic resonance imaging confirmed the wedge-shaped signal-rich lesion. Laboratory tests revealed a leucocytosis of 30,000/microliters, a postoperative rise in serum alkaline phosphatase activity (up to 800 U/l), gamma-glutamyl transaminase (up to 190 U/l) and lactate dehydrogenase (up to 320 U/l), while GOT and GPT activities remained within normal limits throughout. Fever subsided within 3 weeks. --It is stressed that, if a patient's condition worsens after a major abdominal operation, liver infarction should be considered in the differential diagnosis. Modern imaging methods have increased the frequency of this diagnosis. They, together with the clinical picture and the pattern of biochemical tests, make it possible to distinguish reliably infarction from liver abscess.
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PMID:[Liver infarction after Whipple's surgery. Diagnosis based on clinical course and imaging procedures]. 134 77


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