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

Jejunal diverticulosis is an uncommon, acquired condition that has been encountered recently in four patients. These cases (two patients with diverticulitis, one patient with chronic abdominal pain, and one patient incidentally discovered at laparotomy for colonic diverticulitis) are reported. Acute complications of jejunal diverticulosis include diverticulitis, bleeding, and intestinal obstruction. Chronic complications include intractable abdominal pain, malabsorption, and intestinal pseudo-obstruction. Up to 15 per cent of patients with jejunal diverticulosis may require small-bowel resection for treatment of these acute or chronic complications. The clinical significance, proper diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.
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PMID:Diverticular disease of the jejunum and its complications. 211 Apr 29

Forty-one patients admitted to our hospital during an 18-month period with the clinical diagnosis of colonic diverticulitis were analyzed to evaluate the utility of computed tomography (CT). Abdominal pain and leukocytosis were the most common presenting manifestations, 75 and 66%, respectively. Just over one-half of the patients also demonstrated hematuria. Twenty patients required surgical intervention, most commonly for failure to improve despite medical management. Preoperative studies included 10 sigmoidoscopies, 30 plain abdominal roentgenograms, 20 barium enemas (BE), and 24 CT scans. Two CT scans were also obtained after operation for successful percutaneous drainage of intra-abdominal abscesses. Abdominal roentgenograms were most commonly obtained but least helpful, with only one third demonstrating any abnormality whatsoever. Sigmoidoscopy was least commonly performed but almost universally abnormal. Specificity was low, however, in that spasm with inability to advance the endoscope was the most common finding. Of the 20 barium enemas obtained, 60% had findings consistent with diverticulitis, most commonly localized perforation or fixed narrow segment. Sixty-three per cent of CT scans were abnormal. The most frequent findings were localized thickening of the colonic wall and increased density in the pericolic fat. Diverticular abscess, which may be inferred by other studies, was definitely diagnosed in one third of the patients with abnormal CT scans. CT also provided the ability to identify extracolonic intra-abdominal pathology. The study demonstrates that both barium enema and CT are effective in diagnosing diverticulitis, although CT can be performed without risk. CT played no therapeutic role before operation, although two patients benefited after operation by CT-guided drainage of intra-abdominal abscesses. The decision for surgery was most frequently dependent on clinical examination and never solely on the basis of either the barium enema or CT in this study. The major benefit of CT appears to be its ability to identify both gross and subtle changes indicative of diverticular disease and extracolonic pathology in a relatively noninvasive manner.
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PMID:The utility of computed tomography in colonic diverticulitis. 374 Oct 3

Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.
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PMID:Surgery for diverticulitis in renal failure. 390 14

Right-sided colonic diverticulitis is an uncommon disorder that most frequently mimics appendicitis. During pregnancy, displacement of the diseased cecum and ascending colon into the right upper quadrant may result in symptomatology that mimics cholecystitis. A 37-year-old white woman with a history of previous benign incidental appendectomy presented at 20 weeks' gestation with right upper abdominal pain and nausea for 2 days. Significant findings included local rebound tenderness and palpable fullness over the gallbladder, leukocytosis, and low-grade fever, but otherwise unremarkable routine serum laboratory test results and sonographic evidence of biliary tract disease. Cholescintigraphy was rejected by the patient. Persistence of symptoms for 3 hospital days despite administration of broad-spectrum parenteral antibiotics prompted surgical intervention. Laparoscopy demonstrated a normal-appearing gall-bladder and an acutely infected, solitary diverticulum of the midascending colon with adhesions to the omentum and to the parietal peritoneum near the gallbladder. Adhesiolysis, omental biopsy, and peritoneal drainage were performed endoscopically. The patient recovered uneventfully and delivered vaginally at term without fetal or maternal complications. Right-sided colonic diverticulitis may present during pregnancy and may mimic symptoms of acute cholecystitis. Laparoscopic treatment of a solitary, acutely infected colonic diverticulum is feasible in this setting.
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PMID:Right-sided colonic diverticulitis mimicking acute cholecystitis in pregnancy: case report and laparoscopic treatment. 995 Jan 33

Non-steroidal anti-inflammatory drugs (NSAIDs) may cause damage to the colon, either inducing a non-specific colitis or exacerbating colonic diverticulitis or inflammatory bowel disease. Symptoms of NSAID-induced colitis include abdominal pain, bloody diarrhoea and weight loss. Colonoscopy may show non-specific inflammation, ulceration or diaphragm-like stricture. As the mechanism of toxicity is still controversial, management should be to discontinue the drug, treat medically with metronidazole or sulphasalazine, and, in cases of life-threatening complications, treat surgically.
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PMID:Toxicity of non-steroidal anti-inflammatory drugs in the large bowel. 1032 54

We report the case of a 90-year-old woman, previously diagnosed with jejunal and colonic diverticula, who presented with left lower quadrant abdominal pain suggesting either colonic diverticulitis or ischemic colitis. A computed tomography scan revealed a perforated jejunal diverticulum with abscess formation. The patient promptly was treated surgically without complications. A review of the literature indicates the rarity of perforation of jejunal diverticula and the difficulty of early diagnosis. We discuss the etiology, pathogenesis, diagnosis, and management of this rare entity. It is important for primary care physicians to be familiar with this disease. Delay in work-up often results in catastrophic consequences.
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PMID:Perforation of jejunal diverticulum: case report and review of literature. 1069 59

Acute colonic diverticulitis typically occurs in patients older than 60 years of age but is uncommon in patients under the age of 40, which may lead to a delay in diagnosis. Because abdominal pain is a very common presenting symptom in emergency department patients, we retrospectively analyzed the cases of 21 patients 40 years of age and younger diagnosed with acute diverticulitis and characterized the presenting signs and symptoms, laboratory and radiographic findings, treatment, and outcome. There were 17 men and 4 women with a mean age of 34.1 +/-5.9 years. All patients had abdominal pain, with 14 (67%) patients noting pain in the left lower quadrant (LLQ) and 5 (24%) patients noting right lower quadrant (RLQ) pain. Nausea was present in 18 (86%) patients and fever in 15 (71%) patients. The mean pulse rate was 103 +/- 16 and the mean temperature was 100.7 +/- 1.4 F. Leukocytosis was present in 19 (90%) patients. Plain abdominal radiographs were obtained in 19 (91%) patients and were normal in 15 (79%) of these cases. Computed tomographic (CT) scans were obtained in 15 (71%) patients which revealed findings consistent with acute diverticulitis in 14 (93%) patients. The admitting diagnosis was diverticulitis in 10 of the 12 patients with LLQ tenderness and appendicitis in 4 of the 6 patients with RLQ tenderness. Overall, six patients were taken to surgery: three patients had cecal diverticulitis and three patients had perforated colonic diverticulitis. General treatment measures included bowel rest in 18 (86%) patients, and intravenous fluids and antibiotics in all patients. All patients survived. In conclusion, acute diverticulitis is uncommon in patients under 40 years of age; however, this condition may be confused with other conditions, usually acute appendicitis. As a result, clinicians should consider acute diverticulitis in young patients with acute abdominal pain, especially if they are male with nausea, fever, tachycardia, and leukocytosis, and consider obtaining a CT scan to aid in the diagnosis.
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PMID:Acute diverticulitis in patients 40 years of age and younger. 1075 Sep 16

Primary abscess of the omentum is an infrequent disease entity. We report a case of 60-year-old male patient who suffered from left lower quadrant abdominal pain with localized abdominal wall tenderness, nausea and high-grade fever for the previous few days. Computerized tomography scan revealed a heterogeneous lesion that adhered to the abdominal wall. A pre-operative diagnosis of colonic diverticulitis complicated with intra-abdominal abscess was made and a laparotomy was done. At surgical exploration, an indurate mass consisting of abscess within the omentum was identified. The surgical procedure consisted of resection of the omental abscess with abdominal wall debridement, and subsequent antimicrobial therapy was administered. Postoperatively, the patient recovered uneventfully. Clinicians who treated such patients should be aware of this problem because of the difficulty of preoperative diagnosis.
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PMID:Primary abscess of the omentum: report of a case and review of the literature. 1155 71

This prospective study evaluated the use of multi-slice CT (MSCT) for detection of clinically suspected left-sided colonic diverticulitis with regard to diagnosis, complications and alternative diagnoses. One hundred twenty patients with clinically suspected acute left-colonic diverticulitis underwent MSCT of the lower abdomen with IV contrast after rectal application of iodic contrast. The MSCT results were compared with histopathological and intraoperative findings or other radiological or endoscopic methods and clinical outcome. Acute diverticulitis was proven in 67 of the 120 (55.8%) patients, which was detected by MSCT with an accuracy of 98% (sensitivity 97%, specificity 98%). Contained perforation or abscess formation were detected with an accuracy of 96% (sensitivity 100%, specificity 91%) and 98% (sensitivity 100%, specificity 97%), respectively. In 31 of 120 (25.8%) patients diagnoses other than diverticulitis caused abdominal pain, which was correctly diagnosed by MSCT in 71%. The MSCT as well as other concurrently performed diagnostic methods showed normal findings and no causes for the patients symptoms in 22 of the 120 (18.4%) patients. Multi-slice CT is reliable in detecting diverticulitis, including extracolic complications, and often reveals other diagnoses; therefore, MSCT is recommended as standard diagnostic procedure in suspected acute diverticulitis.
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PMID:Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. 1470 99

Giant colonic diverticulum is a rare condition, and the usual site is the sigmoid colon. In this report, magnetic resonance imaging was performed in a patient with lower abdominal pain. The modality was useful for the evaluation of giant sigmoid colonic diverticulitis and the differential diagnosis.
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PMID:Giant sigmoid colonic diverticulitis: case report. 1462 67


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