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

The purpose of this paper is to describe 2 siblings who had a generalized neurological disease which presented as intestinal pseudoobstruction. The siblings had 40-year histories of abdominal pain, distention, and vomiting as well as gait ataxia, small, irregular, poorly reactive pupils, dysarthria, absent deep tendon reflexes, and impaired vibratory and position senses. Compared with age-matched controls, they had inappropriate blood pressure responses to phenylephrine, the Valsalva maneuver, and upright posture, lack of sweating on warming, and pupillary denervation hypersensitivity. Radiographs revealed hyperactive, nonpropulsive contractions of a dilated esophagus and small intestine and extensive colonic diverticulosis. Esophageal manometry recorded repetitive, spontaneous, nonperistaltic waves and positive Mechyolyl tests. Postmortem examinations showed degeneration of the myenteric plexuses of the esophagus, small intestine, and colon of both patients. Myenteric plexus neurons were significantly reduced in number compared with 7 controls. About one-third of the siblings' neurons contained round, eosinophilic intranuclear inclusions, which, by histochemistry, were composed of protein by lacked RNA, DNA, carbohydrate, and fat. By electron microscopy the inclusions consisted of an irregular array of nonviral, nonmembrane-bounded filaments. Neurons and glial cells of the brain, spinal cord, dorsal root, and celiac plexus ganglia contained identical intranuclear inclusions. Intestinal smooth muscle was normal. These 2 siblings represent a unique disease in which degeneration of the myenteric plexus resulted in hyperactive but uncoordinated smooth muscle activity and the clinical syndrome of intestinal pseudoobstruction, the presenting manifestation of their neurological disease.
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PMID:A familial neuronal disease presenting as intestinal pseudoobstruction. 21 42

Diverticulosis of the colon and its clinical sequelae--diverticulitis, peridiverticulitis, and pericolitis--are typical diseases of elderly people. The main causes are weakness of the connective tissue in the colonic wall increasing with age and pathologic motility pattern of the colon due to low dietary fibre consumption. In about 20% of all people with diverticula, acute or chronic-recurrent diverticulitis develops, often with serious complications as perforation, abscess or fistula formation, obstruction, inflammatory pseudotumor and intestinal bleeding. Diagnosis is mainly based on clinical examination and barium enema (double contrast, maximal spasmolysis). Colonoscopy may be helpful in excluding carcinoma of the large bowel. Patients with diverticulosis and uncomplicated diverticulitis should be managed conservatively by medical treatment. The following measures proved to be successful: high-fibre diet, unprocessed wheat bran, and hydrophilic plant colloids to regulate the bowel movements, systemic or local antibiotics if signs of inflammation are present, and antispasmodics or analgesics against abdominal pain. Prognosis depends mainly on the duration of the disease, sufficient dietary-fibre intake, and elective or semi-elective surgical intervention before the development of life-threatening complications. The question as to whether diverticula or relapsing attacks of diverticulitis can be prevented with added dietary-fibre remains open for the time being.
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PMID:[Diverticulosis-diverticulitis]. 628 28

Three cases of symptomatic colonic lipoma are presented. All were submucous. Clinical findings were abdominal pain, changes in intestinal rythm and rectorragia. All patients had an important loss of weight, a previously undescribed finding. Two patients had a colonic diverticulosis too. The diagnosis was made by means of radiology (barium enema) and surgery was performed in all cases with excellent results.
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PMID:[Submucosal lipomas of the colon]. 717 May 37

A 77-year old woman was seen with an unusual pathologic entity after emergent abdominal exploration--a ruptured small bowel diverticulum. This patient had a known previous history of colonic diverticulosis when she had acute onset of severe abdominal pain. The patient underwent an exploratory laparotomy with resection of representative segments of small and large bowel. The large bowel had evidence of diverticulosis, while the small bowel resected segment had evidence of diverticulitis with rupture. An extensive review of the literature revealed a very small number of reported cases in the world literature (less than 150 cases). We reviewed the history of reported cases of ruptured and nonruptured small bowel diverticular disease, as well as this case.
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PMID:Perforation of acquired small bowel diverticulum. 1007 44

Giant colonic diverticulum is a rare complication of colonic diverticulosis. It typically occurs as a single diverticulum located on the antimesenteric border of the sigmoid colon. The most widely accepted theory for its development attributes the progressive dilation to a "ball-valve" mechanism, allowing air to enter but not to exit. Patients usually present complaining of abdominal pain and/or an abdominal mass, although they may remain asymptomatic. Physical examination reveals a tympanic abdominal mass that appears as a round radiolucency on plain radiographs and CT. Barium enema demonstrates the relationship of the diverticulum to bowel and may document communication with the colonic lumen. To alleviate symptoms and prevent complications, the recommended treatment is excision of the diverticulum in continuity with the involved colonic segment. We report a case and discuss the presentation, diagnosis, and management of giant colonic diverticulum.
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PMID:Giant colonic diverticulum: report of a case. 1036 13

The sigmoid colon is the part of the large intestine, which most commonly involved in diverticular disease due to its anatomical properties. Diverticular disease of the colon is being seen with increasing frequency mostly in western countries. Diverticulitis results from inflammation and subsequent perforation of a colonic diverticulum. Mild forms of diverticulitis usually present with gradually increasing symptoms from the lower left quadrant of the abdomen, whereas acute complicated disease is characterised by dramatic onset of abdominal pain, followed by fever within a few hours. The standard treatment for uncomplicated diverticulitis is bowel rest, with liquid diet or intravenous fluids in combination with antibiotics. Prophylactic resection is not to be recommended for patients with diverticular disease, but a high-fibre diet may afford protection by preventing further complications. Patients not responding to conservative treatment within the first 24 hours require further evaluation by computed tomography or ultrasonography. Fistula formation and intestinal obstruction are indications for surgical intervention, although the frequent recurrent attacks, which commonly afflict these patients, are seldom associated with severe complications. Laparoscopic approach has been introduced in the diagnosis and definitive treatment of uncomplicated diverticulitis, with less morbidity and mortality rates, and hospitalisation of the patients and in these terms could be promising in the future.
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PMID:New perspectives in the management of sigmoid diverticulitis. 1167 25

Virtual colonoscopy provides a computer-simulated endoluminal perspective of the air-filled, distended colon using modern CT scanning (spiral CT). According to recent studies the sensitivity and specificity of this technique are high for adenomatous polyps > or = 10 mm. A 67-year-old patient was admitted to our hospital because of diarrhoea and constipation, associated with abdominal pain in the lower right abdomen. Prior to admission the patient had undergone virtual colonoscopy in a specialised radiological practice which had detected no abnormalities apart from colonic diverticulosis. However, conventional video-colonoscopy revealed a subtotal circular malignant stenosis in the region of the right colonic flexure. A poorly differentiated adenocarcinoma was diagnosed histologically. Staging showed peritoneal carcinosis with infiltration of the right ureter and lymphangiosis carcinomatosa of the pectoral lobe of the left lung. After right hemicolectomy because of metastasised carcinoma of the ascending colon (pT4pN1pM1) we started palliative chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin. The risk of misdiagnosis by virtual colonoscopy is clearly increased in patients with subtotal tumour stenosis of the ascending colon. Conventional video-colonoscopy remains the gold standard for the diagnosis of colorectal carcinoma.
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PMID:[A 67-year-old patient with diarrhoea and constipation without any pathological findings in virtual colonoscopy]. 1587 Oct 68

The total visualization of the intestinal surface through wireless capsule endoscopy has furnished new insights for the diagnosis of intestinal diseases. The length, difficulty of access and particular morphology of this region makes a correct diagnosis of gastrointestinal diseases associated with bleeding possible only in 5% of cases. Our study was aimed at assessing the clinical impact and diagnostic outcomes of wireless capsule endoscopy through analysis of the first 50 cases observed in our Endoscopy and Coloproctology Unit. Fifty patients aged 23-85 years (mean age: 43.5) were selected for wireless endoscopy. The main indications were patients with a suspected or established diagnosis of inflammatory bowel disease or malabsorption, abdominal pain, chronic diarrhoea and obscure bleeding. Patients with a clinical or radiological diagnosis of gastrointestinal stenosis, Zencker's diverticula, or colonic diverticulosis were excluded from the study. In 2 out of 8 patients with abdominal pain, erosions of the intestinal wall were detected, while in the only patient with gastrointestinal bleeding a neoplastic lesion of the right colon was accidentally diagnosed. As far as inflammatory bowel disease is concerned, in all the cases of established diagnosis of ulcerative colitis no small bowel lesions were visible at wireless endoscopy, while all the cases with silent Crohn's disease of the terminal ileum were confirmed. No cases of neoplastic lesions of the small bowel were recorded in our series either in celiac-disease patients or in patients with familial intestinal polyposis. In celiac-disease patients (N = 24) wireless capsule endoscopy allowed accurate definition of the extent of the mucosal damage. On the basis of our preliminary experience wireless capsule endoscopy would appear to warrant an important role in the management of patients with small bowel diseases, supplementing information obtained with other diagnostic techniques.
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PMID:[The role of capsule endoscopy in the study of intestinal diseases. Critical analysis and observation of the first 50 cases]. 1736 33

Diverticular disease of the colon, a common problem among adults, is diagnosed rarely in children. We report an adolescent patient with sigmoid diverticulitis who required operative treatment. Pediatric patients with the complications of diverticula typically have conditions that result in genetic alterations affecting the components of the colonic wall. Our patient had Williams-Beuren syndrome, although Ehlers-Danlos syndrome, Marfan syndrome, and cystic fibrosis may also be associated with colonic diverticula in adolescence. Pediatric patients with these disorders who experience abdominal pain should be evaluated for the presence of colonic diverticular complications.
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PMID:Colonic diverticulitis in adolescents: an index case and associated syndromes. 2065 62

We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.
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PMID:Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum. 2178 81


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