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

A rare case of isolated superior mesenteric venous thrombosis (MVT) after endoscopic variceal band ligation (EVL) is reported. A 64-year-old woman with a history of idiopathic portal hypertension presented at the emergency room with vomiting, increasing cramping abdominal pain, and low-grade fever. She had undergone EVL for esophageal varices 4 months before and had had intermittent attacks of mild abdominal pain after the EVL. Ultrasonogram of the abdomen demonstrated marked concentric wall thickening of the ileal loop. Enhanced computed tomographic (CT) scan revealed a central lucency in the lumen of the superior mesenteric vein, surrounded by a high-density vein wall, corresponding to a thrombus. An isolated MVT and venous collateral network in the splanchnic area were confirmed by angiography. Supportive therapy, i.e., water and electrolyte replacement, and anticoagulation improved the clinical condition and radiologic status. This case of MVT after EVL suggests a possible relationship between EVL and MVT. It is necessary for clinicians to be aware of this relationship for the early diagnosis of MVT.
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PMID:A case of mesenteric venous thrombosis after endoscopic variceal band ligation. 777 57

Although many have recorded the incidence of complications after laparoscopic cholecystectomy, few have discussed the possibility of missing intra-abdominal pathology after this procedure. We have evaluated the first two years, September 1990-September 1992, of laparoscopic cholecystectomy in our community. Readmissions within 10 months of the original surgery with another diagnosis similar to gallbladder disease were considered "missed pathology" at the original surgical procedure. For the first 12-month period, 465 laparoscopic cholecystectomies were performed. Seventy-seven patients were readmitted, with 13 of these patients having other intra-abdominal pathology. These readmissions were for carcinoma (6), inflammatory bowel disease (2), diverticular disease, esophageal varices, and appendicitis. In the second year 429 laparoscopic cholecystectomies were performed; 59 patients were readmitted, with 10 of these patients having other intra-abdominal pathology. These readmissions were for carcinoma (3), inflammatory bowel disease (2), strongyloides, peptic ulcer disease, and abdominal pain of unknown etiology (3). Although intra-abdominal pathology was found in only 2%-5% of all patients having surgery for gallbladder disease, of the patients who were readmitted for "missed pathology," 46% the first year and 30% the second year were readmitted for carcinomas. Several other diseases were found in patients whose symptoms mimicked gallbladder disease. It is therefore possible that in the zeal to perform a new procedure, other diagnoses may be overlooked.
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PMID:Missed pathology following laparoscopic cholecystectomy: a cause for concern? 785 69

Extrahepatic portal vein obstruction (EHPO) was seen in 54 adult patients at the Chiba University Hospital and affiliated hospitals from 1978 to 1991. They were classified according to the background disease (Group A, unknown aetiology; Group B, benign disease; Group C, malignant disease). Among the initial symptoms and signs, abdominal pain was the most frequent in Group A (37%), and symptoms attributable to the primary disease in Groups B (44%) and C (75%). Definite or probable diagnosis was made in 45 of the 54 patients (81.8%) by ultrasound (US) examination carried out because of these symptoms and signs. Signs of portal hypertension were observed in 67% of patients; oesophageal varices were seen in 60%. Extrahepatic portal vein obstruction without portal hypertension signs was characterized by thick extensive hepatopetal collaterals or patency of some intrahepatic portal veins. Extrahepatic portal vein obstruction patients without portal hypertension remained free of its signs for more than 3 years of follow up and, in fact, EHPO without portal hypertension signs was a common occurrence. Emphasis is made on the diagnostic value of US examination which was useful in identifying the relation of clinical manifestation of EHPO to pathophysiology, and on the frequent lack of portal hypertension signs in this disease.
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PMID:Extrahepatic portal vein obstruction in adults detected by ultrasound with frequent lack of portal hypertension signs. 847 54

A 56-yr-old male who had been followed for alcoholic liver disease was admitted for abdominal pain and a high fever. Gastrointestinal endoscopy revealed bleeding esophageal varices that were treated by endoscopic sclerotherapy. Blood culture on admission was positive for Aeromonas sobria. Then skin bullas and ulcers and severe muscle degeneration developed. The patient died despite extensive treatment with antibiotics. A. sobria infection in patients with liver cirrhosis is rare.
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PMID:Aeromonas sobria infection with severe muscle degeneration in a patient with alcoholic liver cirrhosis. 867 33

The consequence of an acute mesenteric venous thrombosis following porta-azygos disconnection for the treatment of bleeding esophageal varices due to mansonian schistosomiasis has not been well defined in the literature. The clinical manifestations reported were fever, spasmodic abdominal pain associated with food intake. We treated three patients with thrombosis of the portal-mesenteric trunk following porta-azygos disconnection and adopted a conservative clinical approach in two patients while one had to have a surgical small bowel ressection.
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PMID:[Mesenteric venous thrombosis after azygos-portal disconnection with splenectomy for the treatment of bleeding esophageal varices in mansonian schistosomiasis. Three cases reports]. 900 35

A 33-year-old woman with a history of photosensitivity, persistent abdominal pain, and liver dysfunction was admitted to our department because of abdominal pain and progression of liver dysfunction. On admission, levels of protoporphyrin and coproporphyrin within erythrocytes were markedly increased. Autofluorescent erythrocytes were also detected, leading to a diagnosis of erythropoietic protoporphyria. A liver biopsy specimen revealed cirrhosis with dark brown granules filling hepatocytes, bile canaliculi, and bile ductules. Transfusion of washed erythrocytes, hemodialysis, and administration of cholestyramine and beta-carotene transiently improved levels of porphyrins and liver function. The patient died of rupture of esophageal varices followed by multiple organ failure. However, the treatments were believed to have extended survival.
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PMID:Erythropoietic protoporphyria with fatal liver failure. 1043 22

We reviewed the current techniques and published results of balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices (GV) and hepatic encephalopathy. The portal hemodynamics of gastric varices were classified into three types according to their feeding vessels, and the development of collateral veins under balloon occlusion of gastro-renal shunt was classified into five grades. The main draining veins of gastric varices were gastro-renal and gastro-inferior phrenic shunts. Preprocedural diagnosis of portal hemodynamics is important in selecting the technique for B-RTO. The rate of disappearance or marked reduction of GV was 98%, and the rate of recurrence of GV was 2%. Hepatic encephalopathy due to gastro-renal shunt improved markedly. In contrast, esophageal varices were aggravated at rates of 10% to 62.5% by the post-procedural elevation of portal pressure. Common adverse effects were hemoglobinuria, abdominal pain, and low-grade fever, but ascites and pleural effusion were also reported. Severe complications such as cardiogenic shock, atrial fibrillation, and pulmonary embolism were reported. We await technical improvements and further indications for this procedure.
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PMID:[Balloon-occluded retrograde transvenous obliteration (B-RTO) for portal hypertension]. 1092 Dec 94

Splenic arterial aneurysms (SAA) are rare and are usually atherosclerotic and/or related to pregnancy. Because pregnancy is the most important predisposing factor, the strong predilection of SAA for women is not surprising. The authors report a case of SAA rupture in a man with chronic pancreatitis as the predisposing factor. A 56-year-old man with abdominal pain and hematemesis was resuscitated and underwent endoscopy, but he died 18 hours later of massive hematemesis before definitive surgery could be carried out. At autopsy, there was chronic pancreatitis with fibrous adhesions tethering the tail of the pancreas, spleen, and posterior wall of the stomach together. The SAA was indented into the posterior wall of the stomach, into which it had ruptured from without. He also had alcoholic cirrhosis but no esophageal varices or conventional gastric ulcers. Other important predisposing factors such as abdominal trauma, infective endocarditis, polyarteritis nodosa, and segmental medial arteriopathy were absent. Histologic examination confirmed the rupture of the SAA. The SAA had Monckeberg medial calcinosis but little evidence of atherosclerosis. The well-documented complications of acute and chronic pancreatitis include shock, abscess, pseudocyst formation, and duodenal obstruction. This report describes the rare complication of SAA rupture, which may be fatal.
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PMID:Fatal splenic arterial aneurysmal rupture associated with chronic pancreatitis. 1219 58

Upper gastrointestinal endoscopy has changed the management of upper gastrointestinal problems in children. The aim of this communication is to share our experience with 153 cases on whom upper gastrointestinal endoscopy was done over a period of 24 months at a paediatric gastroenterology unit of a tertiary care hospital of Dhaka, Bangladesh. Children who attended the department with various gastrointestinal problems are the subjects of this paper. Intravenous midazolam and 10% pharyngeal xylocain were used in majority of cases for sedating the children. The ages of the children were between 15 months to 15 years (9.41+/- 3.22 years). The positive diagnostic yield was 92 out of 153 cases (60.1%). The major indication for doing endoscopy in the present series was recurrent abdominal pain (51.6%), followed by upper gastrointestinal bleeding (28.8%). Combining histopathological findings and CLO/rapid urease tests the overall positive yield of recurrent abdominal pain was 45 out of 79 (57%). The sources of upper gastrointestinal bleeding could be identified in 79.5% cases. Esophageal varices indicating portal hypertension were found in 62.5% children who were endoscoped for unexplained splenomegaly with or without ascitis. Endoscopy has become a safe and valuable procedure in the management of upper gastrointestinal problems in children and gastric antral biopsy has increased the positive diagnostic yield of recurrent abdominal pain in the studied children.
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PMID:Upper gastrointestinal endoscopy in children - an experience at a paediatric gastroenterology unit. 1289 47

Cavernous transformation of the portal vein occurs with long-standing portal vein thrombosis (PVT) because of the development and dilatation of multiple small vessels in and around the recanalising main portal vein. Thrombosis and occlusion of the portal vein leads to portal hypertension with enlarged spleen and the development of porto-systemic collaterals. The main clinical presentation is gastroesophageal variceal bleeding and hematologic abnormalities due to splenomegaly (hyperspleenismus-pancytopenia). We described the young patient with splenomegaly and extensive cavernous transformation of portal vein. The patient had thrombosis portal vein in early childhood and massive bleeding from large oesophageal varices at age 13. Full clinical evaluation is required because of abdominal pain. The liver is histologicaly and functionally normal. Diagnosis of cavernous transformation of the portal vein is confirmed by abdominal ultrasography, color Doppler ultrasonography and CT angiography. Oesophagogastroscopy reveals almost complete reduction of oesophageal varices, but confirms portal gastropathy as a source of patient's complaints. Natural course of PVT in this patient shows possibility of full reduction of oesophageal varices, but still the presence of different consequences of portal hypertension.
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PMID:[Cavernous transformation of portal vein]. 1587 81


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