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

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed because of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.
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PMID:Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report. 173 66

The diagnosis of malrotation is easily made in the neonatal period, but is often delayed in older patients. Among 82 patients treated for malrotation in this institution, 45 patients presented with symptoms related to their malrotation, seven were diagnosed at exploration for concomitant intrinsic duodenal obstruction, and 30 patients had malrotations discovered as incidental findings at laparotomy or autopsy. Among the 45 symptomatic patients, 25 (56%) underwent surgery in the first month of life, whereas 20 patients (44%) underwent surgery at an older age. In this last group, the mean age at surgery was 51.5 months (range, 2 months to 16 years), the mean age of onset of symptoms was 2 years (range, 0 to 15 years) and the mean delay in diagnosis was 1.7 years. Although bilious vomiting was the presenting symptom among all patients undergoing surgery in the neonatal period, clinical features of older patients included intestinal obstruction (7), chronic abdominal pain (4), malabsorption/diarrhea (3), peritonitis/septic shock (2), solid food intolerance (1), common bile duct obstruction (1), abdominal distention (1), and delayed transit postappendectomy (1). The frequency of midgut volvulus was equal among both groups. Unusual forms of malrotation were more frequent in patients undergoing surgery beyond the neonatal period. In this group there was evidence of chronic venous and lymphatic obstruction with one case of superior mesenteric vein thrombosis and two cases of intestinal gangrene. A Ladd's procedure was performed in all cases and the most frequent postoperative complication was adhesive intestinal obstruction. There were no deaths. Awareness of the unusual presentation in patients who present beyond the neonatal period may help reduce delays in diagnosis and surgical treatment. We believe that laparotomy is indicated in all patients with malrotation, even if they are asymptomatic.
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PMID:Malrotation presenting beyond the neonatal period. 227 27

Coincident with medical antitumor treatment of 138 patients suffering from mid-gut carcinoid tumors, 51 patients were subjected to surgery with the principal aims of removing primary tumors and debulking mesenteric or liver metastases. Sixteen patients had previously been operated with intestinal resection or, when the tumors had been considered inexcisable, with intestinal bypass or laparotomy alone. Apart from exhibiting symptoms related to the carcinoid syndrome, the majority (approximately 60%) of the 51 patients had generally intermittent, subileus-like abdominal pain and weight loss. In 18 patients, these symptoms were pronounced and associated with intestinal obstruction or severe malnutrition. Computed tomography and arteriography efficiently demonstrated mesenteric and liver metastases. At laparotomy, the primary intestinal tumors were small, mainly less than 1 cm in diameter, and they were multiple in 39% of the patients. Mesenteric metastases measuring up to 12 cm in diameter were present in 86% of the patients. These metastases were frequently associated with a pronounced mesenteric and retroperitoneal fibrosis causing fixation, angulation, and obstruction of the bowel as well as incipient intestinal gangrene in 8 patients. In all but 6 patients, the primary tumors could be removed by comparatively limited intestinal resections although bulky mesenteric metastases were often dissected from the mesenteric vessels. Liver metastases, found in 49% of the patients, were generally bilateral and multiple, and major hepatic metastases were resected in 6 patients. The results support a role for surgery also in the more compromised patients with mid-gut carcinoid tumors and that such intervention may be associated with considerable symptomatic relief and substantial periods of survival.
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PMID:Surgical treatment of mid-gut carcinoid tumors. 236 41

The clinical features and operative findings in 37 infants and 29 older children with intussusception seen over a 10-year period were compared and contrasted. While most of the children presented acutely, 28% of older children had chronic intussusception compared with 5% in infants. Only about a third of all children had the four classical features of abdominal pain, vomiting, abdominal mass and bloody stool; the rest had two or three of the above features. Pain and palpable abdominal mass were more common features in older children while abdominal distension, constipation and diarrhoea were more prominent in infants. Fifty-four per cent of intussusceptions in infants were entero-colic while in older children 69% were colonic. All the intussusceptions in infants were idiopathic while in 14% of older children there were predisposing causes. Resection for gangrene/perforation was required in 30% of infants compared with 7% of older children.
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PMID:Intussusception in infants and older children: a comparison. 244 47

Twenty patients with primary hepatic carcinoma (PHC) treated by hepatic arterial embolization in our department from Dec. 1986 to Mar. 1987 are reported. There were 15 males and 5 females. The ages ranged from 34 to 75 years with an average of 50.7. Preoperative diagnosis and localization of the tumor were done by AFP, B-us, CT and angiography (right lobe 15 cases, left lobe 1 case, both lobes 4 cases). Celiac and superior mesenteric angiography was carried out by femoral artery approach and then highly selective hepatic catheterization was utilized for hepatic arterial embolization. Antitumor agent (5-Fu, adriamycin), iophendylate and foamy gel sponge were used for peripheral and proximal embolization. Manifestations were improved in most of the patients after embolization, such as relief of abdominal pain, improvement of appetite, decrease of tumor size. Total necrosis of the tumor was found in 2 patients who underwent surgery 1 month after embolization. The side effects of the posthepatic embolization such as, nausea, vomiting, abdominal pain and fever could be relieved by symptomatic treatment. No severe complications, such as gangrene of the gall bladder, hepatic failure, liver abscess, intestinal necrosis or pulmonary embolization were found except 3 patients who died of renal failure after the procedure. The liver dys-function returned to normal within 2 weeks. Hepatic arterial embolization provides an alternative treatment for the patients with PHC who has compensated liver function without severe systemic diseases, especially renal endocrine problems and severe portal hypertension. They should have patent portal system as proved by angiography. The authors considered that this therapeutic embolization with hepatic chemotherapy infusion is safe and effective in the management of PHC. It may increase the resectability and provide palliative means for the advanced and terminal cases.
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PMID:[Hepatic artery embolization for primary hepatic carcinoma]. 255 66

Gangrene of the stomach is a rare, often fatal disease which may be due to vascular, chemical, mechanical, or infectious etiologies. The infectious type, acute necrotizing gastritis, is thought to be a variant of phlegmonous gastritis, which has been associated with recent large intake of alcohol, "gastritis," and upper respiratory tract infections. Our patient, who had a history of peptic ulcer disease and gastric outlet obstruction, presented with abdominal pain, hypotension, and pneumomediastinum.
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PMID:Acute necrotizing gastritis in a patient with peptic ulcer disease. 259 58

We report 2 patients with myonecrosis due to Clostridium septicum and associated colon carcinoma and have reviewed the English language literature for all reported cases of atraumatic C. septicum infection. A total of 162 cases of C. septicum infection have been reported. Eighty-one percent of these patients had an associated malignancy. Thirty-four percent of all patients had associated colon carcinoma, while 40% had a hematologic malignancy. Thirty-seven percent of reported patients had an occult malignancy at the time of their infection with C. septicum. In many patients, the portal of entry was found in the large intestine. In a particularly lethal form (79% mortality) of C. septicum infection, known as "distant myonecrosis," infection metastatic from the initial site of infection causes severe myonecrosis, gangrene, and often death within hours of clinical detection. Overall, survival of patients with C. septicum infection is only 35%. Review of all cases of C. septicum infection suggests several conclusions. 1) Patients with malignancy, particularly colonic or hematologic, and patients with cyclic neutropenia who develop signs and symptoms of sepsis, especially with associated findings of abdominal pain or pain in an extremity, should be treated for possible clostridial infection. 2) C. septicum infection does not appear to be a result of a single specific defect in either humoral or cell-mediated immunity. Rather, it may occur in patients who are granulocytopenic and therefore prone to an enterocolitis. 3) Patients in whom an infection with C. septicum is found must undergo a vigorous search for malignancy following acute therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature. 264 85

Because of the devastating consequences of midgut volvulus as a result of malrotation, we reviewed the charts of 70 consecutive children to define the spectrum of presentation. Although 27 patients (39%) had presenting symptoms within the first ten days of life, 35 (50%) were older than 2 months of age. In general, the older children had a longer course of vague, antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain. Associated congenital anomalies were common, with 32 patients (46%) presenting with 56 anomalies, the most prevalent of which were intestinal atresia, imperforate anus, duodenal web, and cardiac and orthopedic anomalies. Upper gastrointestinal (GI) series revealed the diagnosis in 29 cases (41%), as did contrast enema in 24 (34%). It is important to note that volvulus, intestinal gangrene, and mortality occurred regardless of age or chronicity of symptoms. Fifteen patients (21%) were discovered serendipitously while being evaluated and treated for seemingly unrelated conditions. No morbidity of mortality occurred in those patients who underwent subsequent semielective Ladd's procedure. The majority of morbidity and all seven mortalities occurred in patients with volvulus and intestinal necrosis. This study emphasizes the need for consideration of Ladd's procedure for children of all ages. In addition, due to the broad range of initial symptoms, a high index of suspicion is required in evaluating children with possible malrotation. Because it remains impossible to predict which patients will have catastrophic complications (based on age or type of presentation), we urge that even incidentally discovered patients with intestinal malrotation undergo Ladd's procedure.
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PMID:Malrotation of the intestines in children: the effect of age on presentation and therapy. 276 45

Comparing 105 patients with mesenteric infarction, the typical attributes of the underlying diseases, arterial embolization (aE) (n = 26), arterial thrombosis (aT) (n = 40), venous thrombosis (vT) (n = 32) and combined arterio-venous occlusion (n = 7) could be demonstrated. Present heart disease, diabetes and arterial hypertonia, rapid onset of symptoms, severe abdominal pain and signs of peritonitis, extended gangrene of bowel and a high mortality of about 90% is the typical combination for aE. Over 70 years old patients with higher incidence of arteriosclerosis, more digitalis intake, longer duration of symptoms and with bowel problems in the past have a higher incidence of aT and a slightly better prognosis. Risk of thrombosis, long-standing symptoms and a clearly better prognosis are typical for the vT.
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PMID:[Are there differences in prodromal illnesses, symptoms and prognosis for various forms of mesenteric infarct?]. 343 2

The objective of this study was to identify those patients in whom mesenteric venous thrombosis (MVT) is likely to develop and to review the pathophysiology, clinical presentation, diagnostic modalities, and patient outcome. We present a review of the literature from 1911 to 1984 with respect to 372 patients with MVT, including five of our own patients. Data on 99 of these patients were obtained from autopsy reports and were not included in the study. This disease is common in the sixth and seventh decades of life, with 81% of these older patients having associated illnesses. MVT involves segments of the small bowel, but rarely of the colon, with hemorrhagic infarcts rather than gangrene. This disease does not conform to a pattern, although a prodromal period of days or weeks of abdominal pain (which is usually out of proportion to physical findings), marked leukocytosis, and dehydration are all highly suggestive of MVT. Serosanguineous fluid obtained by means of peritoneal tap is a useful diagnostic tool. A high index of suspicion, early diagnosis, and prompt surgical intervention with the addition of anticoagulants seems to improve survival and reduce recurrence.
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PMID:Mesenteric venous thrombosis--1911 to 1984. 356 82


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