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

Patients treated with ventriculoperitoneal (VP) shunt procedures for hydrocephalus may have abdominal pain related to complications stemming from the shunt tubing itself or to other intra-abdominal disease. In patients with VP shunts, usually children, lack of absorption of cerebrospinal fluid (CSF) may produce a painful abdominal CSF pseudocyst. We have reported the rare occurrence of a CSF pseudocyst in an adult. The patient was also found to have cholelithiasis.
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PMID:Abdominal pain resulting from cerebrospinal fluid pseudocyst and cholelithiasis. 150 30

An intra-abdominal cyst is a rare complication of ventriculoperitoneal (VP) shunt. A 19-year-old male was admitted complaining of abdominal pain and distension, dysuria, constipation, headache, and fever. He had undergone a VP shunt for obstructive hydrocephalus caused by a cerebellar astrocytoma 16 years earlier, and had received shunt revision twice, 5 years and 3 months earlier, respectively. Examination on admission revealed neck stiffness, early papilledema, a mass in the lower abdomen, and abdominal muscular guarding with rebound tenderness. Laboratory studies showed leukocytosis of the peripheral blood and pleocytosis of the cerebrospinal fluid (CSF). Abdominal ultrasonograms and computed tomographic scans demonstrated a cystic lesion. Under the diagnosis of meningitis and local peritonitis with an intra-abdominal cyst, we sistemically administered antibiotics and externalized the shunt. However, since the cyst fluid could not be aspirated through the abdominal catheter, it was exchanged with a flexible catheter under fluoroscopic control, according to Seldinger's method. A total of 400 ml of cyst fluid was drained. Staphylococcus epidermidis was detected in both the cyst fluid and the CSF. After meningitis subsided, repositioning of the abdominal catheter into the other side of the abdomen was performed but resulted in shunt malfunction and meningitis due to the same organisms. After meningitis again subsided, the VP shunt was converted to a ventriculoatrial shunt. The clinical course was uneventful thereafter.
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PMID:Intra-abdominal cyst following revision of ventriculoperitoneal shunt--case report. 170 49

Reported cases of pregnancy occurring in association with an extracranial shunt for hydrocephalus are very few. This report documents two uncomplicated pregnancies in a patient with ventriculoperitoneal shunt. Abdominal pain was the most frequent symptom in our patient.
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PMID:Pregnancy and ventriculoperitioneal shunt. Report of a case and literature review. 324 43

Angiosarcoma is a rare malignant tumor originating from vascular endothelial cells. We have experienced a case of 17-year-old man, who had angiosarcoma in the pineal region and the liver. Patient's initial symptom was headache and CT scan revealed a high density mass in the pineal region with obstructive hydrocephalus. After the radiation therapy, the tumor was disappeared completely on CT scan. One year later, he developed abdominal pain, and CT scan and angiogram revealed multiple angioma like lesions in the liver. The mass in the pineal region showed concomitant regrowth, and finally, the patient was died of abdominal hemorrhage. At autopsy, pineal tumor and hepatic tumor were both angiosarcomas, although it was uncertain which was the original tumor.
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PMID:[Angiosarcoma of the liver and pineal region]. 338 82

Liver abscess is a rare complication following the ventriculoperitoneal (V-P) shunt operation. There has been only one case reported in the literature. We present a case of liver abscess developed about 3 months after V-P shunt operation. A 31-year-old female was admitted to our hospital in comatose condition due to second bleeding from an aneurysm of the right internal carotid artery on January 1, 1984. Obliteration of the aneurysm was performed on the following day. She received V-P shunt operation for the marked hydrocephalus on February 4, but she developed low spinal fluid pressure syndrome. She was able to walk by herself after the replacement of shunt valve on March 4. In the middle of April, she suffered from abdominal pain with a pyrexia for about 5 days. On May 13, a new peritoneal tube was placed in another part of the peritoneal cavity because of the recurrence of hydrocephalus. On the following day, she developed severe abdominal and back pains with a high fever. Abdominal CT scans and ultrasonogram were performed on May 22, showing a well-defined, cystic mass lesion in the liver and the peritoneal tube lying just beneath the mass lesion. Approximately 100 ml of white creamy pus was aspirated from the cystic mass by ultrasound-guided percutaneous puncture, and a 8.3 French pigtail nephrostomy catheter was left in place for 9 days until purulent drainage stopped. Microbiologic examination demonstrated staphylococcus epidermidis in the cerebrospinal fluid (CSF) from the shunt tube but was negative in the abscess fluid. The ventricular fluid was drained externally with the V-P shunt tube for a while, but the new ventricular drainage was instituted because of continuous positive cultures in the CSF from the shunt tube. Thereafter, the cultures of the CSF became negative and ventriculoatrial (V-A) shunt operation was performed on July 2. Postoperative course was uneventful. It is considered that the formation of the liver abscess seems to be caused by the focal injury to the liver surface by the insidiously infected peritoneal tube with St. epidermidis, and by the decrease in systemic resistance to infection. Percutaneous aspiration and drainage under the guidance of abdominal computed tomography or ultrasonography are very useful and efficient for the diagnosis and the treatment of liver abscess. When patients show signs of infection to the V-P shunt, we should remove the shunting system and place a new external ventricular drainage, and institute a V-A shunt after confirming negative cultures of the CSF.
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PMID:[Liver abscess secondary to ventriculoperitoneal shunt]. 362 72

Shunting of cerebrospinal fluid to the peritoneal cavity has brightened the outlook for children with hydrocephalus. Nine hundred sixty-nine primary ventriculoperitoneal shunts were inserted for hydrocephalus between 1970 and 1981. During this same period, 2205 shunt revisions were performed in 847 children, some of whose primary shunt had been inserted prior to 1970 or at other institutions. Nineteen patients with a ventriculoperitoneal shunt infection persented with abdominal pain, fever, and abdominal tenderness; each had acute peritonitis. Three underwent laparotomy with the preoperative diagnosis of appendicitis; however, only infected peritoneal fluid and nonobstructing adhesions were found. A fourth child underwent an unnecessary intestinal resection at another hospital and required prolonged nutritional support and treatment of severe postoperative complications. Fifteen children who presented with an "acute surgical abdomen" were managed with intravenous fluids, gastric decompression, antibiotics, and removal of the intraperitoneal shunt. External ventricular drainage was employed until the cerebrospinal fluid was sterile. The shunt was then internalized in the peritoneal cavity. The abdominal signs and symptoms improved after removing the peritoneal tubing in all children. This plan of therapy has eliminated unnecessary laparotomy in those who may require repeated procedures for control of hydrocephalus.
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PMID:Ventriculoperitoneal shunt infection masquerading as an acute surgical abdomen. 666 27

The authors have reviewed the clinical manifestations and therapy of hydrocephalus shunt infections in 32 patients with a total of 35 shunt infections. These 35 infections accounted for 43 hospital admissions. First infections usually developed within 2 months following surgery. At the time of diagnosis, 89% of patients were febrile. Fever and cough as a symptom complex characterized the initial clinical presentation in six of 19 episodes of infection complicating ventriculoatrial (VA) shunts, as compared with none of 21 episodes in which infection complicated ventriculoperitoneal (VP) shunts. Seven of 21 infectious episodes occurring in patients with VP shunts in situ were associated with significant abdominal pain and tenderness. These patients usually had no other clinical features to suggest shunt infection. Both of these symptom complexes often led to delays in diagnosis and treatment. Causative organisms included Staphylococcus epidermidis in 21, Staphylococcus aureus in seven, Gram-negative aerobic bacilli in seven, diphtheroids in five, Streptococcus species in four, and anaerobes in three. Five infections were polymicrobial in nature. Positive blood cultures were seen in 13 of 17 infectious episodes complicating VA shunts, as compared with only three of 13 other infections. When the shunt was completely removed, with or without replacement, all 13 patients were cured. When intravenous antibiotics were administered in conjunction with incomplete shunt removal, only eight of 15 courses resulted in cure. Intraventricular antibiotics were administered in four patients and all were cured. Therapy of shunt infections with parenteral antibiotics and incomplete shunt removal is associated with an unacceptably high failure rate.
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PMID:Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients. 688 52

Medical personnel who evaluate children for child abuse and neglect (CAN) must be familiar with the many pediatric conditions that resemble CAN in order to avoid over reporting. During a 3-year period, a total of 504 suspected child abuse patients were evaluated by our CAN team. After preliminary evaluation, 264 (52%) of these cases were unsubstantiated. Eighteen of these 264 (7%) were initially considered as cases of CAN but were later proven to be conditions that were misdiagnosed as CAN. Thirteen of the 18 (72%) were readily diagnosed after consultation with a pediatrician or other health care consultant. Investigation of the remaining 5 patients (29%) was more difficult and more extensive, requiring a period of separation from the parents with consequent emotional hardship to the family. These conditions included (1) a patient with osteogenesis imperfecta type IV, (2) a patient with Ehlers-Danlos syndrome, (3) two patients with benign external hydrocephaly of infancy, and (4) a patient with Crohn's disease, who was evaluated for sexual abuse because of chronic abdominal pain. A comprehensive literature review of pediatric conditions that may mimic CAN is presented by diagnostic categories to assist clinicians in differentiating medical conditions that may simulate CAN. Methods to support parents who have been incorrectly reported are discussed.
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PMID:The mistaken diagnosis of child abuse: a three-year USAF Medical Center analysis and literature review. 774 27

The abdominal intraperitoneal cerebrospinal fluid pseudocyst is an infrequent but important complication in patients with ventriculoperitoneal shunts. Since 1954, 115 cases of paediatric pseudocysts have been reported in the literature. One additional report deals with an adult patient. We report on 14 cases of sonographically diagnosed abdominal pseudocysts. Their aetiology, diagnosis, clinical signs and symptoms and surgical management are investigated. In our hydrocephalus series we have an incidence of pseudocyst formation of 4.5%. The most common presentation of the paediatric patients is with symptoms of elevated intracranial pressure and abdominal pain, whereas the adults have predominantly local abdominal signs. Diagnosis is readily made with ultrasonography. Predisposing factors for pseudocyst formation are multiple shunt revisions and infection. Microscopically, the pseudocysts consist of fibrous tissue without epithelial lining. The treatment involves surgical removal of the catheter with or without excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant or an intra-atrial shunt. Recurrences are rare, especially under appropriate medical treatment of infection. In our series, microbiologically proven infection was present in 30% of the cases.
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PMID:Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature. 794 87

The tethered cord is the fixation of the cord resulting in stretching as growth occurs. In this paper, three cases of tethered cord with symptoms related to the urinary tract were presented. In the first case, a 12-year-old girl presenting with abdominal pain and urinary incontinence had bilateral hydronephrosis and neurogenic bladder due to a tethered cord without having any other neuropathological manifestation. In the second case, an eight-year-old girl presented with enuresis and a mass in her back was found to have a lipomyomeningocele, hyperactive tendon reflexes in the lower limbs and pes cavus. Tethered cord associated with lipomyomeningocele caused a neurogenic bladder and bilateral hydronephrosis. In the third case, a seven-month-old girl presented with hydrocephalus as well as bilateral dilation of the renal pelvis, unilateral ureteral duplication and vesicoureteral reflux. A tethered cord was revealed in this patient, who had a meningomyelocele operation in the neonatal period. Renal function test in the first two cases were abnormal.
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PMID:The urological manifestations of the tethered spinal cord. 816 Feb 84


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