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

Pouch ileitis is the most poorly understood complication of ileal reservoir surgery. Variability in definition of this syndrome may account for differences in incidence rate, associated symptoms, and response rate to therapy present in the literature. Outcomes of 19 episodes of pouch ileitis in patients having undergone prior colectomy and continent ileostomy construction for presumed ulcerative colitis were analyzed. An episode of pouch ileitis was characterized by: (1) abdominal pain, (2) increased ileal output, (3) mucosal inflammation within the continent ileostomy, and (4) absence of other recognized concurrent postoperative complications. The mean time of occurrence after construction of the continent ileostomy was 25 months (range 3-54 months). The mean length of follow-up of patients included in this analysis was 49 months from the time of continent ileostomy construction (range 22-101 months). Associated clinical symptoms included bloody effluent (53%), nausea or emesis (47%), and fever (42%). Endoscopic features were often nonspecific, with mucosal erythema (84%), edema (79%), friability (58%), and mucosal ulceration (53%) the most common. In those episodes of pouch ileitis where ileoscopy revealed no evidence of mucosal ulceration, complete resolution of the episode occurred 89% of the time, with 78% treated with antibiotics alone. In those episodes where mucosal ulceration was described on ileoscopy, 40% of episodes completely resolved after medical treatment, 20% with antibiotics alone. The varied clinical symptoms, endoscopic findings, and response to treatment raises the possibility that what has previously been described in the literature as pouch ileitis may be a heterogeneous group not of single etiology.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pouch ileitis. 279 1

Yersinia enterocolitica was isolated from the feces of 29 patients over a three-year period following the introduction of a selective culture medium. Y. enterocolitica was the third most common enteric pathogen after Campylobacter jejuni and Salmonella in this series of 3795 specimens from a predominantly adult population. The isolation rate of Y. enterocolitica was 0.9% and this represented 15.8% of positive cultures. The usual symptoms of Yersinia infection were diarrhea (93%) and abdominal pain (72%), often associated with tenderness in the right iliac fossa and fever. Fourteen patients required admission to hospital and four came to surgery for possible appendicitis. Acute terminal ileitis and mesenteric lymphadenitis were noted in each case. Two patients who were HLA-B27 positive had a reactive arthritis as their dominant complaint. In conclusion, Y. enterocolitica has emerged as a common cause of diarrhea in adults. It is an important cause of symptoms resembling those of acute appendicitis and is occasionally complicated by reactive arthritis.
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PMID:Clinical aspects of infection with Yersinia enterocolitica in adults. 330 48

A 76 year old woman presented with abdominal pain and weight loss. At laparotomy she was found to have an adenocarcinoma of the ileum arising in a segment of tuberculous ileitis. The possible significance of this association is discussed.
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PMID:Ileal carcinoma and tuberculous ileitis. 367 Dec 44

The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered.
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PMID:Abdominal pain in patients with acquired immune deficiency syndrome. 378 34

An analysis is presented of the course and outcome of the initial referred attack in a group of 332 patients with Crohn's disease treated at the General Infirmary at Leeds from 1939 to 1968 inclusive. A further 50 cases were excluded on the basis of insufficient diagnostic evidence: usually such patients had acute terminal ileitis. Only 5% of patients achieved full remission on conservative management, and most eventually came to surgery. The overall fatality rate was some 3.3% and this was affected chiefly by the severity of attack and the age of the patient. The severity of attack was classified as mild, moderate, or severe according to a system which took into account factors such as bowel habit, rectal bleeding, abdominal pain, pulse rate, temperature, haemoglobin, and weight. In attacks graded as ;mild', no deaths occurred; in those graded ;severe' the fatality rate was 8.8%. Similarly, whilst no patient under 20 years of age died, the fatality rate in the over 60s was some 14.8%. Further comparison between the present group of 332 patients and an earlier series of 204 patients suffering from ulcerative colitis (Watts, de Dombal, Watkinson, and Goligher, 1966a) shows considerable differences in the course and prognosis of the two diseases. In particular 70% of patients with ulcerative colitis achieved remission on conservative management alone whereas only 5% of Crohn's disease patients did so. These differences, and in particular the poor response to conservative therapy, are discussed, together with their implications for management.
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PMID:Short-term course and prognosis of Crohn's disease. 485 77

Complications after ineffective medical management are indications for surgical treatment in Crohn's disease and ulcerative colitis. Immediate intervention is necessary in perforation, bleeding and intestinal obstruction, but abscess, fistulation, chronic bowel obstruction and an inflammatory tumor need also surgery without longer delay. Acute ileitis terminalis imitating acute appendicitis is an exceptional case of Crohn's disease. Local recurrence, severe abdominal pain, diarrhoea, retardation of growth and development, and risk of malignant change may be reasons for elective surgery. As development of recurrence after operation is frequent and the results of colectomy and proctocolectomy with ileostomy are not always satisfactory some caution to surgery in ulcerative colitis and Crohn's disease in childhood is advisable.
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PMID:[Surgical indications in Crohn's disease and ulcerative colitis in childhood]. 660 Dec 4

By estimation of antibody titres or possibly isolation of the micro-organism, the role of the Yersinia enterocolitica as an etiological agent in mesenterial lymphadenitis, ileal inflammation, or abdominal colics was evaluated in 94 consecutive patients (25 operated upon and 69 treated conservatively) during a 1-year period from 1975-76. Eighty four patients (24 operated upon and 60 treated conservatively) were re-examined 5 years later. Among the 25 patients operated upon, three presented acute terminal ileitis, two of them in association with acute Y. enterocolitica infection. A substantial part of the 22 patients with other peroperative findings also presented trace or positive Y. enterocolitica antibody titres. Some of these patients experienced complaints attributable to the Y. enterocolitica infection over the following years. At re-examination, previously elevated Y. enterocolitica antibody titres had generally normalized, and in the two patients who in 1975 presented acute terminal ileitis associated with acute Y. enterocolitica infection, radiological examination now demonstrated normal terminal ileum. Among 69 patients treated conservatively for abdominal colics, 36 in 1975 presented trace or positive titres. During the 5-year follow-up period, abdominal pain and joint complaints were significantly more commonly experienced by patients with trace or positive titres than by patients with negative titres (p = 0.007 and p = 0.004, respectively). The Y. enterocolitica is an important cause of abdominal disease in our region, and the infection commonly gives symptoms of long duration.
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PMID:The Yersinia enterocolitica infection in acute abdominal surgery. A clinical study with a 5-year follow-up period. 663 78

Yersinia enterocolitica biotype 1, serotype O:21 was isolated from feces or rectal washings of three members of one family in northwestern Saskatchewan. The three isolates gave positive pathogenicity tests in guinea pigs with cultures grown at 22 degrees C as inoculum. All three cases showed clinical symptoms consistent with yersiniosis. All three cases had symptoms of diarrhea and abdominal pain, and two cases had recorded fever. In two cases, appendicitis was initially suspect. One case with ileitis and peritonitis was fatal. The environmental source of the infection was not found, but river water, milk, and person-to-person spread are discussed as possible sources of the infections. The need for microbiology laboratories to culture stool specimens specifically for Y. enterocolitica, using cold-enrichment techniques is emphasized. This family outbreak of yersiniosis provides further evidence that certain biotype 1 strains of Y. enterocolitica are pathogenic.
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PMID:Family outbreak of yersiniosis. 715 10

In the first year after establishing a gastroenterological center in a vineyard and industrial district with 220.000 inhabitants we examined 1.171 patients. In 36.53% we had diseases in the lower gastrointestinal tract excluding proctological disturbances. We could find out 37 cases of colitis ulcerosa and 42 colorectal cancers. Excluding two cancers in colon transversum and ascendens all the tumors were found by coloscopy. Previously 4 cases of colitis ulcerosa were identified by other methods, clinically or by rectoscopy. In 48.6% of the colitis ulcerosa the transfer was done by reason of blood in the feces. The melaena lingers between 1 month and 10 years. Other presumed diagnoses for transfer to our Institute were gastroenteritis, proctitis, hemorrhoids, fissure or ileitis terminalis Crohn. In some rare cases the supposed diagnosis was salmonellosis or mycosis of the intestinum. In colorectal cancers the main reason for special gastroenterological investigation was the addition of blood to stool, whether microscopically or visible. Abdominal pain or ileus were following in frequency. Clinical symptoms were to be reconstructed in 30.9% for six weeks, in 59% for six months and in 9.5% up to one year. Most of the colorectal tumors (85.7%) were localized distal from splenic colonflexur, mostly in the rectosigmoid and colon descendens (see figure 1). Ambulant coloscopy is a method for quickly and definitive clarification, if the practitioner will refer swiftly.
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PMID:[Ambulant coloscopy in colitis ulcerosa and colorectal cancer]. 727 61

A 41-years-old man with ileitis terminalis was presented. He was operated on for chronic abdominal pain, and the histological investigation revealed the Crohn's disease. From among the extraintestinal complications the rare muscle involvement joined the inflammatory bowel disease. The leading symptoms were the progressive muscle pain and tenderness presented early before the verification of intestinal problems. His complaints referred mainly to the calf muscles. The electromyography (EMG) was normal, the serum creatinine-kinase (CK) activity has not increased. The most characteristic histological findings were the slight mononuclear cell infiltrations with large histiocytic cells in the perimysial connective tissue. Occasionally the infiltrations were more prominent resembling granuloma formations. The oxidative enzyme reactions and the electron micrographs showed mild mitochondrial changes. Neither non-steroid antiinflammatory nor steroid medication subsided the complaints.
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PMID:[Muscle involvement in Crohn disease]. 801 22


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