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

The records of 300 patients with a diagnosis of small bowel obstruction were evaluated to determine which factors, if any, were prognostic of clinical outcome. Ninety per cent of patients had at least one prior abdominal procedure; those of a gynecologic or obstetric nature were most common. Abdominal pain (92%), vomiting (82%), abdominal tenderness (64%), and distention (59%) were the most frequent symptoms and signs, and plain abdominal x-rays were abnormal in 273 (91%) patients. Two hundred and nine patients (70%) underwent surgical repair, of which 48 (23%) required resection of intestine for densely adherent or strangulated bowel. Contrast studies were generally not helpful and associated with barium peritonitis in two patients. The mortality rate for the entire series was 9 per cent, which doubled for those who underwent resection. Septic complications occurred in 31 per cent of the survivors in this group. Fourteen of the 16 patients who died from abdominal sepsis had a delay in presentation and/or treatment, which was the most important prognosis factor for patient outcome.
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PMID:The importance of early diagnosis of small bowel obstruction. 341

Pathology and prognosis of 378 cases of IML collected from 28 colleges or hospitals, are reported. The ratio of male and female was 2:1. Ages ranged from 3 to 86 years with a peak age of 21-50. Main symptoms were abdominal pain, mass, intestinal obstruction, diarrhea and intestinal bleeding. The tumor occurred, in order of incidence, in small intestine (42%), ileocecal region (30%), colon (13%), cecum (8%), rectum (3%), duodenum (2%) and anorectum (1%). Multifoci were found in 43 cases (11%). Grossly, the tumor was divided into three types: exophytic, ulcerative and diffuse infiltrative. In histology, follicular type comprised 4% (16 cases) and diffuse type, 96% (362 cases). In the latter, the majority was cleaved, non-cleaved or mixed cell type originating from the follicular center cells. There were a few T cell lymphomas and true histiocytic types but no Hodgkin's lymphoma. Statistically, the prognosis was significantly related to the depth of invasion, gross type, tumor size and stage. By histology, lympho-plasmacytoid type and small lymphocytic type had better prognosis compared with the other diffuse types. In this series, 83 patients were treated by surgery (including operation plus chemotherapy). The survival rate of less than 1 year was 51%, nearly equal to the survival rate of more than 1 year (49%). 10 patients have survived more than 5 years and 6, more than 10 years, 2 of them, more than 18 years. It indicates that the operation plays an important role for prolonging survival. Early detection, early diagnosis and early operation are necessary.
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PMID:[Pathology and prognosis of 378 cases of primary intestinal malignant lymphoma (IML)]. 341

Eight cases of abdominal tuberculosis from the Department of Medicine, Singapore General Hospital are reported to illustrate the varied clinical manifestations of the disease. Presentation ranged from asymptomatic hepatomegaly to acute abdomen (intestinal obstruction/perforation). Chronic non-specific symptomatology (fever, weight loss, abdominal pain, diarrhoea, jaundice) was commonest. There were three patients with hepatic tuberculosis, two with tuberculous mesenteric lymphadenitis and three with intestinal tuberculosis, two of whom had concomitant tuberculous peritonitis. Only three patients had coexisting pulmonary tuberculosis. The diagnosis was unsuspected at presentation in four patients. Initial provisional diagnoses included typhoid, abdominal lymphoma, hepatic malignancy, chronic hepatitis and iatrogenic gut perforation. All patients responded totally to conventional antituberculous therapy.
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PMID:The varied manifestations of abdominal tuberculosis. 343 16

A series of 50 patients with malignant lymphoma, proven by biopsy, was retrospectively studied. 39 were non-Hodgkin's lymphoma and 11 Hodgkin's disease. 45 (90%) had been misdiagnosed because of lack of initial specific symptoms. It is suggested that for patients with a painless progressively enlarging superficial lymph node without adhering to its surrounding tissues and irresponsive to general management, having irregular fever, bloody stool, abdominal pain or mass, complication of partial intestinal obstruction, sharp vigilance be kept for the possibility of malignant lymphoma.
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PMID:[Misdiagnosis of malignant lymphoma--report of 45 patients]. 345 41

Of 217 children with vitelline duct anomalies, 85 (40%) had symptomatic lesions (mean age, 2.4 years). Forty-eight patients presented with rectal bleeding; 28, with intestinal obstruction; five, with abdominal pain; and four, with bilious umbilical drainage. An asymptomatic Meckel's diverticulum was discovered incidentally at laparotomy in 132 children. Surgical therapy included bowel resection in nine patients with volvulus, four with intussusception, seven with bleeding, three with vitelline cysts, and one with a perforation. Diverticulectomy was performed in 189 cases, and excision of a patent vitelline duct was accomplished in four neonates with umbilical drainage. Ectopic gastric mucosa was present in all 48 patients with bleeding and in four of five with inflammation but in only two asymptomatic specimens. More than one third of the cases were symptomatic and presented in younger patients. This suggests that elective resection of asymptomatic vitelline remnants in early childhood is reasonable at the time of laparotomy for other conditions.
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PMID:Vitelline duct anomalies. Experience with 217 childhood cases. 349 50

The records of 128 patients operated on for adhesive complete mechanical obstruction of the small intestine were retrospectively reviewed. The gut proved to be strangulated in 53 cases, irreversibly in 16 and reversibly in 37, while 75 patients had simple obstruction (12, 29 and 59%). Continuous abdominal pain was more common in strangulation than in simple obstruction and leukocytosis was most common in irreversible strangulation (both differences significant). But no preoperative clinical parameter was specific for strangulation obstruction. Preoperative hospital stay greater than 25 hours was significantly more common in irreversible strangulation obstruction than in the other groups. Strangulation was preoperatively recognized in only 25% of the cases. The overall mortality rate was 5.5%, but with no statistical intergroup difference, possibly because so few patients died. The study showed that strangulation usually is unrecognized preoperatively, and that early operation is essential for obstruction due to intestinal strangulation. Early surgery is therefore indicated in most cases clinically diagnosed as intestinal obstruction.
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PMID:Intestinal obstruction with strangulation of the small bowel. 363 May 29

A retrospective study was carried out on 321 cases of adhesive small bowel obstruction in 289 patients admitted at the Chulalongkorn Hospital over an 8 year period. Appendectomy was the most common operation preceding the obstruction. Early operation was performed in 54 cases with two deaths, and nonviable and borderline bowel was found in 30.2 percent. Continuous abdominal pain, generalized tenderness, guarding, and distension appeared to influence the attending surgeons' decisions to operate early. A trial of conservative treatment with nasogastric decompression was carried out in 267 cases with one death. Conservative treatment was successful in 126 cases, but in 140 cases, there was no improvement or the condition became worse and a delayed operation was required. There was no mortality in the delayed operation group and nonviable and borderline bowel was found in 22.8 percent of cases. The incidence of nonviable and borderline bowel did not increase with the length of delay, but was more frequent in those whose condition grew worse after conservative treatment. No preoperative factors that could reliably predict bowel strangulation were found. However, the results in this series justify a trial of conservative treatment with close observation in patients without clinical evidence of strangulation or marked abdominal distension.
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PMID:Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital. 363 5

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.
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PMID:Intussusception: current management in infants and children. 366 Feb 43

Sixty-eight horses with colic caused by small intestinal disease were allotted into 2 groups of 34 on the basis of recorded findings during exploratory celiotomy, necropsy, or response to medical treatment alone. Signalment, history, physical examination findings, and laboratory findings were compared between the group of horses with small intestinal obstruction and the group with duodenitis/proximal jejunitis. A significantly greater proportion of horses with duodenitis/proximal jejunitis were older than 2 years old (P less than 0.05). Differences in sex or breed distribution, or in seasonality of the 2 disease syndromes were not observed. Horses with duodenitis/proximal jejunitis had significantly greater signs of depression than those with small intestinal obstruction (P less than 0.01), and horses with small intestinal obstruction had significantly greater signs of abdominal pain (P less than 0.05). The mean heart and respiratory rates were significantly lower (P less than 0.01) and the volume of nasogastric reflux was significantly greater (P less than 0.05) in the group of horses with duodenitis/proximal jejunitis. Sections of small intestine that were palpable per rectum were less distended and there were more auscultable borborygmi in horses with duodenitis/proximal jejunitis, compared with those with small intestinal obstruction (P less than 0.05 and P less than 0.01). The group of horses with duodenitis/proximal jejunitis had lower mean plasma potassium and higher mean plasma bicarbonate concentrations (P less than 0.05) than the group with small intestinal obstruction. The mean nucleated cell count and total protein concentration of peritoneal fluid specimens were significantly less in the group with duodenitis/proximal jejunitis (P less than 0.01); however, these values were greater than normal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of duodenitis/proximal jejunitis and small intestinal obstruction in horses: 68 cases (1977-1985). 367 78

A 22-year-old man with an incarcerated left paraduodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.
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PMID:Left paraduodenal hernia with acute abdominal symptoms. A case report. 373 64


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