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

An unusual case of colitis in a 37-year-old cocaine addict is described. The patient presented with right-sided abdominal pain and diarrhea exacerbated by his use of cocaine. Significant antibiotic ingestion was denied. At laparotomy, an edematous cecum and ascending colon were found, the cut surface of which revealed diffuse superficial ulcerations and yellowish fibrinous material. Microscopic examination demonstrated findings consistent with pseudomembranous colitis with an ischemic component. A mechanism involving catecholamine-induced mucosal ischemia is postulated to explain the findings seen in this patient.
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PMID:Cocaine colitis. Is this a new syndrome? 397 30

Heterogeneity is the most important consideration in the pathophysiology of peptic ulcer disease. Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation. If they heal there is no predictable recurrence. Factors concerned with mucosal defense are relatively more important than aggressive factors such as acid and pepsin. Local ischemia is the earliest recognizable gross lesion. The gastric mucosa is at least as vulnerable as the duodenal mucosa and probably more so. Most drug-induced ulcers occur in the stomach. Chronic or recurrent true peptic ulcers (penetrating the muscularis mucosae) usually present with abdominal pain. Many duodenal ulcer patients report that the pain occurs when the stomach is empty or is relieved by food, and follows a pattern of relatively long periods of freedom from symptoms between recurrences. Approximately 50% of patients experience a recurrence within a year if anti-ulcer medication is stopped. In most western countries recurrent duodenal ulcer is more common than gastric ulcer. Peptic ulcer disease is also more common in men. Recent evidence indicates genetic and familial factors in duodenal ulcer and increased acid-pepsin secretion in response to a variety of stimuli. However, it is also becoming clear that of all the abnormal functions noted, few are present in all subjects and many are clustered in subgroups. In chronic gastric ulcer of the corpus, defective defense mechanisms, such as duodenogastric reflux and atrophic gastritis, seem to be more important than aggressive factors. Nevertheless, antisecretory medications accelerate the healing of such ulcers. It remains to be seen whether prostaglandins, mucus secretion, or gastric mucosal blood flow are impaired in chronic ulcer disease.
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PMID:The pathophysiology of peptic ulcer disease. 405 22

Acute thrombosis of an abdominal aneurysm is a catastrophic complication which is little known. It presents as a sudden event, characteristically with lower abdominal pain, signs of profound lower extremity ischemia and pronounced bilateral lower extremity neuromuscular dysfunction. While the mechanism of thrombosis is not understood and is unpredictable, it is certain that the condition is rapidly fatal if uncorrected. The mortality of acute thrombosis is very high, similar to rupture, which is the most common complication of an abdominal aortic aneurysm. Diagnosis is not difficult, and must be followed by prompt surgical restoration of circulation of the lower half of the body, if death is to be prevented. This can be accomplished by aneurysm resection and graft replacement. Retrograde transfemoral thromboembolectomy should not be done. This report describes two successfully operated cases which dramatize the symptomatology of the condition and show the gratifying results of immediate surgical intervention. Only 30 cases (15 fatal) have been reported in the literature.
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PMID:Acute thrombosis of abdominal aortic aneurysm. An uncommon entity. 406 45

A case of mesenteric vascular occlusion is detailed. The 30-year-old female had abdominal pain, bloody diarrhea, and small bowel changes seen on x-ray. She had begun taking the oral contraceptive Ovral (.5 mg norgestrel, .05 mg ethinyl estradiol) 3 years prior to hospital admission. Symptoms began to disappear when her oral contraception was discontinued on the ninth hospital day. Over the next 5 days abdominal signs and symptons subsided progressively. A follow-up small bowel series showed complete disappearance of previous abnormalities. In the differential diagnosis of acute abdominal pain progressing to bloody diarrhea, especially in young women or oral therapy, acute vascular insult with small bowel ischemia must be considered.
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PMID:Reversible mesenteric vascular occlusion associated with oral contraceptives. 470 Oct 37

A small series of eleven dogs prepared with a strangulating segment of jejunum demonstrated that a radionuclide, 99mTc-labelled albumin, concentrates in the lumen and bowel wall of the affected intestinal segment. Modern scanning equipment accurately localized the strangulating loop. This technique has the potential of identifying patients with intestinal obstruction, in whom strangulation is a factor, prior to the development of impaired arterial inflow and frank gangrene. These findings confirmed earlier obstructions that were reported when nuclear scanning instrumentation was less sophisticated. Identification of patients at risk for intestinal strangulation requires a high index of suspicion. Excruciating cramping abdominal pain out of proportion to physical findings, roentgenogram evidence, and laboratory studies should alert the physician to the possibility of intestinal ischemia and closed loop obstruction. Radionuclide scanning in such cases may be of assistance in defining or excluding the diagnosis of a strangulating mechanism. The test is simple, relatively economical, and represents a low risk procedure to patients. It would have no place when the classic physical and laboratory findings of intestinal infarction are present.
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PMID:Isotopic identification of intestinal strangulation. 621 69

Fifty-six patients with chronic intestinal ischemia underwent surgical revascularization. All patients had abdominal pain, 98% experienced significant weight loss, and 75% had an abdominal bruit. Visceral artery occlusive disease was documented by angiography in all patients; 77% of our patients had multiple-vessel occlusive disease, and 23% had single-vessel involvement of either the celiac or the superior mesenteric artery. The mortality rate was 8.9%. Ninety-six percent of the survivors were completely relief of symptoms, but an overall late recurrence rate was noted in 26.5%. Fifty-nine percent of our patients underwent revascularization of all stenotic vessels. Complete revascularization in multiple-vessel disease resulted in a late recurrence rate of 11%. When two of three stenotic vessels were revascularized, there was a 29% recurrence rate, and when one of three stenotic vessels was revascularized, there was a 50% recurrence rate. These findings suggest that although single-vessel revascularization may relieve symptoms, the optimal long-term result can be obtained by complete revascularization of all stenotic vessels.
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PMID:Surgical management of chronic intestinal ischemia: a reappraisal. 645 13

A young man with severe abdominal pain and weight loss due to intestinal ischemia was examined. At operation, the origins of the celiac and superior mesenteric arteries were found to be compressed by plexiform neurofibromatosis. Symptoms were relieved by reconstructive arterial surgery.
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PMID:Abdominal angina and neurofibromatosis. 679 34

Early recognition of intestinal strangulation in patients with small bowel obstruction is essential to allow safe nonoperative management of selected patients. We prospectively evaluated preoperative diagnostic parameters as well as the preoperative judgement of the senior attending surgeon for the determination of the presence or absence of intestinal strangulation in 51 consecutive patients who were about to undergo laparotomy for complete mechanical small bowel obstruction. Strangulation was present in 21 (42 percent) of the 51 patients. No preoperative clinical parameter, including the presence of continuous abdominal pain, fever, peritoneal signs, leukocytosis, or acidosis, or a combination thereof proved to be sensitive, specific, and predictive for strangulation. Moreover, the senior surgeon's experienced clinical judgement detected strangulation in only 10 of 21 patients with strangulation preoperatively (sensitivity, 48 percent). Indeed, only 1 of these 10 patients had an early, reversible lesion, whereas 9 had advanced, irreversible infarction. Only 25 of 36 preoperative assessments of simple obstruction proved correct (predictive value of an assessment of no strangulation, 69 percent). Overall, the preoperative assessment was correct in only 35 of the 51 patients (efficiency, 70 percent). These data show that in patients with complete mechanical small bowel obstruction, the preoperative diagnosis of strangulation cannot be made or excluded reliably by any known clinical parameter, combination of parameters, or by experienced clinical judgement. Nonoperative management of complete intestinal obstruction is therefore undertaken at a calculated risk (31 +/- 51 percent in the present series) of delaying definitive treatment of intestinal ischemia.
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PMID:Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. 684 89

Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemic colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding.
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PMID:Analysis of the clinical features of ischemic colitis. 687 95

A 48-yr-old woman with chronic intestinal ischemia and a long history of oral contraceptive use is reported. She presented with a 6-month history of severe diarrhea, abdominal pain, and weight loss. Abdominal arteriography revealed occlusion of the celiac axis at its origin and 90% stenosis of the superior mesenteric artery. This chronic arterial lesion has not been previously noted in association with the use of oral contraceptive agents in otherwise healthy women. The patient's isolated arterial lesions proved amenable to successful surgical bypass. Postoperatively she became completely asymptomatic and has remained so on long-term follow-up.
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PMID:Chronic intestinal ischemia associated with oral contraceptive use. 706 61


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