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

DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical Decision Making was requested.
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PMID:Abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia. 716 38

Computed tomography (CT) performed on two patients with abdominal pain showed irregular, segmental thickening of the submucosa of the colon that proved to be due to ischemic colitis. In one case, CT showed narrowing of the lumen of the right colon by a polypoidal mass that was clearly the CT analog of thumbprinting. In the second case, CT was used as an alternative to barium studies to monitor the course of the patient. It is concluded that CT can be useful in the diagnosis and management of colonic ischemia.
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PMID:Ischemic colitis demonstrated by computed tomography. 717 28

This report intends to emphasize the importance of selective angiography in nonocclusive mesenteric ischemia (NMI). In a 67-year-old male with abdominal pain and weight loss the diagnosis of NMI was made angiographically after enteroclysis had shown extensive ulcerative jejunitis. In this condition, where constriction and obliteration of vasa recta of the superior mesenteric artery are present, operation is contraindicated. Current status of still incomplete understanding of the disease is discussed.
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PMID:[Nonocclusive mesenteric ischemia (author's transl)]. 728 Feb 20

Twenty-six cases of carcinoid-related mesenteric angiopathy and intestinal infarction (three from our institution and 23 previously reported cases) were reviewed. Twenty patients presented with acute abdominal findings, including peritonitis (13 cases), intestinal obstruction (five cases), and bleeding per rectum (two cases). Fifteen patients (75%) experienced antecedent symptoms of abdominal pain and/or diarrhea, averaging 2.5 years in duration. Twelve patients (46%) exhibited symptoms of carcinoid syndrome. Mesenteric angiography in three cases demonstrated encasement and segmental branch narrowing or occlusion of major mesenteric vessels. Eleven patients underwent resection and primary bowel anastomosis with an early survival rate of 91%. Four additional patients who underwent lesser surgical procedures and five patients who did not undergo operation all died. Elastic vascular sclerosis (EVS) was identified in 19 of 22 cases with available histologic material (86%). These changes were observed in proximity to as well as distant to the primary tumor. In general, the severity of EVS did not correlate with the likelihood of gut ischemia. Although not the sole cause of intestinal gangrene in patients with midgut carcinoids, EVS may contribute significantly to the evolution of these ischemic changes.
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PMID:Mesenteric angiopathy, intestinal gangrene, and midgut carcinoids. 728 Oct 10

Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.
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PMID:Evanescent colitis. 729 67

Fifteen patients with ischemia of the colon are presented. The majority showed a similar clinical presentation with hematochezia, abdominal pain, and diarrhea in an elderly patient population having associated disease. Colonoscopy was abnormal in all patients studied. Three endoscopic stages were recognized; (1) acute stage characterized by petechiae, pallor, and hyperemia; (2) subacute stage consisting of ulceration and exudation; and (3) chronic stage characterized by stricture, decrease in haustrations, and mucosal granularity. Conventional barium enemas were abnormal and suggested ischemic colitis in six of 15 patients. Rigid proctoscopy was normal or demonstrated nonspecific proctitis in 12 of 15 patients studied. Colonoscopic biopsies demonstrated superficial inflammatory changes in all patients. Thirteen patients had complete mucosal healing endoscopically in 2 weeks to 3 months with stricture developing in four patients. Because ischemic colitis is a distinct subtype of ischemic bowel disease most often limited to the superficial mucosa, colonoscopy is an alternative and usually safe modality in the diagnosis of this entity and proved more accurate that conventional x-ray and proctoscopy.
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PMID:Colonoscopy in ischemic colitis. 729 23

Twenty-three patients (13 women and ten men, 33 to 73 years old) underwent reconstruction of 33 major splanchnic arteries for relief of symptomatic intestinal ischemia. All patients experienced postprandial abdominal pain and lost weight (average, 12.8 kg). Arterial reconstructions (32 bypass procedures and one endarterectomy with patch-graft arterioplasty) were undertaken with both autogenous saphenous vein (24) and prosthetic condults (nine). Revascularizations involved the superior mesenteric (21), celiac (five), hepatic (four), splenic (two), and inferior mesenteric (one) arteries. There were four postoperative deaths; three occurred after emergent secondary attempts at intestinal revascularization. All of the 19 patients who survived benefited from operative intervention.
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PMID:Splanchnic arteriosclerotic disease and intestinal angina. 736 59

A 71-year old woman initially presented with abdominal pain and an x-ray picture of ischemia of the terminal ileum. The ischemic changes were transient and reversed spontaneously. Six months later, she presented with the same complaint and an x-ray picture of ileocolic intussusception. At operation, a lipoma of the ileum was the leading point of the intussusception and ischemic changes of the ileum were evident.
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PMID:Adult intussusception presenting with transient intestinal ischemia. 740 29

The case was a 61-year-old man who was transported to our hospital with complaining of severe chest and back pain of sudden onset and diagnosed as acute type IIIb aortic dissection. Inspite of intensive medical treatments, severe abdominal pain with abdominal distension and progressive metabolic acidosis appeared at around 11 hours after admission. Aortogram revealed obstruction of both superior and inferior mesenteric arteries suggesting visceral ischemia associated with acute type IIIb aortic dissection. Emergent operation consisting of bypass grafting for the superior and the inferior mesenteric arteries with saphenous vein, partial resection of small intestine, left hemicolectomy and construction of artificial anus was immediately carried out. The patient had no particular trouble after the operation and returned to the previous job.
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PMID:[A case of visceral ischemia associated with acute type IIIb aortic dissection]. 756 13

We report 3 cases of dorsal ischemic myelopathy indicative of aneurysm of the abdominal aorta. In 2 cases the aneurysm was dissecting and in all patients medullary symptoms were preceded by sudden lumbar or abdominal pain. Neurological symptoms were slightly different in each case. One patient experienced 3 episodes of acute paraparesis and rapid regression evoking transitory medullary ischemic accidents (intermittent medullary claudication). Another patient suffered progressive asymmetric paraparesis which first stabilized and later improved partially after surgical treatment of the aneurysm. The third suffered acute paraplegia related to irreversible ischemia of the anterior 2/3 of the medulla. The great variety of clinical manifestations of spinal cord ischemia related to aneurysms of the descending aorta can be explained by the topography of the aneurysm, pecularities of medullary vascularization and, especially, by the diversity of etiopathogenetic mechanisms that give rise to ischemia. We conclude that in the face of symptoms suggesting dorsal ischemic myelopathy, the possibility that an aneurysm of the abdominal aorta may be the cause must be considered, whether or not pain has been experienced prior to signs of medullary involvement.
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PMID:[Spinal cord ischemia indicating aneurysm of the abdominal aorta. Report of three cases]. 761 38


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