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

Surgical emergencies can be missed easily in children, who are not always able to volunteer relevant information. Awareness of the entities discussed in this review might help the EP uncover subtle clues to early diagnoses that might not be initially apparent. Ill-appearing children who have abdominal pain and vomiting should be considered to have ischemic or necrotic bowel until proven otherwise. Possible diagnoses include volvulus, intussusception, and necrotizing enterocolitis. Bilious vomiting, especially in a young infant, should be considered to be an indication of a high bowel obstruction such as midgut volvulus, which warrants immediate surgical consultation. Significant rectal bleeding with abdominal pain can result from intussusception, volvulus, or an inflamed Meckel's diverticulum. Rectal bleeding with unstable vital signs can result from an upper GI bleed (eg, peptic ulcer disease). Painless rectal bleeding can result from a Meckel's diverticulum, polyps, arteriovenous malformation, or a tumor. Examination of the genitalia is imperative, especially in boys, to exclude the possibility of an incarcerated hernia or testicular torsion.
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PMID:Abdominal surgical emergencies in infants and young children. 1470 13

Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2 % of the population. The most common complications associated with a Meckel's diverticulum include obstruction, bleeding, and inflammation (7, 9, 11, 18-20). The estimated lifetime risk of developing symptoms with a Meckel's diverticulum is 4-6 % (16), with the risks of complications decreasing with age. Stones within Meckel's diverticulum are recognized as a rare complication in the adult population (13,15). However, it has not been reported in the pediatric age group. The authors describe a 19-month-old male who presented with intermittent abdominal pain and vomiting, chronic microcytic anemia and a calcified stone in the lower abdomen, who was found to have a Meckel's enterolith.
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PMID:Migrating calcified enterolith and chronic anemia: an unusual case presentation of a Meckel's diverticulum. 1563 Jun 49

Wireless capsule endoscopy is a diagnostic procedure to study the pathology of the small intestine physiologically and painlessly. The capsule dimensions are 11 x 26 mm, and takes 2 picture per second whilst 8 hours. Unexplained occult gastrointestinal tract bleeding is the main indication, but everyday new indications for its use come to the literature. Our objective were to review our experience about the clinical usefulness and impact in our clinic. We included 45 cases, excluding 3 because of technical problems. There were 24 women and 18 men, with an average age of 54 years old (18 to 86 years old). Indications for the study were: Gastrointestinal bleeding of obscure origin in 24 cases, anemia in 6 cases, chronic diarrhea in 8 cases, chronic abdominal pain in 2 cases and Crohn's disease in 2 cases. The source of bleeding in the first group was identified in 18 patients (75%), where jejunal and ileal angiodysplasias were found in 11 patients, in 4 cases there were ulcers or erosions, in one case a Meckel diverticulum was found and, in the last one an hammartomatous lesion with an active bleeding was found. In chronic diarrhea patients a lesion was found in 5 cases (62.5%), where mucosal atrophy were found in two patients who responded to a free gluten diet, and in 3 patients acute inflammations with ulcers were treated as Crohn's disease. In the patients with anemia a lesion was found in 2 cases (33%), where a submucosal tumor and a jejunal ulcer were the findings. No lesions were found in the patients with chronic abdominal pain. Finally in the patients with Crohn's disease we were able to know the extent and one patient presented two stenotic lesions. In conclusion, wireless capsule endoscopy is a useful diagnostic tool that let us study easily the small intestine and should be integrated to different study protocols as gastrointestinal bleeding of obscure origin, chronic diarrhea and evaluation of Crohn's disease. It is not useful for abdominal pain, nevertheless we just studied two patients.
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PMID:[Capsule endoscopy: The evolution in the diagnosis of small bowel diseases]. 1616 99

A 42-year-old woman presented with intractable crampy abdominal pain continuing for 1 year. The pain worsened after eating and improved when walking. She had undergone laparoscopic adjustable gastric banding 4 years previously, with re-banding 18 months later because of anterior band slippage. The patient underwent numerous examinations, all with normal findings. A scintigraphy finally showed some tracer enrichment in the terminal ileum, which led to the assumption that a Meckel's diverticulum was causing her discomfort. Subsequent diagnostic laparoscopy showed no Meckel's diverticulum but instead displaced tubing, which was wrapped around the mesenteric root. The mesenteric root showed scarred alterations from chronic strangulation. After replacing the tubing from the band the abdominal pain immediately vanished. In retrospect, the contrast study of the gastric band shows unnatural traction of the tubing towards the lower abdomen, allowing suspicion of the intraoperative findings.
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PMID:Intractable abdominal pain following laparoscopic adjustable gastric banding. 1625

We report a case of a 57-year-old woman admitted for abdominal pain and a not reducible mass in left inguino-abdominal region. With a diagnosis of strangulated inguinal hernia, the patient underwent urgent surgery. The surgical exploration showed a gangrenous intestinal loop with a Meckel's necrotic diverticulum. A small bowel resection (20 cm) was performed. The post-operative course was uneventful. This seems the first case reported in the literature of woman with a Meckel's diverticulum involved in a strangulated left inguinal hernia.
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PMID:[Gangrene of Meckel's diverticulum in strangulated left inguinal hernia]. 1637 Nov 91

Meckel's diverticulum is an evolution of omphalomesentric channel one of the most frequent embryologic abnormality of digestive tract. It is observed in two circumstances: during a routine exploration or after a complication: intestinal obstruction, peritonitis, recurrent abdominal pain. Only open or laparoscopic explorations allow a diagnosis. Resection of the diverticulum is recommended in children because the complications are frequent and serious. The preferred therapeutic method is the bowel resection with immediate anastomosis.
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PMID:[Laparoscopic surgery of Meckel's diverticulum]. 1653 Jan 54

Split notochord syndrome is a group of developmental abnormalities caused by abnormal splitting or deviation of the notochord, clinically resulting in the duplicated bowel associated with vertebral anomalies. In this syndrome, initial presentations due to duplicated bowel, vomiting, abdominal pain, and failure to thrive, usually occur before 1 year of age. We here report a 12-year-old boy with intermittent vomiting, previously diagnosed with cyclic vomiting syndrome. On abdominal x-ray examination, a defect in the closure of posterior vertebral arches was observed in the 5th lumbar vertebral body, indicating the complication of spina bifida occulta. This finding suggested the diagnosis of split notochord syndrome. A magnetic resonance imaging study revealed a cystic mass lesion in the pelvic cavity. (99m)Tc-pertechnetate scintigraphy, which is frequently used to detect ectopic gastric mucosa for the diagnosis of Meckel's diverticulum, showed a positive spot corresponding to the cystic mass lesion. Surgical resection of the cystic mass lesion demonstrated ileal duplication with ectopic gastric mucosa. Surgical findings suggest that symptoms of the patient were due to ulceration, inflammation, or bleeding caused by acid-peptic juice secreted from ectopic gastric mucosa. Duplication of the alimentary tract should be considered as a possible cause in patients with symptoms suggesting cyclic vomiting syndrome.
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PMID:Split notochord syndrome: ileal duplication causing intermittent episodes of vomiting. 1686 61

We report a child of elongated retrocecal appendicitis who presented with abdominal pain over the right upper quadrant and circular skin erythema over the right flank. Sonography showed an elongated tubular structure over the right abdomen. By the location, relationship to adjacent tissue and origin of tubular structure, the sonographic findings were differentiated from those of other similar diseases, such as colonic duplication or Meckel's diverticulum. This case illustrates retrocecal appendicitis should be considered as one of the differential diagnoses for earlier surgical intervention if a patient exhibits such atypical clinical manifestations accompanied with an elongated tubule structure of the right abdomen by sonography.
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PMID:Atypical manifestations of acute retrocecal appendicitis in a child. 1692 35

An 18-year-old man was admitted to a local hospital with abdominal pain and bloody stool. Upper and lower gastrointestinal endoscopy failed to show any bleeding sites; however, an angiography of the superior mesenteric artery done on hospital day 4 showed an abnormal artery with an aneurysm, branching from the ileal artery. This artery was thought to be the vitellointestinal artery, a feeding artery of Meckel diverticulum. After embolization, he was transferred to our hospital, where we performed emergency laparotomy with partial resection of the ileum, including a bleeding Meckel diverticulum. Pathological examination revealed ectopic gastric mucosa and peptic ulceration, which we assumed was the origin of the bleeding. The patient had an uneventful postoperative course. Visceral artery aneurysms are rare but important vascular lesions because of their potential for fatal rupture. Although a minimally invasive procedure can be performed for a vitellointestinal artery aneurysm in patients with asymptomatic Meckel diverticulum, we treated our patient surgically because he presented with hemorrhagic shock and had been unresponsive to an H(2)-receptor antagonist.
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PMID:Bleeding Meckel diverticulum associated with a vitellointestinal artery aneurysm found on preoperative angiography: report of a case. 1712 44

During a cholecystectomy for stones, an unusual lesion mimicking a neoplasm was found in a 40-year-old man. The lesion was resected using an endoscopic stapler, and the histologic diagnosis was Meckel's diverticulum with chronic inflammation and calcification of the diverticular wall. It is possible that the diverticulum had been responsible for abdominal pain in this patient, in whom it had an atypical appearance.
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PMID:Calcified Meckel's diverticulum: an unusual incidental finding during laparoscopy. 1736 93


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