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

As our population ages, more patients will be presenting with acute abdominal problems which require attention. Unlike younger patients, the aged present later in the course of their disease and also often have concomitant underlying diseases. The diagnosis of an acute abdomen is further complicated by the relative lack of physical findings which is due to the elderly's lack of pain perception. The surgical problems in the elderly also tend to be more rapidly life-threatening than in younger patients. This further emphasizes the need for rapid diagnosis should an elderly patient present with abdominal pain. Methods to decrease the mortality from acute surgical problems are limited, but are potentially very effective. The first is to arrange for elective correction of the problem should it be known, and the second is to refer the patients promptly for operative consideration before sepsis becomes firmly established. Exact diagnosis before referral, while intellectually satisfying, is often contributory to a poor outcome in these patients.
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PMID:Approach to the acute abdomen. 268 68

A case report of a ligamentary ectopic pregnancy that failed to respond to prostaglandin E2 for induced abortion for sepsis at 24 weeks is presented. The 27-year-old nullipara had normal ultrasound findings for gestational age up to 21 weeks gestation. She had consulted at 5 weeks for abdominal pain and bleeding, at 14 weeks again for abdominal pain, shoulder pain and vaginal bleeding, although both times the pain and bleeding resolved spontaneously. She was seen again at 16 and 21 weeks gestation, when ultrasound scans were normal for dates. At 24 weeks, she experienced vaginal discharge of blood and tissue, and was managed as premature rupture of membranes. She became septic 12 days later. She was treated with transcervical PGE2 and iv oxytocin without response for 3 days. Surgical evacuation was successful, but bleeding persisted. During laparotomy she had a large left broad ligament hematoma, a left ruptured uterus, and open left internal iliac artery and vein. These were repaired, and she received 40 units of blood, 8 platelets and 14 of plasma. Only after histology was the diagnosis of ligamentary pregnancy made. The lack of response to PG for abortion should raise suspicion of ectopic pregnancy, although preoperative diagnosis of ligamentary pregnancy is extremely rare.
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PMID:A rare gynecologic contraindication to the use of prostaglandins and oxytocin to induce abortion. A case report. 279 68

Thirteen patients with Aeromonas species septicemia were seen at Westmead Hospital between 1983 and 1987. In 10 patients (77%) septicemia was caused by A. sobria, and in 3 (23%) by A. hydrophila, A. caviae was not isolated. Chronic underlying illness was present in 10 patients (77%), hematological malignancy being the most common (46%). The average age of the patients was 65.8 years. Seven patients (54%) presented with clinical sepsis, diarrhea and abdominal pain. The biliary tract, lung and soft tissue were other primary sites of infection. Nosocomial infection occurred in 5 patients (38%). Cross-infection was not seen. Contact with fresh water or fish was observed in only 2 patients (15%). The majority of cases occurred in the warmer months of the year. The overall mortality was 46%. All isolates of Aeromonas species were resistant to ampicillin 8 mg/L. Ten isolates were resistant to tobramycin 1 mg/L, and 3 to tobramycin 4 mg/L. In contrast, 3 isolates were resistant to gentamicin 1 mg/L, and none to 4 mg/L. The isolates showed a varied pattern of resistance to other antibiotics tested, but all were susceptible to piperacillin 64 mg/L, imipenem 4 mg/L, ciprofloxacin 1 mg/L, and amikacin 16 mg/L.
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PMID:Aeromonas septicemia: relationship of species and clinical features. 281 70

Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to stagnant bile, food and calculi pooling in the distal bile duct 'sump' with resultant biliary or pancreatic duct obstruction and sepsis. Endoscopic sphincterotomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post-CDDY symptoms. Eight such patients (M: F = 1:7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37-72 years) and the median period since CDDY was 11 years (range: 1-28 years). The median follow-up after ERCP was 18 months (range: 14-94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain, cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bile duct abnormalities in four, consisting of filling defects alone (two), anastomotic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven, of whom three (all with filling defects at ERCP) remain asymptomatic and three are significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post-CDDY biliary symptoms, endoscopic sphincterotomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Oddi.
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PMID:Treatment of postcholedochoduodenostomy symptoms. 281 37

Three cases of fatal clostridial septicemia in patients with acute leukemia are described. Predisposing factors and treatment are discussed. Clostridium septicemia should always be suspected when a patient with neutropenia suddenly develops diffuse abdominal pain, fever, and tachycardia over 120/min. The importance of early treatment with penicillin or another adequate antibiotic is discussed.
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PMID:Clostridium perfringens septicemia and acute leukemia. 286 67

A prospective study was conducted at Muhimbili Medical Centre (MMC) over a 2-year period on 16 patients with advanced abdominocyesis. The incidence of 1 in 3259 deliveries was higher than that of previous years. Infertility prior to index pregnancy was a significant antecedent factor (P less than 0.001). The most consistent symptom both in early and late pregnancy was abdominal pain. Difficulty in fetal palpation and abnormal lies were the most significant signs. The sensitivity of clinical suspicion was 68%, ultrasound 85% and X-ray diagnosis 93%. Sepsis was the leading maternal complication, especially when the placenta was left in situ. Perinatal mortality was 87.5% and maternal mortality was 6.4%. Abdominal pregnancy remains a diagnostic challenge and certain aspects of fetal mortality are ill-understood. Early diagnosis of abdominal pregnancy can be improved upon by more detailed history taking, a high index of suspicion and meticulous interpretation of sonographic and radiological signs. It is suggested that the placenta be removed except in the rarest trying cases and that pregnancy be terminated on diagnosis.
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PMID:Advanced abdominal pregnancy in Muhimbili Medical Centre, Tanzania. 288 Jul 56

Although mycotic aneurysms of small visceral arteries are rare, they have a high morbidity and mortality due to rupture and sepsis. Any patient with abdominal pain and bacterial endocarditis should be suspected of having a mycotic aneurysm. Selective arteriography confirms the diagnosis. In the case we have reported, diagnosis of a mycotic aneurysm of the inferior pancreaticoduodenal artery was established by angiography, and the patient was treated by percutaneous transcatheter embolization. This case demonstrates that mycotic aneurysms of small visceral arteries may be managed nonoperatively with antibiotics and percutaneous transcatheter embolization therapy.
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PMID:Mycotic aneurysm of the inferior pancreaticoduodenal artery: successful nonoperative management. 291 56

Neutropenic typhlitis is a frequently fatal disease most commonly reported in leukemics. The authors have treated eight such patients over the last 18 months. All patients had abdominal pain and sepsis during chemotherapy-induced neutropenia. CT scanning was diagnostic in six patients thought to have typhlitis. Two patients were not diagnosed before exploratory laparotomy. The authors have found nonoperative treatment highly effective in patients who do not manifest signs of peritonitis, perforation, gastrointestinal hemorrhage, or clinical deterioration. Recurrent typhlitis was frequent after conservative therapy (recurrence rate, 67 percent), however. One patient underwent an elective right hemicolectomy after a second episode, and typhlitis did not recur despite neutropenia associated with a subsequent course of chemotherapy. It is concluded that successful treatment of this disease hinges on: 1) early diagnosis provided by a high index of suspicion and the use of CT scanning, 2) nonoperative treatment for uncomplicated cases, and 3) elective right hemicolectomy to prevent recurrence.
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PMID:Recurrent typhlitis. A disease resulting from aggressive chemotherapy. 292 Jun 27

A retrospective review of 108 consecutive patients with perforated typhoid enteritis managed operatively over a 4-year period at Baptist Medical Centre, Ogbomoso, Nigeria is presented. There were 75 males and 33 females with an average age of 19.7 years. Presenting symptoms were fever, abdominal pain, vomiting, and either diarrhea or constipation. One hundred patients (93 percent) underwent debridement of the perforation and two-layer bowel closure. Postoperative morbidity included intraabdominal abscess, wound dehiscence, and subsequent bowel perforation. Most of the 35 deaths (32 percent mortality) were attributed to overwhelming sepsis which progressed despite aggressive operative management and antibiotic administration. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.
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PMID:Perforated typhoid enteritis: operative experience with 108 cases. 292 66

Diverticulitis represents a spectrum of clinical entities ranging from minimal pericolitis in the adjacent mesentery to uncontrolled intra-abdominal sepsis and septic shock. The presentation most often described is left lower quadrant abdominal pain, fever, chills, and left lower quadrant tenderness associated with a mass. Unusual presentations occur when infection tracts to distant locations. Diverticulitis is a common cause of intra-abdominal sepsis associated with high morbidity and mortality. The pathogenesis of intra-abdominal sepsis is not well understood, but likely involves circulating host inflammatory mediators. The role of computed tomography in the early diagnosis of diverticulitis is increasing and supersedes barium enema in the assessment of the extracolonic extent of disease. Also, computed tomographic-directed percutaneous drainage of intra-abdominal abscesses is, in most cases, as effective as surgical drainage. Predictably, the micro-organisms involved are representatives from the commensal flora of the lower gastrointestinal tract. These bacteria are usually sensitive to a wide range of antimicrobial agents that are effective against facultative and obligate anaerobic gram-negative bacilli. Surgical intervention is reserved for those individuals who do not respond to therapy, or for generalized peritonitis, uncontrolled sepsis, free viscus perforation, and fistulas.
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PMID:Diverticulitis. 304 50


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