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

A 66-year-old man with a history of abdominal pain, diarrhoea and weight loss was admitted for evaluation. Gastroscopy disclosed a severe gastric ulceration covering the lesser curvature. There was none of the usual risk factors for peptic ulcer disease and no malignancy was found. After 2 weeks' treatment with a proton pump inhibitor no healing was observed. The patient had a known atherosclerotic vascular disease, and angiography disclosed severe mesenteric ischaemia. After a revascularization procedure with stenting of the superior mesenteric artery was performed, the patient's symptoms disappeared. Healing of the gastric ulceration was observed at a further gastroscopy 2 weeks later. Chronic ischaemia is a rare cause of gastric ulcer, but should be suspected when no other cause is found and when the usual treatment with proton pump inhibitors does not result in healing.
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PMID:Ischaemic gastric ulceration with endoscopic healing after revascularization. 1653 21

Mirizzi syndrome (MS) is an uncommon complication of gallstone disease and occurs in approximately 1% of all patients suffering from cholelithiasis. The syndrome is characterized by extrinsic compression of the common hepatic duct frequently resulting in clinical presentation of intermittent or constant jaundice. Most cases are not identified preoperatively. Surgery is the indicated treatment for patients with MS. We report here a 71-year-old male patient referred to the surgical outpatient department for diffuse upper abdominal pain and mild jaundice (bilirubin rate: 4.2 mg/dL). Ultrasound examination revealed a stone in the cystic duct compressing the common hepatic duct. The patient had a history of gastrectomy for gastric ulcer 30 years ago. MRCP revealed a stone impacted in the cystic duct causing obstruction of the common hepatic duct by extrinsic compression. With these findings the preoperative diagnosis was indicative of MS. At laparotomy a moderately shrunken gallbladder was found embedded in adhesions containing a large stone which was palpable in the common bile duct. The anterior wall of the body of the gallbladder was opened by an incision which extended longitudinally along the gallbladder towards the common bile duct. The stone measuring 3.0 cm in diameter, was then removed setting astride a large communication with the common bile duct. A Roux-en-Y cholecysto-choledocho-jejunostomy was performed. The subhepatic region was drained. The patient had an uneventful recovery. He was discharged eleven days after operation and remained well after a 30-mo follow-up.
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PMID:An alternative surgical approach to a difficult case of Mirizzi syndrome: a case report and review of the literature. 1700 6

A 6-year-old boy was hospitalized because of dark feces and facial pallor of 1 weeks duration. Other gastrointestinal symptoms, including vomiting and abdominal pain, were absent, but he felt dizziness when standing and fatigue on effort. Hematologic studies revealed iron-deficiency anemia, and endoscopy showed gastric erosions and a duodenal ulcer. All test results for Helicobacter pylori infection, including H. pylori antigen in stool, anti-H. pylori IgG immunoassay in serum, and the (13)C-urea breath test, were positive. Because an H. pylori-associated gastric ulcer had been diagnosed with endoscopy in the patients father 3 years earlier, father-son transmission was suspected. The patient was treated with triple-agent eradication therapy (proton pump inhibitor [lansoprazol], amoxicillin, and clarithromycin) for 2 weeks. One month after therapy was completed, eradication of H. pylori was confirmed by negative results on the stool antigen test. Peptic ulcer disease can occur in young children, as in this case. The stool antigen test kit is a useful and reliable method that can be used even in preschool children to diagnose H. pylori infection.
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PMID:Helicobacter pylori infection with a duodenal ulcer in a 6-year-old boy. 1710 82

Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula. Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also, gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25 cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration. Postoperative course was uneventful. Per oral intake started on the 4(th) postoperative day, and the patient was discharged on the 8(th) postoperative day. In summary, this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.
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PMID:Spontaneous gastrojejunal fistula is a complication of gastric ulcer. 1723 Jun 26

Esophagopericardial fistula is a rare and severe complication, involving several benign, malignant and traumatic pathologies of the esophagus. Only few cases of esophagopericardial fistula have been published so far, as compared to more frequently reported cases of gastropericardial fistula. We report on a 25-year-old female with an esophagopericardial fistula following retrosternal esophagogastroplasty for esophageal caustic stenosis. One month before admission to our hospital, the patient had fever and nonradiating substernal chest pain which was relieved by aspirin, unfortunately without adequate antacid therapy. After 3 weeks, for abdominal pain and worsening chest pain with shock, she was admitted to another hospital and underwent laparotomy: an haemoperitoneum was found, due to a rupture of an ovarian cyst which was removed. For persistent shock, the patient had an echocardiogram which revealed a cardiac tamponade, treated with placement of a pericardic drainage (300 cc of purulent liquid). She was then transferred to our unit: an esophageal swallow with a small amount of methilene blue revealed a fistula between the stomach of the esophagogatroplasty and the pericardium. She eventually underwent surgery. A pericardial window was created, the gastric tube was taken down because of the impossibility to suture the gastric ulcer, and an esophagocoloplasty was used for the reconstruction of the alimentary transit. The postoperative course was unevenqf&l. She is alive and well at 15 months after surgery. Esophagopericardial fistula is a rare complication, with a high mortality rate. A timely decision is mandatory and an aggressive treatment often necessary.
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PMID:[Treatment of esophagopericardial fistula following esophagogastroplasty for esophageal caustic stenosis]. 1772 1

A recalcitrant rheumatoid arthritis patient taking low dose weekly methotrexate was given oral 2-chlorodeoxyadenosine (cladribine) for 8 months in a multicenter trial. He developed dual infections over the course of the trial: disseminated herpes zoster and staphylococcal arthritis of the right elbow. His disseminated herpes zoster started with severe, unremitting abdominal pain caused by a gastric ulcer, followed by disseminated cutaneous herpes, hepatitis, pancreatitis, encephalitis, homonymous hemianopsia, the syndrome of inappropriate secretion of antidiuretic hormone (ADH), and malabsorption. Both the herpes zoster and S. aureus infections required prolonged proper chemotherapies. Serious, complicated viral, bacterial, or other unusual infections should be considered in patients with severe rheumatoid conditions treated with combination immunosuppressive therapy.
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PMID:Disseminated herpes zoster and s. Aureus septic arthritis in a rheumatoid arthritis patient treated with 2-chlorodeoxyadenosine (cladribine) and methotrexate. 1907 80

Equine gastric ulcer syndrome (EGUS) is common in horses. A history of mild intermitted recurrent colic signs after eating is noted in many horses. Management of horses with abdominal pain caused by gastric ulcers is especially difficult, because non-steroidal anti-inflammatory agents, typically used to control abdominal pain, may exacerbate this condition. Effective pharmacologic agents are available to treat EGUS and eliminate abdominal pain, but more comprehensive measures of environmental and dietary management are needed to manage horses with EGUS and prevent recurrence. This article focuses on the history, clinical signs, diagnosis, and management of horses with abdominal pain associated with gastric ulcers. The primary goal is to provide an understanding of EGUS and to review effective pain management and specific antiulcer treatments and management strategies in horses with EGUS.
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PMID:New perspectives in equine gastric ulcer syndrome. 1958 Sep 40

We report a case of gastrocolic fistula (GCF) caused by a gastric ulcer and rare endoscopic findings indicating the early stages of GCF formation. The patient was a 58-year-old man who was hospitalized with upper abdominal pain. He was diagnosed as having a gastric ulcer, and was prescribed a proton pump inhibitor (PPI), but did not comply with the medication. One year later, he was again referred with recurrent abdominal pain. Endoscopic examination showed what appeared to be a portion of exposed colonic wall located in the center of an active gastric ulcer, and repeated endoscopy after PPI treatment for 8 days demonstrated a typical GCF. A preoperative diagnosis of GCF was made, and the patient underwent wide gastrectomy with partial resection of the transverse colon.
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PMID:Formation of gastrocolic fistula during treatment for peptic ulcer. 1969 73

Two complications are reported from excessively taut application of percutaneous endoscopic gastrostomy (PEG) external bumpers against the abdominal wall skin. First, a 55-year-old woman status post PEG developed a gastric ulcer, complicated by acute gastric bleeding, directly underneath the internal gastric PEG bumper. This complication was associated with replacement by an unknown healthcare worker of the standard flexible external (cutaneous) PEG bumper with an unauthorized rigid external clamp (bumper) and with excessively taut application of this clamp against the abdominal wall skin. No other causes or risk factors for gastric ulcers were present. The pathophysiology of this ulcer, similar to that of a decubitus ulcer, appears to be mucosal ischemia and pressure necrosis. Second, a 37-year-old man status post PEG developed a buried internal gastric bumper that caused PEG malfunction and abdominal pain from excessively taut application of the external PEG bumper. These case reports should alert healthcare workers that replacing a flexible external bumper with a rigid one and that tightening the external bumper excessively may cause pressure necrosis manifesting either as gastric or cutaneous ulcers or as a buried internal bumper. This alert is particularly important for nurses as they are likely to be the first healthcare workers to notice or be told of PEG failure because of their close involvement in the day-to-day care of the patient and their typically close rapport with the patient's family.
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PMID:Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper. 1969 2

Metaplasia represents the process of transforming a well-differentiated adult tissue into another type of adult tissue. Pancreatic metaplasia of the gastric mucosa represents the process in which the normal mucosa of the stomach is replaced with pancreatic formations, which mimic the structure of pancreatic acini. We describe the case of a male patient aged 39 who was admitted for abdominal pain, vomiting, hematemesis, melena, pale teguments, intense perspiration and nausea. The patient underwent surgery for suturing a perforated duodenal ulcer five years prior to this episode (2002). A gastric ulcer complicated with superior digestive bleeding and a chronic duodenal ulcer complicated with partial stenosis and perivisceritis were found during surgery. Gastric wall fragments were harvested and underwent usual histological techniques and immunohistochemistry. We found an ulceration from the gastric mucosa to the submucosa, covered by fibrino-leukocytic detritus. In the mucosal chorion we found numerous round or oval shaped nested formations which occupied the lower two thirds of the chorion, to the muscularis mucosae. Some metaplasic acini contain cells variable in shape, color and immunophenotype. Surrounding the nested acini we found tubular formations, formed of cubic shaped cells, representing excretory canals which were continued by gastric glands or opened directly in the crypts of the gastric epithelium.
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PMID:Pancreatic metaplasia of gastric mucosa associated with gastroduodenal ulcer. 2049 57


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