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

Two patients with filling defects on films of the upper urinary tract caused by venous impressions are reported. To date, the literature includes 22 other cases. These cases are frequently associated with hematuria, flank or abdominal pain; the filling defect might be found incidentally during the evaluation of another problem. The two most frequent causes are varices--of renal vein, renal pelvic vein, ureteral veins, and normal renal vessels. Generally, the lesions were not diagnosed without surgical intervention. The filling defects of our cases were caused by other types of lesions. Their diagnosis was made nonoperatively through the use of intravenous pyelography, renal arteriography, and retrograde phlebography. Filling defects caused by venous impressions on the upper urinary tract should be diagnosed by the use of these three studies rather than surgically.
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PMID:Nonoperative diagnosis of pyelocalyceal deformity due to venous impressions. 43 37

The radiographic appearance and clinical significance of gastric varices in the absence of esophageal varices and secondary to splenic vein occlusion were studied. Eighteen patients were evaluated through medical records, angiography, and barium studies of the stomach and esophagus. The presence of splenic vein occlusion was determined by arteriography in 18 patients and its etiology confirmed by surgery in 17 patients. This condition should be suspected in patients with chronic abdominal pain, weight loss, and iron deficiency anemia who show fundal polypoid filling defects or prominent gastric folds on an upper GI series.
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PMID:Gastric varices secondary to splenic vein occlusion: radiographic diagnosis and clinical significance. 47 32

A patient with an uncommon cause of portal venous hypertension, pancreatitis, is depicted. The patient had an equally uncommon pattern of symptoms and signs consisting of abdominal pain and lower gastrointestinal hemorrhage caused by colonic varices. A unique treatment, with angiographic placement of an expandable intraluminal stent within the portal vein, was employed to reopen the portal venous system and reduce portal pressure. Relief of bleeding was accomplished and sustained for more than 1 year.
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PMID:Variceal hemorrhage associated with portal vein thrombosis: treatment with a unique portal venous stent. 159 80

An 18-year-old man developed a sudden onset of upper abdominal pain with vomiting. Ultrasound and computed tomographic (CT) scans revealed the spontaneous rupture of an intrahepatic artery aneurysm with subcapsular hematoma. A celiac arteriogram demonstrated a ruptured intrahepatic artery aneurysm in the right lobe of the liver, right extrahepatic artery aneurysm, obliteration of gastroduodenal artery, and abnormal flow pattern of the splenic artery. Portal vein phase, using superior mesenteric arteriography, showed portal vein varices and obliteration of the portal trunk. A right hepatic lobectomy was performed. The cut surface of the resected liver revealed a ruptured intrahepatic artery aneurysm with massive hematoma.
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PMID:Spontaneous rupture of intrahepatic artery aneurysm with complicated vascular anomalies. 201 34

Haemoperitoneum due to a ruptured porta-systemic shunt in patients with cirrhosis and portal hypertension seems to be rare, and the diagnosis is generally first established during surgery. A case of intraperitoneal bleeding due to a ruptured varix in a cluster of varices between the greater omentum and the right broad ligament is reported and the literature is reviewed. In cirrhotic patients, sudden onset of abdominal pain in combination with hypotension should result in ultrasonography of the abdomen. Any free fluid present should be aspirated and when blood is encountered the patient must be operated upon immediately. The mortality rate is high. Suture ligation of the bleeding varix seems to give the greatest likelihood of survival.
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PMID:[Spontaneous intraperitoneal hemorrhage in patients with cirrhosis of the liver: a complication of extra-intestinal shunts]. 202 17

A retrospective review of all admissions to the University of Kentucky Medical Center from 1977 to 1987 revealed six persons in whom splenic vein thrombosis could be documented. The patients had either upper gastrointestinal bleeding from gastroesophageal varices or abdominal pain. Pancreatic disease was present in five patients (83%), three (50%) had splenic enlargement, and five (83%) had normal results of liver function tests. Angiography showed an occluded splenic vein with collateral flow and a patent portal vein in each of the four patients studied. All patients had splenectomy, with or without additional procedures. After a mean follow-up period of 9 1/2 months, five patients (83%) were alive, and none has had further gastrointestinal bleeding. One patient had died of recurrent pancreatic carcinoma at nine months. Our data suggest that localized portal hypertension induced by splenic vein thrombosis is appropriately treated by splenectomy.
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PMID:Splenic vein thrombosis. 218 90

Although restricted transhepatic portal flow is necessary for development of generalized portal hypertension (GPH), increased splanchnic arterial inflow also contributes to GPH and its clinical sequelae. In this context, we describe 7 male and 6 female patients (mean age 48 years) in whom the lesser splanchnic (gastrosplenic) system played a key role in the signs and symptoms of GPH. These 13 patients (9 with hepatic cirrhosis, 3 with primary myeloproliferative disorder, and 1 with extrahepatic portal block) shared common features of massive splenomegaly, huge splenofundic gastric varices, often with a prominent natural shunt to the left renal vein. Total or near total splenectomy alone or combined where appropriate with coronary vein ligation was effective in controlling varix hemorrhage (10 patients), ascites (3), or complications of an enlarged spleen-anorexia and abdominal pain (3), hemolytic anemia (1) and profound thrombocytopenia with severe epistaxis (1). Intraoperative jejunal portal venography was crucial in operative management in order to establish definitively the presence or absence of coronary venous collaterals, and when present, to verify their operative ligation. These distinctive patients illustrate: 1) GPH is a heterogeneous syndrome of divergent splanchnic circulatory patterns, a feature which should be taken into account in selecting operative treatment; 2) one well-defined subgroup displays prominent hyperdynamic lesser splanchnic and specifically, splenic blood flow as a major contributor to clinical complications; and 3) within this subgroup, splenectomy combined with documented absence or surgical interruption of coronary venous collaterals as corroborated by intraoperative portography is effective alternative treatment.
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PMID:Preeminence of lesser splanchnic blood flow in selected patients with generalized portal hypertension. 227 22

Clinical, laboratory, and ultrasonographic features of 75 patients of primary hepatocellular carcinoma (PHC) living in the Gizan Area of Saudi Arabia and their follow-up, during a 2-year period, were characterized. Eighty-nine percent of the cases were defined histologically, whereas in the rest, ultrasonographic (US) evidence along with an alphafetoprotein (AFP) level exceeding 480 ng/ml were taken as the positive evidence for PHC. Eighty percent of the cases were male patients, with the peak incidence during the seventh decade. The most common clinical presentations were hepatic enlargement (91%), abdominal pain (76%), splenic enlargement (33%), and acites (33%), followed by bruit, fever, metastases, and varices. Alteration in a liver function test was manifest in 97% of the cases, AFP values greater than 480 ng/ml in 57%, and a hepatitis B virus surface antigen (HBsAg) positivity in 65% of the cases. There was no intersex variation in positivity for HBsAg, antibody to HBsAg (anti-HBs), antibody to hepatitis B virus core antigen (anti-HBc) among the 30 PHC cases studied. Positivity for HBsAg or the overall hepatitis B virus exposure in PHC cases was higher than the normal controls (P less than 0.001). In addition to histologic confirmation of PHC in 67 cases, there was histologic evidence of cirrhosis in 25%, or chronic active hepatitis in 19% of the cases. At the time of diagnosis, the average duration of the presenting illness was less than 2 months, while the mortality in the ensuing 2-month period was 73%. The average span of total illness in the vast majority of cases was 4 to 6 months. Two female patients (one with fibrolamellar carcinoma) however, survived for 2 years. Immunization against hepatitis B virus should be considered for all newborns in such hyperendemic communities. A continuous program should be started in such communities to screen and immunize all those yet unexposed to hepatitis B virus. The established HBsAg carriers should be periodically examined ultrasonographically along with an AFP estimation for initiating the chemotherapeutic and other measures against PHC in fairly early stages of malignancy.
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PMID:A profile of primary hepatocellular carcinoma patients in the Gizan Area of Saudi Arabia. 242 66

This report describes a series of 553 flexible upper gastrointestinal (GI) endoscopies performed on 382 children in two surgical centers between 1975 and 1987. Indications included abdominal pain (180), reassessment of known disease (149), upper GI bleeding (99), foreign body ingestion (77), vomiting (14), dysphagia (10), and miscellaneous (24). Findings were chronic peptic ulcer (47), gastritis/duodenitis (63), healing disease (92), nonhealing disease (22), recurrent disease (32), foreign body impaction (22), stricture (9), esophagitis (7), varices (7), mass (6 [3 polyp, 1 lymphoma, 1 fungus ball, 1 inflammation]), normal (209), and miscellaneous (37). Endoscopic diagnosis was uniformly correct except on two occasions, when the presence of recurrent tracheoesophageal fistula in small infants was missed due to use of an inadequate instrument. A pathologic lesion is likely to be identifiable in GI bleeding (84.8%). Endoscopic surveillance for progress of known disease was found to be valuable, particularly in peptic ulcer management, as both incomplete healing after standard therapy as well as recurrence are frequent. The recent practice of routine antral biopsy in children with severe "nonspecific abdominable pain" enabled four cases of Campylobacter pylori colonization in the stomach to be diagnosed, thus allowing appropriate treatment. Endoscopy was therapeutic on 61 occasions: injection sclerotherapy (32), foreign body removal (20), polypectomy (3), and stricture dilatation (6). Endoscopy-guided bougienage, in particular, represents a recent major advance. There was no morbidity or mortality in the entire series. It is concluded that pediatric upper GI endoscopy performed by experienced surgeons is safe and effective. As a result of better understanding and technological advances, a changing trend of wider and more rational applications of the procedure is now evident.
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PMID:Pediatric upper gastrointestinal endoscopy: a 13-year experience. 273 8

A 50 year old man, who had had liver cirrhosis of 10 years, without previous variceal bleeding, presented with sudden abdominal pain, distension and hypotension and was admitted. The diagnosis of ruptured periumbilical varices was established at laparotomy. Despite surgical intervention to halt the bleeding varices the patient died of hepatic failure fourteen days postoperatively. The differential diagnosis and management of hemoperitoneum in this cirrhotic patient are discussed, and sixteen previously reported cases of intraabdominal variceal bleeding are reviewed.
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PMID:Intraabdominal bleeding attributed to ruptured periumbilical varices. A case report and a review of the literature. 349 75


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