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

Diagnostic barium enema is not a substitution for well executed physical examination, and its use should be reserved only for obscure situations. An abnormal roentgenogram provides valuable information, since the fear of missing acute appendicitis in these children is minimized. When normal, this diagnostic test may bring to early operation those with minimal symptoms or unusual presentations, thus avoiding the possibility of prolonged observation and perforation. In children with known associated severe medical maladies, diagnostic barium enema can serve to reaffirm the diagnosis prior to the hazardous operative intervention. It may also eliminate the need for operation in those conditions which mimic acute appendicitis. The use of diagnostic barium enema in the past three and a half years significantly improved our diagnostic capabilities in children with abdominal pain. There was a corresponding reduction in the number of normal appendixes removed. The efficancy and, above all, the safety of this procedure make it a valuable diagnostic aid in the care of children.
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PMID:Barium enema as a diagnostic aid in children with abdominal pain. 84 51

A family pedigree containing sixteen individuals with acute appendicitis is presented. In all but one the position of the appendix was retrocecal. In two other members explored for abdominal pain wherein acute appendicitis was not the cause, the appendix was also found to be retrocecal. The anatomic retrocecal location of the appendix in this pedigree shows a degree of uniformity that implies a common predisposing factor inherited as a simple, dominant unit-character.
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PMID:Familial retrocecal appendicitis. 86 16

Carcinoid tumors of the appendix in 25 children (21 girls, 4 boys) below 15 years corroborated the previously reported preponderance of females. 17 children were operated upon because of acute appendicitis, one because of oxyuriasis in the appendix and the remaining 7 because of diffuse recurrent abdominal pain. All the patients were subjected to appendectomy and one of them later also to right-sided hemicolectomy because of carcinoid in the margin of the resection of the appendix but not in the cecum. Despite deep infiltration of the wall of the appendix to the serosa in 9 children and lymph node metastases in one, no signs of a recurrence have been seen during follow-up of 5 to 17 years (mean 12 years).
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PMID:Carcinoid tumors of the appendix in children. A report of 25 cases. 92 15

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

Thirty-four pregnant women with acute appendicitis presented at Parkland Memorial Hospital during a 15-year period. Abdominal pain, usually accompanied by nausea with or without vomiting, was the most common presenting symptom. Anorexia was less constant, and its occurrence decreased with advancing gestation. Physical findings usually included direct abdominal tenderness and, less often, rebound tenderness. Leukocytosis and/or a "left shift" were common laboratory findings, and the urinalysis was normal in most cases. Diagnosis was increasingly difficult as gestation progressed. This was reflected both by the increasing severity of the disease process found at surgery and by increasing fetal loss. If the diagnosis of appendicitis is suspected in the gravid patient, immediate surgical intervention is indicated to prevent the catastrophic complications associated with procrastination in diagnosis and treatment.
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PMID:Appendicitis complicating pregnancy. 112 71

Three case histories illustrate the diagnostic dilemma encountered whenever a patient with CF who is receiving antibiotics is evaluated for abdominal pain. Although acute appendicitis with perforation and abscess formation is not a common complication of CF, it occurs more frequently than is generally appreciated. The large number of abdominal situations in CF which can cause pain confused with but not typical of acute appendicitis. The true underlying condition is further masked by the concurrent use of antibiotics for pulmonary infection. A higher index of suspicion is needed to rule out acute appendicitis in a patient with cystic fibrosis and abdominal pain. A greater awaremess of the possibility of occult appendiceal abscess may help to avoid this complication.
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PMID:Occult appendiceal abscess complicating cystic fibrosis. 126 60

Twelve patients who underwent laparotomy for suspected acute appendicitis were found to have Crohn's disease of the terminal ileum. Appendectomy was performed in all although in only four patients was the appendix grossly inflamed. Postoperative complications, either abscess or fistula, developed in four patients (33%). Careful investigation of the records revealed some preoperative diagnostic clues: a history of recurrent abdominal pain and/or diarrhea (83%), physical examination revealing normal temperature (50%), and laboratory results compatible with a chronic process such as microcytic anemia (33%) and hypoproteinemia/hypoalbuminemia/hypocholesterolemia (50%). As the differential diagnosis between Crohn's disease and appendicitis is difficult and the surgical approach to the appendix in the presence of Crohn's disease is controversial, we illuminate some practical points in the preoperative evaluation of these patients and deal with the question of whether appendectomy should be performed in these patients.
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PMID:Preoperative clues to Crohn's disease in suspected, acute appendicitis. Report of 12 cases and review of the literature. 129 36

We had a 20% rate of negative appendectomies in our patients presenting with suspected appendicitis. We suggested that an improved clinical examination would reduce this rate. 84 consecutive patients presenting with suspected acute appendicitis were prospectively studied. 10 clinical features were used to calculate a score which should distinguish appendicitis and non-specific abdominal pain. 53 appendectomies with 6 (11.3%) perforations, 41 (77.4%) acute inflammations and 6 (11.3%) normal appendixes have been performed. 26 patients suffered from non-specific abdominal pain, 5 had an other surgical disease. In the appendectomized patients the score was 4.2 +/- 1.2 with perforation, 4.4 +/- 1.1 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients without operation was significantly lower (2.0 +/- 1.1; p less than 0.01). Patients with other surgical disease had a score of 2.8 +/- 1.5 with no significant difference to patients which had undergone appendectomy. Negative appendectomies were reduced by improved clinical examination from 20.3% to 11.3% without change in the rate of perforation. The remaining patients with negative appendectomies could not be identified by improved clinical examination even by means of the score. But the use of the score improved the performance of the clinicians.
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PMID:[Negative appendectomies can be decreased by improved clinical assessment alone]. 138 95

The diagnosis of acute appendicitis is still difficult to ascertain in children. However, a complete anamnesis, an accurate physical examination as well as a careful evaluation of other medical and surgical possibilities causing abdominal pain allow to arrive to a correct diagnosis in 80% of cases. Laboratory findings may be helpful but usually don't add further information. Each patient suspected to have appendicitis should be admitted to the hospital and kept under observation; if no improvement is registered during the following hours then a surgical exploration is needed. The surgeon, however, must be acquainted with the different medical affections causing abdominal pain in order to decide whether a laparotomy is required. The Authors report their experience in 426 patients submitted to appendectomy and stress the correlation between abdominal pain and intraoperative finding.
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PMID:[Acute abdominal pain and appendicitis in childhood]. 138 86

Acute hydrops of the gallbladder (AHGB) is a rare paediatric disease being diagnosed with increased frequency due to its association with other illnesses and the availability of ultrasonography. The symptoms and signs of AHGB include abdominal pain, vomiting, abdominal mass and/or tenderness. As these clinical features mimic the more common surgical conditions such as acute appendicitis, intussusception and volvulus, some cases are still diagnosed only at laparotomy. Diagnosis is established by ultrasonography of the abdomen demonstrating normal biliary ducts and a distended gallbladder without calculi or congenital malformation. The aetiology of acute hydrops of the gallbladder is unknown but may be multifactorial. Treatment varies from non-operative management to surgical intervention.
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PMID:Acute hydrops of the gallbladder in childhood. 139 81


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