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

Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly benign, even with catastrophic conditions such as abdominal aortic aneurysm rupture and mesenteric ischemia. Changes that occur in the biliary system because of aging make older patients vulnerable to acute cholecystitis, the most common indication for surgery in this population. In older patients with appendicitis, the initial diagnosis is correct only one half of the time, and there are increased rates of perforation and mortality when compared with younger patients. Medication use, gallstones, and alcohol use increase the risk of pancreatitis, and advanced age is an indicator of poor prognosis for this disease. Diverticulitis is a common cause of abdominal pain in the older patient; in appropriately selected patients, it may be treated on an outpatient basis with oral antibiotics. Small and large bowel obstructions, usually caused by adhesive disease or malignancy, are more common in the aged and often require surgery. Morbidity and mortality among older patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation.
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PMID:Diagnosis of acute abdominal pain in older patients. 1711 93

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.
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PMID:Acute cholecystitis caused by Clonorchis sinensis. 1712 Dec 88

A 75-year-old woman came to our emergency clinic complaining of abdominal pain. Acute cholecystitis was diagnosed, and parenteral antibiotic therapy was initiated. Because of palpitation, she had a consultation with the cardiology clinic. Echocardiography showed a 2.7 x 2.2 cm mobile thrombus attached to the apex of the right ventricle. Since no thromboembolic complications were present, we decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. The patient received low-molecular weight heparin in addition to sodium warfarin for 5 days. Administration of heparin was then stopped and treatment was continued with sodium warfarin. In the series of weekly echocardiography evaluations, a gradual reduction was noted in the apical mass, which was initially considered to be a thrombus, and 3 weeks later evaluation revealed that the thrombus in the right ventricle had disappeared completely. No thromboembolic complications were observed during the follow-up period.
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PMID:Successful treatment of right ventricular thrombus with heparin and sodium warfarin therapy: a case report. 1716 99

A 36-year-old man was admitted with a 3-day history of severe abdominal pain in the right upper abdomen and was initially diagnosed with acute cholecystitis or acute retrocecal appendicitis. The patient was transferred to the department of surgery for close surgical observation. CT of the entire abdomen was performed just before the operation, which demonstrated inflammation in the omental fat. Surgery revealed primary omental torsion and subsequent resection of the infarcted segment offered a rapid recovery. We report a case of primary segmental omental torsion and discuss the diagnostic and therapeutic implications of this unusual entity.
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PMID:Primary torsion of the greater omentum. An obscure and unusual cause of acute abdomen. 1741 Jul 38

The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients. Sometimes many of these signs can lack and, as a consequence, the diagnosis might be very difficult. This may cause a fatal delay for the patients. We describe a singular case in which the rupture of an abdominal aortic aneurysm was simulating an acute cholecystitis: the presented symptoms, together with a negative personal medical history, were so atypical that even four experienced practitioners misdiagnosed the vascular lesion and the diagnosis was possible only at autopsy.
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PMID:The misdiagnosis of ruptured abdominal aortic aneurysm: an ancient problem always present. Report of an atypical case. 1754 88

Acute right-sided abdominal pain is a common presenting symptom in the emergency department. Acute cholecystitis and acute appendicitis are the most likely etiologies for right upper and lower quadrant pain, respectively. However, other differential possibilities include right-sided diverticulitis and perforated colon carcinoma. This case report of an 18-year-old man with segmental omental infarction highlights a much less frequent, self-limited cause of right-sided abdominal pain, which is increasingly identified on computed tomography scans.
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PMID:Segmental omental infarction. 1756 1

Tako-Tsubo cardiomyopathy (TTC) which is usually precipitated by profound emotional stress has been widely reported in the past. Recently, several co-morbidities have been found to be associated with this new cardiac entity. In this case we report from a female patient suffering from both, physical and emotional stress. After a persistent episode of severe abdominal pain due to acute cholecystitis and recurrent events of emotional stress, characteristic features of TTC could be documented. Histopathological analysis documented characteristic structural alterations including contraction band necrosis. Thus, this case confirms the hypothesis of an overstimulated sympthatoadrenergic system in TTC resulting from both, severe physical and emotional stress.
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PMID:Sympathoadrenergic overstimulation in Tako-Tsubo cardiomyopathy triggered by physical and emotional stress. 1770 25

True aneurysms of the epigastric artery are rare. We report a case of a 65-year-old female who was admitted for increasing upper abdominal pain. A leukocytosis, pyrexia, breathing stop on inspiration, and a palpable mass next to the right costal arch with severe local pain were suspicious for acute cholecystitis. Surprisingly, sonography and CT scan revealed a 5 x 4 cm structure limited to the abdominal wall directly above the gallbladder, which showed an arterial flow in the duplex scan. After resection and an uneventful postoperative course, the histological findings confirmed the diagnosis of a symptomatic true atherosclerotic aneurysm.
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PMID:The rare case of a symptomatic atherosclerotic aneurysm of the superior epigastric artery mimicking an acute cholecystitis. 1782 48

The laparoscopic approach has represented a major step forward in general and emergency surgery. Its application in the emergency setting still raises a number of concerns that limit its more widespread use. To assess the true scope of laparoscopic surgery in the acute abdominal setting, we retrospectively evaluated our experience. From February 2003 to June 2007, 314 patients underwent an emergency laparoscopic operation, for low abdominal pain (193 patients), acute cholecystitis (78 patients), bowel obstruction (18 patients), diffuse peritonitis (16 patients), blunt abdominal trauma (6 patients), and acute pancreatitis (3 patients). Laparoscopy yielded a good diagnostic definition in all cases. The conversion rate was 16.6% (52 patients). Mean operative time was 63 +/- 29 minutes. The general major morbidity rate was 1.5% (4 patients) and the mortality rate was 0.4% (1 pt.). The laparoscopic approach in patients with abdominal emergencies is a useful tool that yields a reliable diagnostic definition in uncertain cases and allows minimal access treatment of the causative disease in the majority of cases.
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PMID:[Emergency laparoscopic surgery]. 1868 67

Although acute cholecystitis in the context of acute hepatitis A virus (HAV) infection is extremely rare, previous cases have been reported. However, this manifestation of HAV infection is little known. In the present article, we briefly review previously documented cases and present a new case. We report the case of a 39-year-old woman with fever, abdominal pain and moderately elevated transaminase levels who developed jaundice and peritoneal irritation. Diagnosis of acute cholecystitis was given by abdominal ultrasound and magnetic resonance imaging. The patient underwent surgery. In the postoperative period, positive IgM antibody titers for HAV were obtained, confirming the diagnosis of HAV infection.
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PMID:[Acute acalculous cholecystitis associated with acute hepatitis A virus infection]. 1878 88


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