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

In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17 per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10-29 years (31 per cent) and 60-79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20-29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4.4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged greater than or equal to 60 years, and patients aged 80-89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.
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PMID:Abdominal pain: a surgical audit of 1190 emergency admissions. 259 64

There is no place for investigative CT scans in patients who have the classical triad of abdominal aortic aneurysm rupture, namely excruciating abdominal pain or backache, a pulsatile mass and hypotension. These patients require immediate surgery. However, in the absence of this triad, CT scans play an important role in the diagnosis of abdominal aortic aneurysm rupture. The CT scan findings will dictate whether the patient requires immediate surgery as in the case of acute rupture, or, whether the surgery can be delayed up to 24 hours to allow for stabilisation and hydration, as in the case of subacute and chronic rupture.
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PMID:The CT appearances of ruptured abdominal aortic aneurysms. 277 77

Two patients with duodenal obstruction as the presenting symptom of an abdominal aortic aneurysm are reported. The increasing frequency of aortic aneurysm in an ageing population may make this rare cause of duodenal obstruction more common. Vomiting, abdominal pain, and weight loss are the common presenting, symptoms. This report includes only the third successful aortic replacement in these patients. Upper gastrointestinal examination with contrast and endoscopy and computerized tomography scan of the abdomen are considered the most relevant investigations.
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PMID:Duodenal obstruction as the presenting symptom of aortic aneurysm. 325 Apr 28

Two cases of "Inflammatory" aneurysm of the abdominal aorta and a review of this type of lesion were presented. The incidence of inflammatory aneurysm of the abdominal aorta in the literature is 2.5 to 15%, but there were no detail reports concerning with this in Japan. The pathogenesis is not clear, but it is evident both macroscopically and microscopically that the inflammatory aneurysms are different from athelosclerotic ones. They are characterized by perivascular peel of inflammatory fibrous tissue. It is possible that this type of aneurysms are merely a variant of Takayasu's disease. Until recently, the diagnosis of this type of aneurysm has not been made before surgery. The symptom of abdominal pain, weight loss, elevated ESR in a patient with abdominal aortic aneurysm are highly suggestive an inflammatory aneurysm. Characteristics of CT scan lead to more frequent preoperative diagnosis of inflammatory aneurysms of the aorta. It reveals a thickened often calcified aortic wall surrounded by a soft tissue mantle. Dynamic scanning shows an enhancing perianeurysnal mass. Graft replacement in these patients is often difficult and associated with increase in morbidity and mortality. At surgery, no attempt should be made to mobilize adjacent viscela in order to avoid injury. Arterial control should be obtained with as little as possible dissection. Some reports refer to successful steroid therapy resolving the inflammatory process and alleviating symptoms. Further research may resolve the treatment of choice for this type of lesion and optimize the timing of surgery.
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PMID:[Surgical treatment of "inflammatory" aneurysms of the abdominal aorta]. 332 Jul 39

Rupture of an abdominal aortic aneurysm often presents with a pulsatile abdominal mass, abdominal pain, and hypotension. Recent clinical reports describe patients with less apparent clinical signs and symptoms who were found later in their evaluation to have a contained rupture of an abdominal aortic aneurysm. Even more unusual is a chronic contained rupture of an abdominal aortic aneurysm. Our patient had a chronic contained rupture of an abdominal aortic aneurysm that presented with erosion into the lumbar vertebral bodies and subsequent lumbar neuropathy. CT scan confirmed the contained rupture of the aortic aneurysm and the patient underwent successful repair of his aortic aneurysm. Our report discusses the significance of atypical presentations of abdominal aortic aneurysm rupture and the importance of prompt diagnosis and definitive repair.
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PMID:Chronic contained rupture of an abdominal aortic aneurysm presenting as a lower extremity neuropathy. 334 24

348 cases of abdominal aortic aneurysm were reviewed for typical features of inflammatory aneurysm (IAAA) (marked thickening of aneurysm wall, retroperitoneal fibrosis and rigid adherence of adjacent structures). IAAA was present in 15 cases (14 male, 1 female). When compared with patients who had ordinary aneurysms, significantly more patients complained of back or abdominal pain (p less than 0.01). Erythrocyte sedimentation rate was highly elevated. Diagnosis was established in 7 of 10 computed tomographies. 2 patients underwent emergency repair for ruptured aneurysm. Unilateral ureteral obstruction was present in 4 cases and bilateral in 1. Repair of IAAA was performed by a modified technique. Histological examination revealed thickening of the aortic wall, mainly of the adventitial layer, infiltrated by plasma cells and lymphocytes. One 71-year-old patient operated on for rupture of IAAA died early, and another 78-year-old patient after 5 1/2 months. Control computed tomographies revealed spontaneous regression of inflammatory infiltration after repair. Equally, hydronephrosis due to ureteral obstruction could be shown to disappear or at least to decrease. IAAA can be diagnosed by computed tomography with high sensitivity. Repair involves low risk, but modification of technique is necessary. The etiology of IAAA remains unclear.
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PMID:[Inflammatory abdominal aortic aneurysm]. 339 98

Abdominal ultrasound is an extremely useful diagnostic tool in the evaluation of the patient with abdominal symptoms. Its advantages include its being noninvasive, portable, and not requiring the use of radiographic contrast material. Sonography has great utility in the diagnosis of abdominal aortic aneurysm. For purposes of diagnosing ectopic pregnancy, ultrasound is best used in conjunction with beta-HCG radioimmunoassay. With respect to the patient with right upper quadrant abdominal pain, ultrasonic scanning has become the method of choice for visualizing the gallbladder and identifying cholelithiasis. The choice of ultrasound for demonstrating urinary obstruction due to ureterolithiasis is somewhat more controversial. Its use should particularly be considered in patients to whom the administration of radiographic contrast material is inadvisable.
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PMID:Abdominal ultrasound. 351 92

The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients. As preoperative diagnostic examinations i.v. pyelography was done in two patients and ultrasound scanning and angiography of the abdominal aorta in a further two patients. In one ultrasound scanning a dilated inferior vena cava and hepatic veins were seen as an indirect sign of ACF, while in both angiograms the ACF was seen. In these two cases the diagnosis of ACF was made preoperatively, while in four other cases the diagnosis was made during the operation. Three patients survived the operation and were still alive after eight months, four years and six years respectively. Postoperative complications developed in two patients: postoperative ileus in one and deep venous thrombosis and pneumonia in another. Because of its rarity aorto-caval fistula is difficult to diagnose. The presence of haematuria in a patient suffering from abdominal aortic aneurysm should strongly suggest the diagnosis of an aorto-caval fistula.
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PMID:Diagnosis and treatment of spontaneous aorto-caval fistula. 355 68

Of ten patients with pancreaticopleural fistulas, who ranged in age from 28 to 62 years, eight had primarily thoracic symptoms and no abdominal symptoms. The other two had abdominal pain after acute pancreatic injury. Computed tomographic scans disclosed pseudocysts in nine patients. The effusions resolved in four of the ten patients with transthoracic drainage, although two of these patients later required surgery because of recurrent pseudocysts. One patient died 17 days after repair of an abdominal aortic aneurysm; this patient had been treated by tube thoracostomy. Five patients underwent surgery; in four of them pancreatography was used to delineate the site of disruption preoperatively. These patients all survived, and none required subsequent surgical treatment.
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PMID:Pancreaticopleural fistulas. 357 78

A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. Four days later he presented to the emergency department in severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made. We discuss the pathogenesis of the genital discoloration and make the correct historical attribution of this sign to John Henry Bryant, a turn-of-the-century physician at Guy's Hospital.
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PMID:The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm. 362 39


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