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

Diverticulitis represents a spectrum of clinical entities ranging from minimal pericolitis in the adjacent mesentery to uncontrolled intra-abdominal sepsis and septic shock. The presentation most often described is left lower quadrant abdominal pain, fever, chills, and left lower quadrant tenderness associated with a mass. Unusual presentations occur when infection tracts to distant locations. Diverticulitis is a common cause of intra-abdominal sepsis associated with high morbidity and mortality. The pathogenesis of intra-abdominal sepsis is not well understood, but likely involves circulating host inflammatory mediators. The role of computed tomography in the early diagnosis of diverticulitis is increasing and supersedes barium enema in the assessment of the extracolonic extent of disease. Also, computed tomographic-directed percutaneous drainage of intra-abdominal abscesses is, in most cases, as effective as surgical drainage. Predictably, the micro-organisms involved are representatives from the commensal flora of the lower gastrointestinal tract. These bacteria are usually sensitive to a wide range of antimicrobial agents that are effective against facultative and obligate anaerobic gram-negative bacilli. Surgical intervention is reserved for those individuals who do not respond to therapy, or for generalized peritonitis, uncontrolled sepsis, free viscus perforation, and fistulas.
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PMID:Diverticulitis. 304 50

Widespread use of antibiotics and change in pathogenesis altered the bacteriology of infected aortic aneurysms. In the past, bacterial endocarditis was the major source of emboli infecting the aorta. Now, gram-negative sepsis in elderly patients is often the initiating event of infection in atherosclerotic aneurysms. Four cases of gram-negative infection in aortic aneurysms were treated. The etiology, presentation, and surgical management are reviewed. Three abdominal aortic aneurysms were infected during urinary tract sepsis and one infection occurred with Salmonella septicemia. The clinical triad of fever, abdominal pain, and a pulsatile abdominal mass led to a preoperative diagnosis in three of four patients. Debridement of infected tissue and bypass through non-infected tissue planes remain the cornerstones of modern surgical management. Despite prompt diagnosis and proper surgical management, the mortality of gram-negative aortic infection remains high because of early rupture and extensive atherosclerotic disease.
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PMID:Gram-negative bacterial infection of aortic aneurysms. 329 84

The records of 300 patients with a diagnosis of small bowel obstruction were evaluated to determine which factors, if any, were prognostic of clinical outcome. Ninety per cent of patients had at least one prior abdominal procedure; those of a gynecologic or obstetric nature were most common. Abdominal pain (92%), vomiting (82%), abdominal tenderness (64%), and distention (59%) were the most frequent symptoms and signs, and plain abdominal x-rays were abnormal in 273 (91%) patients. Two hundred and nine patients (70%) underwent surgical repair, of which 48 (23%) required resection of intestine for densely adherent or strangulated bowel. Contrast studies were generally not helpful and associated with barium peritonitis in two patients. The mortality rate for the entire series was 9 per cent, which doubled for those who underwent resection. Septic complications occurred in 31 per cent of the survivors in this group. Fourteen of the 16 patients who died from abdominal sepsis had a delay in presentation and/or treatment, which was the most important prognosis factor for patient outcome.
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PMID:The importance of early diagnosis of small bowel obstruction. 341

The treatment of acute leukemia in childhood has been increasingly successful. Infectious complications are the major cause of morbidity and mortality among these patients receiving aggressive chemotherapy. In particular, neutropenic enterocolitis or typhlitis has had a reported mortality of 50% to 100%. The authors reviewed a series of 77 previously untreated patients with acute myelogenous leukemia begun on treatment from March 1976 to June 1984 to better define the characteristics of typhlitis and its optimum management. Twenty-five patients had episodes of typhlitis, characterized by fever, abdominal pain, and tenderness, occurring during periods of neutropenia. Ten of these patients had watery diarrhea as a major additional symptom, and nine patients had a significant episode of gastrointestinal bleeding. In seven instances, blood culture results were positive, all for intestinal flora. The episodes of typhlitis occurred most frequently during the induction therapy (19 patients). Five patients experienced typhlitis during maintenance therapy, and one patient had acute appendicitis. Two patients had typhlitis during their reinduction therapy, and of note, one had had abdominal symptoms during her initial induction. All patients were treated initially with broad-spectrum antibiotics and bowel rest. Four criteria have been used for surgical intervention: (1) persistent gastrointestinal bleeding after resolution of neutropenia and thrombocytopenia and correction of clotting abnormalities; (2) evidence of free intraperitoneal perforation; (3) clinical deterioration requiring support with vasopressors, or large volumes of fluid, suggesting uncontrolled sepsis; and (4) development of symptoms of an intra-abdominal process, in the absence of neutropenia, which would normally require surgery. Using these criteria, five patients required surgical intervention for typhlitis or its sequelae and one for acute appendicitis. There was one perioperative death resulting from miliary tuberculosis. Among the 21 patients managed medically, there was 1 death resulting from typhlitis in a patient in whom surgery was deferred because of her multiple failures to enter remission.
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PMID:The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. 348 59

The clinical features of group A beta-hemolytic streptococcal sepsis were studied in 15 consecutive patients seen at an urban general hospital over a two-year period. Although 14 of the 15 patients had underlying disease, no patient had malignancy and none had undergone immunosuppressive therapy. Only one infection was nosocomially acquired. Mortality was 20%. Bacteremia arose from a cutaneous infection in 10 cases, from pneumonia in two, and from the urinary tract in one. Streptococcal bacteremia was unexpected in the remaining patients, two women who presented with severe abdominal pain. Unlike most other patients described in the literature, neither woman had an identifiable primary focus of infection. A review of the literature for potential sources of group A streptococcal bacteremia revealed that this pathogen is not part of the indigenous flora of the normal host at any body site.
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PMID:Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature. 354 Nov 28

Computed tomography (CT) is useful in evaluating patients with pneumatosis intestinalis while excluding other causes of abdominal pain and sepsis. We present a case along with additional illustrative CT sections to show its usefulness in such cases.
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PMID:The role of computed tomography in the evaluation of pneumatosis intestinalis. 357 98

Among the surgical complications of intravenous drug addiction, pyogenic splenic abscess is considered to be a rare entity. A review of the literature reveals only 24 cases of splenic abscess secondary to this particular etiology. The authors report five patients with intravenous drug addiction who underwent splenectomy for pyogenic splenic abscess within 1 year. Fever and abdominal pain were the only constant physical signs. Three patients had associated infective endocarditis, and the other two patients sustained blunt trauma to the left side of the trunk weeks earlier. Computed tomography (CT) and ultrasound were diagnostic in all five patients preoperatively, and they were complementary when combined. Four of the five patients had Staphylococcus aureus septicemia at the time of splenectomy. Three patients recovered from their operations, and the other two, both with endocarditis, died postoperatively from causes unrelated to splenic abscess and splenectomy. A high index of suspicion is warranted in this susceptible group of patients with vague abdominal signs and persistent sepsis to rule out splenic suppuration. The noninvasive imaging methods, CT scan and ultrasound, facilitate early diagnosis in these patients.
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PMID:Pyogenic splenic abscess in intravenous drug addiction. 357 50

A seventy-five year-old woman developed adrenal hemorrhage and acute adrenal insufficiency while receiving anticoagulant therapy. Abdominal CT scan was consistent with bilateral adrenal hemorrhage and was an important contribution to diagnosis and therapy. Acute adrenal hemorrhage should be suspected in patients, especially the elderly, who have recently begun anticoagulant therapy and develop upper abdominal pain followed by decreased sensorium, high fever, hypotension, and hyponatremia. Any consideration of the diagnosis of sepsis with shock in a recently anticoagulated elderly hospital patient should suggest the possibility of acute adrenal hemorrhage. Abdominal CT scan and a cosyntropin stimulation test should be performed to confirm the diagnosis. Failure of diagnosis has generally been associated with death in most patients, whereas prognosis in patients treated with corticosteroids is excellent.
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PMID:Adrenal hemorrhage: a complication of anticoagulant therapy--a case history. 359 6

The superior mesenteric artery is a frequent site of mycotic aneurysm formation. With the increasing popularity of parenteral drug abuse the incidence of superior mesenteric aneurysms is likely to increase. It should be suspected in any patient who has a history of bacterial endocarditis, sepsis, and abdominal pain. Abdominal CT scanning and visceral angiography are most useful in establishing the diagnosis, and surgical therapy should ensue with minimal delay. The various intraoperative methods of eradicating this lesion are described, with a review of the literature and report of successful management of one such case.
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PMID:Mycotic aneurysm of the superior mesenteric artery. 359 85

Six horses had been admitted to the hospital because of illness other than renal failure; diarrhoea, myositis, abdominal pain and/or suspected bacterial sepsis. Hypotension and disseminated intravascular coagulopathy were frequent findings in the horses. Abnormally high serum creatinine concentration and urine specific gravity of less than 1.022 were found in the horses with acute renal failure. Hyponatraemia and hypochloraemia were the most common abnormal electrolyte findings. Pronounced hyperkalaemia was not found. Variable degrees of tubular necrosis were seen in three of the four horses that had kidney sections submitted for microscopic examination. Renal cortical necrosis occurred in one horse. Intravenous fluid and electrolyte replacement was the most important therapy in those cases that were non-oliguric. Furosemide, mannitol and dopamine were used in horses with oliguria. The prognosis was generally good if the predisposing cause could be corrected and the acute renal failure was not oliguric.
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PMID:Acute renal failure in six horses resulting from haemodynamic causes. 360 51


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