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

We report a case of malignant fibrous histiocytoma originating in a renal capsule. A 43-year-old woman was admitted with a chief complaint of right lower abdominal pain. Physical examination was unremarkable. Serum C-reactive protein and erythrocyte sedimentation rate increased to 3.8 mg/dl and 60 mm/hr., respectively. Computed tomography (CT) and magnetic resonance image (MRI) showed a heterogeneous enhanced mass, 4 x 9 x 13 cm in size, in contact with the lateral part of the right kidney. Selective right renal arteriography revealed a hypovascular tumor, the main feeding artery of which was the right adrenal artery. Preoperative clinical diagnosis was a retroperitoneal sarcoma and transabdominal tumor resection was performed. The adhesion between the tumor and the right kidney was so severe that right nephrectomy was also necessary for a radical surgery. The tumor, measuring 13 x 9 x 6 cm, was located laterally adhering to the right renal capsule. Microscopic examination of the tumor demonstrated spindle-shaped fibroblast-like cells arranged in a storiform pattern with fibrous stroma and clusters of rounded histiocyte-like cells and pleomorphic giant cells with bizarre nuclei. Histopathological diagnosis was malignant fibrous histiocytoma arising from the renal capsule and there was no tumor invasion to renal parenchyma. No adjuvant therapy was performed but she has remained well for 31 months since the operation without evidence of disease.
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PMID:[Malignant fibrous histiocytoma originating in a renal capsule: a case report]. 1175 55

A 67-year-old man was admitted with abdominal pain on April 23, 2000. Continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis was diagnosed. Administration of antibiotics for five days obtained no improvement. Therefore the peritoneal catheter was removed on April 28th. Although his condition became settled, C-reactive protein remained positive. Moreover, two kinds of bacilli were detected from the CAPD fluid, just before the catheter was removed. As abnormalities in the colon were possible, an enema examination was performed on May 23rd. A constriction and several diverticula of the sigmoid colon were detected. High grade fever appeared on May 23rd, and the patient complained of abdominal pain the next day. As there was no improvement, we performed enhanced computed tomography and detected an abscess in the Douglas pouch on May 29th. The abscess was resected on the same day, and he was discharged. The number of patients with chronic renal failure has increased in recent years. Although hemodialysis has been the treatment of choice, peritoneal dialysis should be considered. More investigations into complications created by peritoneal dialysis are required, especially in elderly people who seldom show symptoms of CAPD-related peritonitis until they reach a critical condition. If peritoneal dialysis is being performed and inflammation reactions continue, it is necessary to examine the patient for perforated peritonitis and abscess formation.
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PMID:[A rare case illustrating the difficulty of diagnosing and treating elderly patient with CAPD-related peritonitis caused by the perforation of sigmoid colon diverticulum]. 1207 95

We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.
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PMID:Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user. 1259 67

Peritoneal tuberculosis is rarely observed in European countries. We report on peritoneal tuberculosis in two female immigrants from Somalia and Columbia who presented with diffuse abdominal pain, fever, weight loss and exudative, lymphocytic ascites. Laboratory investigations showed an increase in C-reactive protein and carcinoma antigen 125 serum levels. Nodular peritoneal lesions and adhesions were detected by ultrasound and computed tomography. In both patients, peritoneal biopsy from laparoscopy revealed epitheloid granulomas with central necrosis and multinucleate giant cells. Microscopy and PCR analysis were, however, negative for Mycobacterium tuberculosis in both patients. Despite repeated testing, ascites culture became positive for M. tuberculosis in only one patient. Shortly after starting antituberculous drug treatment, both patients improved, ascitic fluid disappeared and C-reactive protein and carcinoma antigen 125 serum levels returned to normal. Even in Western countries, peritoneal tuberculosis should be considered in any febrile patient with abdominal signs and symptoms, particularly if ascites is present. Empirical antituberculous treatment is justified in patients with clinical and histological features highly suggestive of peritoneal tuberculosis, even in cases with negative results from microscopy, culture and PCR analysis.
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PMID:Peritoneal tuberculosis with negative polymerase chain reaction results: report of two cases. 1267 41

We describe an unusual case involving an infected hepatic cyst. An 88-year-old woman presented with acute onset of right upper quadrant abdominal pain, mild left lower abdominal pain, diarrhea, and fever. On admission, computed tomography revealed multiple hepatic cysts including an 8-cm cyst located in the left medial segment of the liver, which demonstrated a thickened wall enhanced with contrast media. Ultrasonography showed an 8-cm hypoechoic lesion which differed in appearance from the other, anechoic hepatic cysts. The serum concentration of C-reactive protein was 29.8 mg/dL; white blood cell count, 12,800/microL; CA19-9, 96 U/mL; and CEA, 2.2 ng/mL. Diagnosis of infected hepatic cyst was made by percutaneous transhepatic drainage of the cyst. Milky fluid was obtained and the patient's right upper quadrant abdominal pain resolved after drainage. The cyst fluid CA19-9 concentration was 18,000 U/mL. Cytology of the cyst fluid was negative. Serum CA19-9 (41 U/mL) and CEA (1.8 ng/mL) concentrations were improved 1 week after drainage. Escherichia coli was cultured from the drainage fluid. The patient was discharged 27 days after admission. Percutaneous transhepatic drainage is effective in the treatment of infected hepatic cysts.
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PMID:Infected hepatic cyst. 1274 58

From September 1997 to March 2002, a total of 84 children were admitted to Chang Gung Children's Hospital due to influenza A virus infection. Influenza A virus infection was documented in 61 cases by viral isolation from throat and in 23 cases by serologic studies. The mean age of patients was 43.8 months, ranging from 20 days to 16 years. Forty-one (49%) patients were male. Lower respiratory tract infection (53 of 84 cases) was the most common clinical manifestation, occurring predominantly in children younger than 5 years (49 of 53 cases). The types of lower respiratory tract infection included bronchiolitis/bronchopneumonia in 33 cases, pneumonia in 17, and croup in 3. Central nervous system dysfunction was noted in 26 patients, predominantly in older children (18 of 26 cases). This included encephalopathy in 11 cases, encephalitis in 10, aseptic meningitis in 2, psychosis in 1, febrile convulsions in 1, and acute disseminated encephalomyelitis in 1. Gastrointestinal symptoms were mild in most patients. Diarrhea occurred in 18.4% of the children younger than 5 years, compared with only 8.4% of the older children. By contrast, abdominal pain was more common in older children (16.7%) than in younger children (6.7%). Ten children had leukocytosis (white blood cell > or = 15000 /microL) and 9 of them were younger than 5 years. Eleven children had a C-reactive protein level greater than 100 mg/L and 10 of them were younger than 5 years. The mean duration of fever and hospitalization were 4.6 +/- 2.8 days and 7.4 +/- 5.7 days, respectively. The clinical outcomes were excellent in all but 1 patient who died from intractable pulmonary hemorrhage. The frequency and duration of hospitalization due to influenza A virus is much greater than generally thought in Taiwan, suggesting an urgent need for educational programs to increase awareness of the characteristics and risks for this illness.
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PMID:Clinical characteristics of children with influenza A virus infection requiring hospitalization. 1288 62

A 45-year-old woman with 20-year history of diabetes mellitus was admitted to our hospital because of high fever and abdominal pain. Radical hysterectomy and bilateral pelvic lymphadenectomy had been performed 4 months before admission for invasive cervical cancer. On admission, elastic hard tumors were palpable in the lower abdomen. Laboratory examination showed positive C-reactive protein (CRP), anemia and renal dysfunction. Computed tomography (CT) revealed several lymphocysts in the pelvis. She was diagnosed with infection of pelvic lymphocysts. Since her mother also had diabetes associated with deafness, we examined mitochondrial DNA in leukocytes and detected an A to G transition at the nucleotide position of 3243 (A3243G mutation). She was diagnosed as maternally inherited diabetes mellitus and deafness (MIDD). Puncture of the cysts followed by administration of antibiotics resulted in marked improvement of symptoms and laboratory findings. This is a rare case of pelvic lymphocyst infection in a patient with a mitochondrial disorder. Although the exact mechanism of infection is not clear, MIDD may represent an unusual risk factor for infection, and further investigation is necessary to assess the influence of mitochondrial dysfunction on the immune system. Pelvic lymphocyst infection should be considered in the differential diagnosis of abdominal pain and fever in patients with MIDD after abdominal surgery.
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PMID:Pelvic lymphocyst infection associated with maternally inherited diabetes mellitus. 1295 Dec 83

Abdominal tuberculosis (TB) tends to present with non-specific features and can be hard to diagnose. In the University Hospitals of Leicester, which serve a large immigrant population, 36 patients had this diagnosis between 1995 and 2001. We examined their records to identify features, including history, clinical presentation, investigations and diagnostic procedures, that might help with diagnosis of future cases. 32 of the patients were of Asian origin, predominantly from the Indian subcontinent. The most common presenting complaints were abdominal pain and weight loss. On clinical examination the findings were non-specific. Only 2 patients were found to have concurrent pulmonary TB. The most consistent laboratory finding (>90%) was a low haemoglobin with a raised C-reactive protein. The tuberculin test (Mantoux) was positive in only 7 patients (22%), and Ziehl-Neelsen staining of ascitic fluid was negative in all 11 patients in whom it was examined. An ultrasound scan of the abdomen revealed findings consistent with TB in 9/28 patients and a CT scan was helpful in 6/11. Laparoscopy, although usually performed as a last resort, proved the most effective investigation, yielding the diagnosis in 23 (92%) of the 25 patients in whom it was performed. In patients with the relevant background and clinical history, laparoscopy is the investigation of choice.
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PMID:Diagnosis of abdominal tuberculosis: the importance of laparoscopy. 1499 81

An unusual case involving an infected hepatic cyst in which the correct diagnosis was made without operation is reported. A 93-year-old woman presented with acute onset of right upper quadrant abdominal pain, mild left lower quadrant abdominal pain, diarrhea, and fever. On admission, computed tomography revealed a 15 cm solitary hepatic cyst in the anterior-superior segment of the liver with a thickened wall that enhanced with contrast media. Ultrasonography demonstrated a 15 cm anechoic lesion with a hypoechoic area in the dependent portion of the cyst and a thickened wall. The serum concentration of C-reactive protein was 24.3 mg/dL, and the white blood cell count was 13,800/microL. A diagnosis of infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. Milky yellow fluid was obtained and the patient's right upper quadrant abdominal pain resolved after drainage. Klebsiella pneumoniae was cultured from the drainage fluid. The patient was discharged 20 days after drainage. Infection has not recurred and the hepatic cyst has not enlarged after 18 months.
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PMID:Infected solitary hepatic cyst. 1468 92

Portal vein thrombosis (PVT) has rarely been documented in patients after splenectomy for gastric malignancy. We report a case of PVT that occurred after splenectomy as part of an en-bloc node dissection performed to treat gastric malignant lymphoma. A 38-year-old man underwent total gastrectomy and splenectomy with en-bloc D2 lymph node dissection. The spleen weighed 480 g. On postoperative day (POD) 31, the patient complained of abdominal pain in the right upper quadrant accompanied by fever. Moderate elevations of C-reactive protein (CRP), aspartate transaminase (AST), and alanine transaminase (ALT) were noted. Contrast-enhanced computed tomography (CT) and ultrasonography disclosed thrombus in the portal vein and the splenic vein. There were no abnormalities in the levels of lupus anticoagulant, protein C antigen, protein S antigen, or antithrombin III (AT III). A diagnosis of PVT was made, and prompt treatment, including intravenous heparin combined with tissue plasminogen activator (tPA) was initiated, followed by longterm warfarin. This treatment resulted in clinical improvement, but failed to achieve thrombolysis in the portal vein. At follow-up after 6 months, the patient complained of postprandial abdominal pain with persistent peripheral edema and ascites. This case indicates that splenectomy for en-bloc node dissection in gastric malignancy is a possible cause of PVT. Because both the symptoms and the laboratory data in PVT are nonspecific, a high level of clinical suspicion and a low threshold for obtaining imaging examinations are important in the early diagnosis of PVT. Surgeons should remember PVT among several other complications whenever patients treated with radical gastrectomies are symptomatic and imaging studies are considered necessary.
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PMID:Portal vein thrombosis after splenectomy for gastric malignant lymphoma. 1471 20


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