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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 severe metabolic acidosis associated with acute renal failure and septicaemia following treatment with maximal therapeutic doses of metformin and diclofenac. On the second day of intensive care the patient deteriorated with respiratory insufficiency and abdominal pain during continuous renal replacement therapy. A laparoscopy revealed a perforated cholecystitis with abscess formation. The patient regained renal function and recovered. Intake of diclofenac 5 days before this episode could have been the main cause of renal insufficiency and metabolic acidosis in this patient and could also have delayed surgical treatment by masking early clinical signs of perforated cholecystitis. The renal failure may also have caused metformin and lactate to accumulate, contributing to the mixed pattern of metabolic acidosis. This case report describes a mixed organic and non-organic metabolic acidosis associated with acute renal failure, presumably resulting from a combination of drugs and diseases often found in the elderly - metformin for diabetes mellitus and a non-steroidal anti-inflammatory drug for cholecystolithiasis. Acid-base balance and electrolyte changes were rapidly normalized by continuous renal replacement therapy.
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PMID:Intensive care treatment of severe mixed metabolic acidosis. 1575 11

Gallstones are usually asymptomatic in the majority of patients. Gallstones can migrate through a cholecysto-duodenal fistula and may cause an intestinal obstruction anywhere along the gastrointestinal tract. The obstruction usually occurs at the level of the ileocecal valve. In most cases, the clinical presentation includes symptoms related to the intestinal obstruction including abdominal pain and vomiting. We report an unusual case of gallstones presented with acute prerenal azotemia as the major manifestation.
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PMID:Unusual presentation of gallstones. 1599 Sep 39

A 62-year-old lady presented with fever and abdominal pain. History revealed cholecystectomy two years ago due to cholecystolithiasis, complicated by perforation of the common bile duct, leading to hepaticojejunostomy, jejunocholedochostomy, endoscopic retrograde insertion of two plastic stents and percutaneous drainage of bilioma. The patient was lost to follow-up until she presented two years later in the emergency room. ERC was performed. Both stents were occluded. After extraction dirty bile popped out. Injection of contrast medium showed stones in the remaining common bile duct and dilatation of the intrahepatic bile ducts and the interposed jejunum. After stone extraction a subphrenic intrahepatic fluid collection became visible when injecting contrast medium in the intrahepatic bile ducts. Pus was aspirated. The abscess was drained with a nasobiliary tube. Antibiotics were given. Temperature and CRP normalized. The nasobiliary tube was removed when the biliary fluid was clear. Recovery was uneventful with complete resolution of symptoms.
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PMID:[Cholangitis with subphrenic abscess after complicated cholecystectomy due to occluded plastic stents]. 1662 60

Situs viscerum inversus is a rare condition in which the organs are transposed, totally or partially, to the opposite side of the body. Normally, there are no organ dysfunctions. Clinically, symptoms of cholelithiasis may be clear but confused by the location of the gallbladder on the opposite side. We report the case of a 43-year-old female with occasional colic pain in the epigastrium radiating to the right side and subscapular region, particularly after lunch. The laboratory findings showed normal values and, at physical examination, deep palpation of the abdomen in the epigastric region provoked pain. X-rays, ultrasonography, and CT scan showed the presence of multiple gallstones and the situs viscerum inversus of the abdominal organs. The only pathological finding was cholecystolithiasis. Laparoscopic cholecystectomy was judged advisable. Situs viscerum inversus is not a contraindication for laparoscopic cholecystectomy. This abnormal anatomical condition may create some initial difficulty for the surgeons, because of the inverted position of the organs. The peculiarity of our case is the unlikely site of the abdominal pain, located in the epigastrium and on the right side although the patient had situs viscerum inversus. Laparoscopic cholecystectomy can be performed on the left-sided gallbladder proceeding with the "american technique". In difficult cases, open cholecystectomy can be unavoidable.
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PMID:Cholecystectomy in situs viscerum inversus totalis. Does laparoscopy increase the pitalls? 1673 66

There are not many studies of gallbladder disease in Africa. The disease appears to be not uncommon in Ethiopia. To determine the prevalence and evaluate the management of gallstone disease in a central teaching hospital, a 5-year retrospective study was undertaken in 747 patients surgically treated for gallbladder disease in the period 1995-99 in Tikur Anbessa Hospital, Addis Ababa. The sex ratio (M:F) was 1:5, narrower ratio in complicated cholelithiasis. The mean age was 42 years. About 80% of patients were in the age group between 30 and 60 years. The median duration of symptoms at admission was 2 years. Abdominal pain, in 96% of cases situated in the right upper quadrant (RUQ) and usually aching type, was the most frequent presenting symptom; RUQ tenderness was the most common sign. Clinically, 29.4% of patients were categorized obese. Gallstone detection rate by ultrasound was about 96% but cholecystitis appeared to be overlooked. At operation, about 77% of cases had features of chronic cholecystitis, 2% acalculous cholecystitis. Majority of the stones were grossly cholesterol stones. Cholecystectomy was performed in 99% of cases, most often through the oblique subcostal and transverse routes. The overall in-hospital mortality rate was 0.4%. Nearly 87% of cases had postoperative course without incident. The etiologic factors and the type of gallstones, we believe, are not different from that of the developed world. Cholecystectomy is a safe and most effective procedure that provides ultimate cure for symptomatic gallstone disease.
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PMID:Gallstone disease in a teaching hospital, Addis Ababa: a 5-year review. 1744 63

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.
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PMID:[Childhood cholelithiasis in a district hospital]. 1758 24

Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula.
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PMID:[A case of jejunal perforation in gallstone ileus]. 1838 51

Gallbladder congenital duplication is a rare disease difficultly diagnosed preoperatively. Eight days after a laparoscopic cholecystectomy a 72-year-old man, complaining of abdominal pain and vomiting, presented to our emergency department. Ultrasound and computer tomography (CT) scans demonstrated a gallbladder-like structure with a 12-mm diameter stone and a subhepatic fluid collection. During an endoscopic retrograde cholangiopancreatography, a probably second gallbladder with a fistula of the posterior wall was filled with contrast. Laparoscopic exploration confirmed a missed gallbladder, which was successfully removed. Histologic diagnosis of cholecystolithiasis and chronic cholecystitis was made. The postoperative course was uneventful. Symptomatic double gallbladder should be considered also during the complicated postoperative course after the laparoscopic cholecystectomy and laparoscopic reoperation is feasible.
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PMID:Perforation of missed double gallbladder after primary laparoscopic cholecystectomy: endoscopic and laparoscopic management. 1850 79

Acute pancreatitis is an inflammatory disorder, that is classically accompanied by abdominal pain and elevated serum lipase and amylase levels. While about 80% of the patients recover without complications, 20% develop severe local and systemic damages. Gallstone migration into the common bile duct and excessive alcohol abuse account for most of the cases, but also drugs have been shown to induce acute pancreatitis. Treatment of acute pancreatitis is only supportive, especially in severe episodes an interdisciplinary cooperation of gastroenterologists, radiologists, intensivists, and surgeons is required. The better understanding of the pathophysiology might merge into more tailored therapeutic procedures and improve the outcome of this disease.
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PMID:[Acute pancreatitis: etiology, diagnosis and therapy]. 1973 51

Epidermoid cysts are the most common type of cutaneous cyst. However, their occurrence in the deep abdominal wall has not yet been reported. Here, we present the case of a 60-year-old woman who developed an epidermoid cyst in the deep abdominal wall, which was resected laparoscopically. The patient presented with right upper quadrant abdominal pain on admission to our hospital. Computed tomography revealed cholecystolithiasis and an incidentally identified well-defined hypoattenuating mass (62 x 47 x 65 mm) in the deep abdominal wall on the left side of the navel. We performed laparoscopic complete resection of the abdominal wall tumor followed by cholecystectomy. The excised specimen was a cyst covered with a smooth thin membrane and contained sludge. Histopathologic examination revealed an epidermoid cyst. This is a very rare case with no previous reports on a similar type of epidermoid cyst.
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PMID:Laparoscopic excision of an epidermoid cyst arising from the deep abdominal wall. 1985 Dec 59


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