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

A 77 year old man was treated for duodenal ulcer and obstipation for 2 years; the diagnosis was not confirmed by endoscopy. Because of recurrent and increasing abdominal pain the patient was admitted to hospital as recurrent duodenal ulcer; this was excluded by emergency endoscopy. At laparotomy a sealed-off perforation of an inflamed jejunal diverticulum was identified complicating the jejunal diverticulosis. The entire jejunal segment involved by diverticulosis was removed. The patient made an uneventful recovery and is well 15 months after surgery. Jejunal diverticulosis may be associated with a variety of complications; it should be considered, especially in the elderly patient, with recurrent gastrointestinal symptoms of obscure origin.
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PMID:[Acute diverticulitis of the jejunum. A rarely diagnosed cause of peritonitis]. 205 45

Jejunal diverticulosis is an uncommon, acquired condition that has been encountered recently in four patients. These cases (two patients with diverticulitis, one patient with chronic abdominal pain, and one patient incidentally discovered at laparotomy for colonic diverticulitis) are reported. Acute complications of jejunal diverticulosis include diverticulitis, bleeding, and intestinal obstruction. Chronic complications include intractable abdominal pain, malabsorption, and intestinal pseudo-obstruction. Up to 15 per cent of patients with jejunal diverticulosis may require small-bowel resection for treatment of these acute or chronic complications. The clinical significance, proper diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.
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PMID:Diverticular disease of the jejunum and its complications. 211 Apr 29

Acquired (non-Meckel's) ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. To gain insight into the frequency of surgical complications of ileal diverticula, we reviewed our experience during the past ten years with 21 patients, 12 women, and nine men. The mean patient age was 62 years; 16 patients (76%) were more than 50 years of age. Thirteen patients had associated diverticula in another segment of the small intestine. In 15 patients ileal diverticulosis was diagnosed during gastrointestinal (GI) radiologic evaluation of abdominal symptomatology. Ileal diverticula were identified intraoperatively in the remaining six patients. In three patients ileal diverticulosis was an incidental finding. Documented surgical complications of acquired ileal diverticula occurred in four patients (19%). Three patients had acute diverticular perforation, and one patient had diverticulitis without perforation. These patients underwent successful operative intervention. Three other patients, all managed nonoperatively, had abdominal symptoms that may have been related to ileal diverticula and were of potential surgical significance. Two patients experienced recurrent rectal bleeding, and the third patient had severe chronic abdominal pain. Although the majority of patients with acquired ileal diverticula do not require surgical treatment, complications such as perforation, bleeding, or incapacitating abdominal pain may necessitate ileal resection.
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PMID:Surgical significance of acquired ileal diverticulosis. 211 67

Reports of adults with Williams syndrome (WS) have been rare. We have evaluated 13 adult WS patients and reviewed 16 case reports of WS in patients older than age 16 years. Adults in our study had progressive multisystem medical problems. Cardiovascular complications were common (12/13) including hypertension (8), supravalvular aortic stenosis (9), aortic hypoplasia (3), pulmonic artery stenosis (4), peripheral stenoses (3), and mitral valve prolapse (2). Joint limitation (12/13) was progressive, often accompanied by kyphoscoliosis and lordosis. Recurrent urinary tract infections in 6 individuals led to radiologic studies showing urethral stenosis in 2, and bladder diverticula and vesicoureteral reflux in 3. Gastrointestinal problems included obesity (5), chronic constipation (7), diverticulosis (3), and cholelithiasis (4). Hypercalcemia was documented in 5 patients, although others had hypercalcemic symptoms (abdominal pain, polyuria, and constipation). One 45-year-old man had parathyroid hyperplasia. Previous reports likewise document significant morbidity. Thus, Williams syndrome in an adult appears to dictate aggressive evaluation and monitoring. Investigation of calcium metabolism should be undertaken in each adult WS patient.
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PMID:Adults with Williams syndrome. 189 83

Small intestinal diverticulosis is a rare cause of abdominal pain. We report the case of a patient whose chronic intermittent abdominal pain was due to recurrent spontaneous perforation of jejunal diverticula, and who ultimately developed an acute volvulus of the small bowel, a very rarely reported association of the disorder.
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PMID:Jejunal diverticulosis complicated by volvulus and recurrent spontaneous diverticular perforation. 212 24

Indicators of a risk group for complicated diverticular disease have been suggested. They are: a) Age 50 years, 2) short history of left lower quadrant abdominal pain, 3) short segment of colon with diverticula, 4) elevated motility index.
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PMID:[Diverticular disease of the colon. Concepts to be reviewed for a rational therapeutic approach]. 213 80

Eleven cases of diverticular disease of the colon were seen in a review of 603 adult barium enema examinations carried out over a 2-year period (January 1984-December 1985) at the University College Hospital, Ibadan, Nigeria--a prevalence of 1.85%. All the cases were clinically unsuspected and the diagnosis was established only at barium examination. Five of the 11 patients presented with rectal bleeding, six with alteration in bowel habit, six with abdominal pain and associated fever and one with right iliac fossa pain and tenderness mimicking appendicitis. Although an uncommon disease in Nigerians, clinicians are urged to suspect diverticular disease in their differential diagnoses of disorder of the colon in Africans in order not to miss a potentially lethal but treatable condition.
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PMID:Diverticular disease of the colon in Ibadan, Nigeria. 255 53

A retrospective study of diverticular disease of the appendix was made in 3,343 consecutive instances of appendectomies. A 2 per cent incidence of diverticular disease was found. These instances were classified into four morphologic types: 1, acute diverticulitis; 2, acute appendicitis with acute diverticulitis; 3, acute appendicitis with diverticulum, and 4, appendix with diverticulum. Types 1, 2 and 3 were divided into subgroups with or without perforation. The elements of clinical behavior in each group were examined in detail. Diverticulitis of the appendix is presented as a clinically variant form of the inflamed appendix. Some followed the pattern of typical acute appendicitis. However, most were distinctive at a later age of onset, longer interval of disease, fewer or absent symptoms of the gastrointestinal tract, failure of typical abdominal pain progression, delay in surgical treatment and a remarkably high incidence of perforation. In a chi-square analysis of 56 patients with acute diverticulitis of the appendix compared with 2,503 patients with acute appendicitis, more than a fourfold incidence of perforation in acute diverticulitis was significant beyond the 0.001 level. These findings of variant behavior and high incidence of perforation are cautionary features of this frequently overlooked disease.
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PMID:Diverticular disease of the appendix. 290 28

A total of 541 open access referrals for fibresigmoidoscopy over five years were compared with 495 hospital initiated procedures during the same period. The number of open access fibresigmoidoscopies doubled during the five years but diagnostic yield remained unchanged at about 40% and was similar to that of the hospital initiated procedures. Colorectal carcinoma was seen in 64 open access patients compared with 47 hospital referred patients, the proportion of Dukes's type A lesions being similar (34%) in both groups. Polyps, colitis, and diverticular disease were equally common in open access and hospital referred patients. Fibresigmoidoscopy failed to detect disease in only 12 patients (1.2%) and the procedure was unsatisfactory in only 54. Referral was considered justified in 475 (88%) open access patients, and only 54 (17%) patients with normal appearances at endoscopy required further investigations. Diagnostic yields were low (19%; 30/156 cases) in open access patients under 40 and in patients with abdominal pain, constipation, or abdominal pain with constipation (0-17%). Most of these young patients presumably suffer from the irritable bowel syndrome and do not justify fibresigmoidoscopy. In contrast, there was a high diagnostic yield (90-100%) in patients of all ages referred for diarrhoea and rectal bleeding, altered blood from the rectum, and rectal bleeding associated with abdominal pain. Open access fibresigmoidoscopy is an effective service that should be freely available to general practitioners.
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PMID:Open access fibresigmoidoscopy: a comparative audit of efficacy. 313 21

To gain insight into the surgical significance of acquired jejunal diverticula, we reviewed the experience at the teaching hospitals in our city during the past ten years. An antemortem diagnosis of jejunal diverticulosis was made in 27 men and 59 women with a mean age of 69.6 years. In 71 patients the diagnosis was made during upper gastrointestinal roentgenologic evaluation for abdominal symptoms, in three it was made during mesenteric arteriography or bleeding scan for massive rectal bleeding, in six it was made during exploratory laparotomy for acute abdominal signs and symptoms, and in the remaining six it was an incidental intraoperative finding. Surgical indications occurred in 13 patients (15%) and consisted of massive lower gastrointestinal bleeding in four patients, blind loop syndrome in three, small bowel obstruction in three, diverticular perforation in two, and chronic abdominal pain requiring jejunal resection in one. In three additional patients with melena and nine with chronic abdominal pain, jejunal diverticulosis was the only abnormality detected; none of these patients had operation. Although the majority of patients with jejunal diverticula do not require surgical treatment, it may be necessitated by complications such as bleeding, perforation, obstruction, blind loop syndrome, or intractable abdominal pain.
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PMID:Surgical implications of jejunal diverticula. 314 56


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