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

Forty splenic infarcts in 23 patients were examined with ultrasound (US). At clinical presentation, splenic infarction was associated with severe left upper quadrant pain (n = 10) or diffuse abdominal pain (n = 4) or was asymptomatic (n = 9). In this retrospective study, predominantly wedge-shaped (n = 17) or round (n = 23), irregularly delineated (n = 33) or smooth (n = 7), hypoechoic (n = 40) and anechoic (n = 5) lesions were found at first examination. During follow-up observation, four patients died because of complications unrelated to infarct, and five patients underwent splenectomy as a consequence of US findings. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood (even in spleens shown to have an intact surface at sonography), and flow phenomena in the area of infarction demonstrated at B-mode pulsed Doppler US were identified as infarct-related complications associated with the risk of splenic rupture. Despite the high self-healing tendency in splenic infarction, short-term follow-up with US is recommended for early recognition of these possible complications.
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PMID:Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. 240 85

Two recent cases of splenic infarction of unusual cause stimulated a review of our experience with this condition. We conducted a retrospective chart review of selected patients with pathologic diagnosis of splenic infarction seen at a large metropolitan private teaching hospital during the past 30 years. Variables analyzed included sex, age, etiology of infarction, underlying diseases, diagnostic tests, splenic pathology, and complications. Splenic infarction occurred in 59 patients (33 male and 26 female; average age, 55 years; range, 2-87 years). Etiologies included hematologic disorders (n = 35), thromboembolic disorders (n = 17), and other diseases (n = 7). Symptoms were present in 69 per cent of the patients and included abdominal pain, fever and chills, and constitutional symptoms; 18 patients were asymptomatic. Patients with nonmalignant hematologic conditions were often asymptomatic (55%); abdominal pain was common in all groups, and fever was especially common in patients with embolic conditions (70%). CT scan was the most frequent radiologic study. Patients with hematologic conditions usually were explored for complications of those conditions (69%), while complications of splenic infarction were a frequent indication for operation in patients with emboli (60%). Overall morbidity was 36 per cent, with pulmonary complications most frequent, and mortality was 5 per cent. We conclude that splenic infarction must be suspected in patients with known hematologic or thromboembolic conditions who develop left upper quadrant pain and signs of localized or systemic inflammation. CT scan is currently the preferred diagnostic test, but ultimate diagnosis depends on pathologic examination of the spleen. Surgical complications of splenic infarction include abscess and rupture.
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PMID:The clinical spectrum of splenic infarction. 948 95

Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2- to 3-cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient's symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.
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PMID:Indirect evidence of ectopic pancreatic fascioliasis in a human. 1692 33

We report a case of splenic abscess that was successfully treated with percutaneous ultrasound-guided drainage and without splenectomy. A 40-year-old woman was admitted to Nippon Medical School Hospital because of pyrexia and left upper quadrant pain, which had persisted despite antibiotic treatment. On admission, computed tomography demonstrated a low-density area in the spleen, which had been been seen on computed tomography 3 months earlier. Ultrasonography demonstrated a hypoechoic area in the spleen. Initial laboratory tests revealed a serum C-reactive protein concentration of 19.7 mg/dl and a white blood cell count of 15,800 /microl. The serum glucose concentration was 267 mg/dl, and the glycolated hemoglobin value was 7.7%. A splenic abscess was diagnosed and was treated with percutaneous drainage. Milky yellow fluid was obtained, and the patients left upper quadrant abdominal pain and pyrexia resolved. A culture of the drainage fluid yielded Escherichia coli. The drainage catheter was removed 12 days after insertion. The patient was discharged 6 days later. The splenic abscess has not recurred during 3 months of follow-up. Our results suggest that ultrasound-guided percutaneous drainage is a safe and effective alternative to surgery for the treatment of splenic abscess and allows preservation of the spleen.
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PMID:Successful percutaneous ultrasound-guided drainage for treatment of a splenic abscess. 1762 77

A 27-year-old man, an alcohol abuser, had alcoholic pancreatitis complicated by a 3.2 cm pancreatic tail speudocyst and intrasplenic pseudocysts presenting with left upper quadrant pain of one-month duration. Surgical resection or percutaneous drainage of the cystic lesions of the pancreas and the spleen was refused. Analgesic agents were given for relief of abdominal pain. Three months later, another episode of alcoholic pancreatitis occurred. A computed axial tomographic scans of the abdomen showed diffuse enlargement of the pancreas with a 3.0-cm pseudocyst in the pancreatic tail, but there was no evidence of previous intrasplenic pseudocysts. The patient was treated conservatively and was discharged on the 7th hospital day. There was no recurrence of abdominal pain after 3 months follow-up.
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PMID:Pancreatic tail pseudocyst associated with spontaneous resolution of intrasplenic pancreatic pseudocyst. 1921 6

A 31-year-old man with no significant medical history presented with a 5-day history of progressive left upper quadrant abdominal pain. Physical examination revealed a tender guarded abdomen, no icterus, and bilateral corneal "arcus senilis"-like changes. Laboratory workup showed a mild normocytic, normochromic anemia; and target cells were seen in the peripheral blood smear. Serum was turbid; and the lipid profile showed elevated total cholesterol, low high-density lipoprotein cholesterol, and elevated triglycerides. Urinalysis revealed nephrotic range proteinuria with microhematuria. An abdominal computed tomographic scan demonstrated a homogeneously enlarged spleen. The patient was discharged after symptomatic treatment to be followed as an ambulatory patient. Several days later, he returned with severe left upper quadrant pain and was admitted to the surgical service for further evaluation. A splenectomy was performed for a suspected splenic lymphoma. Upon gross examination, spleen was moderately enlarged, weighing 780 g. Sectioning revealed a beefy red cut surface without gross lesions. Wright-Giemsa-stained touch imprints showed many sea-blue histiocytes. A renal biopsy was also performed, demonstrating focal segmental glomerular sclerosis and mesangial expansion with extramembranous and intramembranous deposition of lipids. In the absence of hematologic malignancy and in light of the abnormal lipid profile, a disorder of lipid metabolism was suspected. Histologic and ultrastructural findings in the kidney and spleen raised the likelihood of lecithin-cholesterol acyltransferase (LCAT) deficiency, which was confirmed by the markedly decreased serum LCAT activity and serum LCAT mass. We describe a case with the triad of splenomegaly with sea-blue histiocytes, nephropathy, and dyslipidemia in a patient with LCAT deficiency.
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PMID:Splenomegaly with sea-blue histiocytosis, dyslipidemia, and nephropathy in a patient with lecithin-cholesterol acyltransferase deficiency: a clinicopathologic correlation. 1959 52

A 31-year-old Canadian Aboriginal man from northwestern Ontario presented with left upper quadrant pain and a tender left upper quadrant mass. Evaluation with a computed tomography scan showed multiple lesions within the spleen, a collection between the splenic tip and splenic flexure of the colon, and several small adrenal lesions. Computed tomographic-guided needle biopsy showed necrotizing granulomatous inflammation and multinucleated giant cells. Gomori's methenamine silver stain showed broad-based budding yeast consistent with Blastomyces dermatitidis. Abdominal symptoms resolved after two months of oral itraconazole. Multiple splenic abscesses are a rare presentation of blastomycosis and should be considered in the differential diagnosis of left upper quadrant abdominal pain in a patient with a history of travel or residence in a region endemic for B dermatitidis.
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PMID:Blastomycosis presenting as multiple splenic abscesses: Case report and review of the literature. 2135 86

Epicardial pacemaker leads placed during childhood are often not removed when transvenous systems are placed later in life. The risk of complications related to retained pacemaker leads and generators is not clear but is generally considered low. We report the case of a 23-year-old pregnant woman who presented with left upper quadrant pain at 20 weeks gestation. The patient was born with {S,L,L} transposition of the great arteries and had high-grade conduction disease in infancy compelling epicardial pacemaker placement. A standard transvenous pacemaker was placed at age 9 years, without removal of the epicardial system. The patient's abdominal pain was attributed to herniation of abdominal contents through a diaphragmatic defect at the site of the abandoned epicardial pacing wire. Her pain improved spontaneously but worsened later in pregnancy leading to repair of the diaphragmatic hernia via anterolateral thoracotomy at 30 weeks gestation. The procedure was well tolerated by mother and fetus. At 38 3/7 weeks gestation, the patient underwent uneventful delivery by cesarean section for breech presentation. This case illustrates the importance of multidisciplinary collaboration in the care of women with congenital heart disease.
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PMID:Discovery and management of diaphragmatic hernia related to abandoned epicardial pacemaker wires in a pregnant woman with {S,L,L} transposition of the great arteries. 2171 59

Splenic cystic lymphangioma is a very rare benign neoplasia characterized by cystic dilation of the lymphatic vessels of the splenic parenchyima. It may occur in the spleen only or in multiple organs. We describe the case of a 46 year-old female, with he diagnosis of splenic cystic lymphangioma. Its clinical manifestations include abdominal pain, especially in left upper quadrant pain, abdominal distension, loss of appetite. Physical examination showed no specific findings. Ultrasonography and CT scann imaging showed multiple cysts replacing the normal parenchyma of the spleen. We report herein the surgical significance of lymphangioma of the spleen from both diagnostic and also therapeutic aspects, and we discuss laparoscopic splenectomy as an effective procedure for an excision of a splenic tumor suspected to be benign. .Histologic study after splenectomy confirmed the diagnosis of cystic lymphangioma of the spleen.
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PMID:[Splenic cystic lymphagioma]. 2178 13

Solitary caecal diverticulitis is a rare and often misdiagnosed cause of abdominal pain. A 63-year-old Caucasian woman was admitted with a 3-day history of left upper quadrant pain and constipation. Preoperative imaging identified a possible transverse colonic tumour. At laparotomy a long, mobile ascending colon resulted in the caecal pole lying in the left upper quadrant and an inflamed gangrenous solitary caecal diverticulum was found. A right hemicolectomy was performed and the patient recovered promptly.
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PMID:An unusual presentation of caecal diverticulitis. 2193 80


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