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

Diagnostic laparoscopy is rapidly becoming a procedure used by general surgeons in increasing numbers. Its use will follow the therapeutic procedures now being used by many fellow surgeons. As the procedure is generally performed under local anesthesia, new techniques must be learned. The indications include abdominal pain (acute and chronic), focal liver disease, ascites, preoperative evaluation of malignant disease, and second-look evaluations after medical therapy for malignant disease. The overall diagnostic rate is 99% for acute abdominal pain, 70% for chronic pain syndromes, 95% for focal liver disease, 95% for abdominal masses, 97% for ascites, and greater than 80% for retroperitoneal disease. Diagnostic laparoscopy should be used with increasing frequency when a tissue diagnosis is needed.
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PMID:Diagnostic laparoscopy. 826 33

The porphyrias are a group of disorders of haem metabolism. A knowledge of which anaesthetic can precipitate an acute attack of porphyria is important, since an accumulation of metabolites can result in life threatening symptoms, such as abdominal pain, vomiting, photophobia, neuropathy, bulbar paresis and respiratory failure. Treatment consists primarily of adequate calorie intake e.g. glucose, but is otherwise symptomatic. Anaesthetic drug recommendations are based both on animal experiments and patient experience, primarily case histories. An array of local anaesthetics, hypnotics, sedatives, neuroleptics, analgesics, muscle relaxants, inhalation anaesthetics and some antibiotics are reviewed. Patients with a history of porphyria should be in an optimal condition and maintain a high calorie intake perioperatively. The pre-operative fast should be a minimum and iv-glucose is advisable while fasting. There are anaesthetic agents that are safe for both regional and general anaesthesia.
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PMID:[Anesthesia and porphyria]. 831 98

A 3-month-old llama with a presenting complaint of lethargy, anorexia, and a painful, distended abdomen was evaluated. The llama had intermittently strained to defecate during the 3 days prior to admission. Physical examination results, hematologic data and lateral abdominal radiographs were used to diagnose a large umbilical abscess, which was causing a partial obstruction of the gastrointestinal tract. Under general anesthesia, 3 liters of purulent exudate were drained from the abscess. The abscess cavity was then lavaged with saline solution and its capsule was marsupialized to the skin. Cultures of the abscess content yielded Proteus sp, Streptococcus equisimilis, and Clostridium septicum. Two days after surgery, the llama was drinking, eating, and passing feces. The abscess was lavaged daily for a total of 11 days. Six months after surgery, the llama was the same size as other llamas of the same age, and the owners were pleased with the cosmetic appearance of the ventral abdomen. Umbilical abscesses can vary in size and clinical presentation; they should be recognized as a possible cause of abdominal pain with a potential for causing intestinal obstruction in llamas.
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PMID:Abdominal pain associated with an umbilical abscess in a llama. 841 58

A 49-year-old male "Jehovah's Witness" was transferred to our hospital with hypotension, abdominal pain, and abdominal distension, and a diagnosis of ruptured thoracic saccular aneurysm was made. He and his family insisted on having an emergency operation for his ruptured aneurysm without blood transfusion. After an intensive discussion among the patient, his family, surgeons, and the director of the hospital, we performed the operation without blood transfusion. The operation using cardiopulmonary bypass took about five hours under enflurane anesthesia, but he died of circulatory collapse fifteen hours after the end of operation. As there may be various opinions concerning how we should take care of Jehovah's Witness patients, we have to manage them case by case.
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PMID:[An emergency operation for a Jehovah's Witness with ruptured thoracic saccular aneurysm]. 846 93

The coeliac plexus block is an approved method for the relief of upper abdominal pain due to cancer of the upper intra-abdominal viscera or to chronic pancreatitis. While there are many reports concerning the posterior approach to the coeliac plexus block, little attention has been given the anterior approach. There are two ways of implementing the anterior approach to the coeliac plexus: CT-guided and the ultrasound guided approach. METHODS. The ultrasonic-guided anterior approach to the coeliac plexus block is used with the patient in the supine position. The aorta and discharge of the truncus coeliacus or the a. lienalis respectively, are ultrasonographically presented at two levels. After setting local cutaneous and subcutaneous anaesthesia, a 15-cm-long 25 G-needle is introduced into the epigastrium. The point of the needle is--ultrasonographically guided--inserted into the pre-aortic area near the discharge of the truncus coeliacus. The position of the needle point is ultrasonographically controlled on two levels. For the enforcement of a diagnostic coeliac plexus block after careful aspiration on two levels, 10 ml of bupivacaine 0.5% is injected. The spread of the solution is evaluated by ultrasound. If the needle position is correct; a few minutes later the patient has a feeling of warmth in the upper abdominal region. For the enforcement of a neurolytic coeliac plexus block 10 ml ethanol 96% and 10 ml prilocaine 1% can be administered. The two solutions are applied as small volumes in permanent succession. Thus the burning pain, which is often observed after the injection of alcohol, is avoided. RESULTS. In the literature there are only a few reports, about the results and side-effects after use of the anterior approach in the coeliac plexus block. The results of these investigations and our own show total pain relief or at least good pain reduction by at best 85%. The reduction in pain achieved continues in as many as 60% of the treated patients. There is the possibility to stop or at least reduce the analgesic premedication. These results are comparable with those after using the posterior approach to the coeliac plexus block. When carrying out the anterior approach in the coeliac plexus block, most of the patients showed increased intestinal motility. Therefore, about 60% of all patients had transitory diarrhoea. In 12-25% of the patients orthostatic hypotension was observed. This side-effect is avoided by an appropriate infusion before enforcement of the block. In a frequency of 4-100% the occurrence of burning pain was reported during injection of the alcohol. No serious side-effects were observed. CONCLUSIONS. The results concerning total pain relief or at least pain reduction are comparable to the posterior approach for the block. Nevertheless, there are some advantages to the ultrasound-guided anterior approach. There is less risk using this technique. No methodological complications have been observed so far. There is no risk of neurological complications such as paraplegia. Because the patients remain in the supine position, the anterior approach to the coeliac plexus block is suitable for terminally ill patients, who are not able to tolerate the prone position and need careful supervision and good ventilation. Also, no contrast medium is necessary. Only a small volume of local anaesthetics or alcohol is required. We prefer the anterior approach of the coeliac plexus block as a fast, safe and cost-effective method, which should receive increasing attention during the next few years.
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PMID:[The anterior sonographic-guided celiac plexus blockade. Review and personal observations]. 848 98

We described an 11-year-old boy with reflex sympathetic dystrophy (RSD). He presented symptoms of allodynia and hyperesthesia in the right foot with pale color and coldness. Before the onset he had abdominal pain and a change of taste. The symptoms were resistant to physical therapy and the right foot became atrophic. Intermittent lumber epidural anesthesia by an indwelling catheter was performed for three weeks after 5 months from the onset. Improvement of symptoms did not occur during the anesthesia, but did soon after that. The pathogenesis of RSD remains unknown, although a psychological factor may have been involved in this case. RSD in childhood is usually considered to be more responsive to conservative therapy. However, some children such as our patient are resistant to conservative therapy. Recognition of RSD and early interventions such as physical therapy and psychological approach are important. In intractable cases invasive approaches such as sympathetic blockade should be also considered.
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PMID:[Reflex sympathetic dystrophy: a case report]. 853 15

A prospective study of cases of primary peritonitis in children at the Korle-Bu Teaching Hospital, Accra, was undertaken to find diagnostic clinical and aetiological features of the disease. Seventeen children, 15 females and two males, diagnosed as primary peritonitis underwent laparotomy with peritoneal toiletting. Peritoneal exudate and high vaginal swabs (HVS) were taken under anaesthesia for bacteriological analysis. Patients were followed up for one month. Thirteen patients (70%) were aged between 6 to 10 years. Presentation was early (65% presented in less than 48hrs of onset of symptoms). The commonest presenting feature were fever (100%) and abdominal pain (100%) in the absence of headache (100%). All had classical signs of diffuse peritonitis. There was leucocytosis in 15 cases (88%). No bacterial growth was obtained in 50% of cases cultured. Pneumococcus was the commonest organism isolated (33.3%). Of the 7HVS taken, 4 did not yield any bacterial growth and 2 grew escherichia coli but no pneumococcus. There was no correlation between the bacteriological findings of the peritoneal exudate and the HVS. Post-operative complications were few, insignificant and there was no mortality recorded. Sixty five percent (11/17) of cases could be predicted from the clinical symptoms and signs. The results of this study do not support any aetiological theory of causation.
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PMID:Primary peritonitis in previously healthy children--clinical and bacteriological features. 865 34

Pseudocyst formation is a well-known complication of pancreatitis. Pseudocysts of the pancreas are localized collections of fluid occurring within the pancreatic mass or the peripancreatic spaces often following acute pancreatitis or in a patient with chronic pancreatitis without any previous history of an acute episode. The pathogenesis depends on the etiology: in acute pancreatitis, enzyme-rich fluid and products of autodegradation accumulate; in chronic pancreatitis, the cyst results from an obstructed duct. The natural history of the diseases has become clearer with the advent of ultrasound and computed tomographic scanning. The incidence of pseudocysts is noted to be higher as a result of better diagnostic techniques. Pseudocysts must be suspected in patients who have persistent abdominal pain or consistently elevated levels of pancreatic enzymes. Nearly one third of pancreatic pseudocysts resolve spontaneously. Some, however, require intervention. Surgery was the only option available for many years. Recently, newer methods, such as percutaneous drainage and endoscopic cystenterostomy, have been used. Percutaneous drainage is inexpensive, has a low complication rate, and is done under local anesthesia. The recurrence rate is high with a one-time needle aspiration; this rate can be reduced to less than 10% by using an indwelling catheter. On the basis of a review of literature and our own experience, we believe that percutaneous continuous catheter drainage should be the first choice in the management of pseudocysts that require intervention. Experience with the endoscopic technique is increasing, and it may prove to be a viable alternative in skilled hands in the future.
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PMID:Pancreatic pseudocyst. 868 44

Video-thoracoscopic transthoracic splanchnicectomy has been applied to patients in the end stage of pancreas cancer who had intractable pain mediated through the splanchnic nerve in the left upper quadrant. The procedure is performed under general anesthesia in a right hemilateral position. Following the establishment of access to the thoracic cavity, the left splanchnic nerve is cut off at the level immediately above the aortic hiatus, through a small opening made in the pleura between the descending aorta and the vertebrae. All patients had immediate and complete relief of pain postoperatively. Only a transient drop in the mean arterial pressure was observed immediately after cutting off the nerve. No other detrimental effect of the procedure on the general condition was observed. No patients developed postoperative complications. The present method may, thus, be a treatment of choice directed toward the relief of intractable abdominal pain in selected patients with pancreatic cancer.
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PMID:Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain. 871 11

At the Glasgow Royal Infirmary in Scotland, a 26-year-old woman requested termination of her 18-week pregnancy. She had no history of cervical or uterine surgery. She was administered under supervision 200 mg oral mifepristone followed 48 hours later by 600 mcg vaginal misoprostol, which was repeated 6 hours later. Four hours later painful uterine contractions developed. She was administered slow intravenous (IV) diamorphine (total 10 mg) for analgesia. She had vaginal bleeding (about 100 ml). 30 minutes later, the fetus was delivered but not the placenta. Severe abdominal pain ensued, requiring 10 mg more IV diamorphine. She then blanched and peripherally shut down. Physicians had to perform emergency manual removal of the placenta under general anesthesia. They then checked the uterine cavity digitally and discovered a large defect in the uterine wall and a palpable ovary (right) within the uterine cavity. A laparotomy revealed an 8 cm right uterine side wall rupture with considerable hemorrhage into the broad ligament and abdominal cavity. The surgeons performed a hysterectomy and right salpingo-oophorectomy to control the bleeding. The patient lost about 4000 ml of blood. She required 7 units of packed red cells, 1500 ml gelofusine, and 2 l crystalloid and 2 units of fresh frozen plasma. She received 1.2 g augmentin and 120 mg gentamicin perioperatively. She recovered uneventfully. Pathological analysis confirmed the 8 cm rupture. It also revealed normal endometrial decidualization and myometrial hypertrophy and no underlying weakness. This case is the first recorded of uterine rupture after administration of oral mifepristone and vaginal misoprostol. Uterine rupture occurs rarely in second trimester medical terminations of pregnancy. Many cases had risk factors associated with uterine rupture. As a result of this 26-year-old case, the physicians have amended their regimen for drug-induced abortion in cases of second trimester termination of pregnancy.
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PMID:Uterine rupture during second trimester termination of pregnancy using mifepristone and a prostaglandin. 873 Jun 20


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