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

Although surgical textbooks commonly include foreign bodies in the differential diagnosis of acute abdomen, this cause of abdominal pain has not been reported in the obstetric literature. A 35-year-old woman presented at 24 weeks' gestation with right lower quadrant pain and peritoneal signs. The only abnormal finding at exploratory laparotomy was a free-floating intraperitoneal foreign body, presumably left inadvertently during prior surgery. The differential diagnosis of acute abdomen in pregnancy should include intraperitoneal foreign body in any woman with a history of previous abdominal surgery.
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PMID:Intraperitoneal foreign body as a cause of acute abdomen in pregnancy. 777 87

A retrospective case series was conducted at a teaching hospital with an emergency department (ED) census of 100,000 patients per year to identify the incidence of, and factors associated with, the misdiagnosis of appendicitis in nonpregnant women aged 15 to 45 years. There were 174 nonpregnant women identified with a pathologic diagnosis of appendicitis. Clinical features were then compared between patients misdiagnosed (seen in prior 10 days and given an incorrect diagnosis) and those who were initially diagnosed correctly. The results showed that 33% of the women with appendicitis were initially misdiagnosed. The most common misdiagnoses included pelvic inflammatory disease, gastroenteritis, and urinary infections. Misdiagnosed women more frequently exhibited diffuse and bilateral lower abdominal pain and tenderness, cervical motion, and right adnexal tenderness. Misdiagnosed women also had a lower incidence of right lower quadrant pain and tenderness, and peritoneal signs. In addition, misdiagnosis was associated with an increased incidence of perforation, abscess formation, and an increase in the total length of hospitalization. In conclusion, the incidence of misdiagnosis of appendicitis in women of childbearing age is high. Women who are misdiagnosed have less typical symptoms and physical findings and more frequent abnormal pelvic findings than those who are diagnosed correctly. Emergency physicians should be aware that atypical signs and symptoms are associated with misdiagnosed appendicitis in nonpregnant women of childbearing age.
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PMID:Misdiagnosis of appendicitis in nonpregnant women of childbearing age. 778 32

A case of right lower quadrant pain in a 53-year-old postmenopausal female who underwent appendectomy 21 years previously is presented. Recurrent appendicitis with rupture was noted in the appendiceal stump on exploratory celiotomy after diagnosis by computed tomography scan. Although rare, pathology of the appendiceal stump, whether inverted or not, is a real entity that can be encountered on laparotomy. Malignancy and hemorrhage can also occur in the appendiceal remnant, but the large number of disorders that can cause acute right lower quadrant abdominal pain makes appendiceal stump pathology extremely difficult to detect preoperatively. Because of the extensive differential diagnosis, timely operative intervention for clinical peritonitis in this region should not be delayed.
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PMID:Delayed pathology of the appendiceal stump: a case report of stump appendicitis and review. 797 78

To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. Misdiagnosed patients had a 91% incidence of ruptured appendix, more extensive surgical procedures, and more postoperative complications. Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.
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PMID:Misdiagnosis of acute appendicitis: common features discovered in cases after litigation. 803 44

From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.
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PMID:[Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases]. 878 19

Appendicitis is a common cause of abdominal pain for which prompt diagnosis is rewarded by a marked decrease in morbidity and mortality. The history and physical examination are at least as accurate as any laboratory modality in diagnosing or excluding appendicitis. Those signs and symptoms most helpful in diagnosing or excluding appendicitis are reviewed. The presence of a positive psoas sign, fever, or migratory pain to the right lower quadrant suggests an increased likelihood of appendicitis. Conversely, the presence of vomiting before pain makes appendicitis unlikely. The lack of the classic migration of pain, right lower quadrant pain, guarding, or fever makes appendicitis less likely. This article reviews the literature evaluating the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis.
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PMID:Does this patient have appendicitis? 1876 59

Other pathology besides appendicitis may be found in patients with right lower quadrant pain. This has led some to advocate diagnostic laparoscopy/laparoscopic appendectomy for all such cases. This policy would substantially raise the costs of care without a priori proof of its efficacy. However, a selective approach on when to proceed with diagnostic laparoscopy will depend on the frequency of finding unexpected, nonappendiceal pathology. To determine this, we reviewed our experience with 202 appendectomies. For females < 50 years old, 33 per cent had normal appendices, 12 per cent had periappendicitis, 47 per cent had acute appendicitis, 12 per cent had perforated appendicitis, and 26 per cent had other nonappendiceal pathology. For males < 50 years old, 13 per cent had normal appendices, 8 per cent had periappendicitis, 67 per cent had acute appendicitis, 15 per cent had perforated appendicitis, and 5 per cent had other pathology. For patients > 50 years old, 7 per cent had normal appendices, 13 per cent had periappendicitis, 33 per cent had acute appendicitis, 60 per cent had perforated appendicitis, and 20 per cent other pathology. Other nonappendiceal pathology was found in 42 per cent of females < 50 with normal appendices, 57 per cent with periappendicitis, and 14 per cent with acute/perforated appendicitis. In males < 50 years, 50 per cent of those with normal appendices, 10 per cent of those with periappendicitis, and 0.7 per cent of those with acute appendicitis had nonappendiceal pathology. In conclusion, women of childbearing age and patients > 50 years old have a significant incidence of nonappendiceal pathology. In this group of patients, a diagnostic laparoscopy appears justifiable to identify the cause of the abdominal pain.
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PMID:When it's not appendicitis. 945 30

Right colon diverticulitis, representing 1-3.6% of cases of diverticular disease is an uncommon cause of right lower quadrant pain. Its presentation is difficult to distinguish from acute appendicitis. Patients are between 35 and 50 years old, have a history of 2-3 days of abdominal pain and few gastrointestinal symptoms. The diagnosis is best confirmed by computed tomography and colonoscopy. Conservative treatment is justified in uncomplicated disease, whereas perforations, abcesses and inflammatory tumors require resection. We describe the cases of six patients treated at our institution from 1991 to 1996. Presentation, geographic variations, diagnostic procedures and management are discussed.
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PMID:[Diverticulitis of the cecum and ascending colon]. 955 Dec 61

We report a rare clinical case of recurrent isolated torsion of the Fallopian tube. An 18 year old woman presented with acute right lower quadrant pain, nausea and vomiting. Torsion of the Fallopian tube was detected by laparoscopy and detorsion was performed. Two years later, a second similar episode of pelvic pain recurred. Having in mind the first episode, diagnosis was facilitated and detorsion was performed in accordance with the patient's wishes. However, the dilemma of ideal management of recurrent cases of torsion of the same tube remains open for discussion. The possibility of torsion of the Fallopian tube and recurrent torsion of the tube, although rare, should be considered in any patient with acute onset of lower abdominal pain.
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PMID:Isolated recurrent torsion of the Fallopian tube: case report. 1060 Oct 86

There is no clear scientific evidence for a clinically relevant chronic form of appendicitis in the absence of acute flares. Lacking typical symptoms of acute appendicitis or corresponding imaging findings, no indication is given for appendectomy from the internal medicine point of view. By contrast, chronic or recurrent right lower quadrant pain is often of functional origin and may be part of the Irritable Bowel Syndrome or the Functional Abdominal Pain Syndrome. These syndromes are linked to a higher rate of appendectomies in the medical history. The Irritable Bowel Syndrome may be diagnosed based on clinical symptoms alone. But in doubt and in considering malignancy, the indication for diagnostic imaging is given, after ultrasound particularly by colonoscopy. For positively diagnosing these functional syndromes, the typical clinical presentation, extraintestinal pain syndromes, and psychic factors should be evaluated. The visceral hypersensitivity is the predominant pathophysiologic finding and measured by rectal distention stimuli. Medical treatment comprises relaxatives of smooth muscle and low dose antidepressants as modulators of visceral perception. These are supplemented by the psychosocial management.
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PMID:[Chronic appendicitis. Recurrent abdominal pain in the right lower quadrant from the viewpoint of the internist]. 1067 96


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