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

The Authors report a case of appendicular mucocele admitted in an emergency setting in the Emergency Department (DEA II). The patient, 78 y-old man, went to attention complaining diffuse abdominal pain: physical examination revealed mild tenderness and right lower quadrant pain to palpation. Rx plain and CT scan demonstrated a right iliac fossa cystic lesion with mural calcification, adherent to the caecum. On basis of imaging, clinical and laboratory findings the patient underwent surgery postoperative diagnosis was mucocele of the appendix. The aim of this report is to discuss the role of imaging and clinical approach in treatment of appendicular mucocele, which is known to be so aspecific in presentation, especially when it occurs in an emergency setting.
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PMID:[Emergency treatment and diagnosis of appendix mucocele]. 1204 68

Neutropenic enterocolitis (NE) is a serious complication in neutropenic patients. Once exclusively thought to be found in patients with leukemia and lymphoma, it is now being seen with increased frequency during bone marrow transplant, chemotherapy for solid tumors, and in patients suffering from acquired immune deficiency syndrome and cyclic neutropenia. The pathophysiology of NE is not completely understood, but unquestionably involves neutropenia, mucosal barrier damage, and infection resulting in a necrotizing process of the bowel wall. The cecum, ileus, and ascending colon are most commonly involved. Initial symptoms are usually nonspecific abdominal pain and fever. Localized, severe right lower quadrant pain, sepsis, and bowel perforation may rapidly develop. Once considered a fatal complication, the outcome for the child with NE has improved with better diagnostic imaging techniques and antibiotics. Most children can be successfully managed conservatively with early introduction of broad-spectrum antibiotics and supportive care. However, a significant number will need surgical intervention. Nursing care of these children requires knowledge of the disease process, excellent clinical assessment skills, and a compassionate, family-centered approach.
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PMID:Nursing care of the child with neutropenic enterocolitis. 1244 72

Infectious complications are not uncommon in children undergoing treatment for cancer. Abdominal pain, especially right lower quadrant pain secondary to appendiceal and cecal inflammation, is a major concern in immunocompromised hosts and a potential source of sepsis. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on preoperative chemotherapy for Wilms tumor, stage IV, favorable histology. Problems related to diagnosis and management of acute abdominal pain and infection in an immunocompromised child with an abdominal mass are discussed along with a review of the literature.
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PMID:Acute perforative appendicitis during preoperative chemotherapy for Wilms tumor. 1255 25

Appendiceal mucocele is a rare clinical condition that causes distension of the appendix lumen with mucus. A seventy-three-year-old female patient presented with complaints of abdominal pain, nausea, and vomiting. Abdominal examination revealed mild tenderness, right lower quadrant pain upon palpation, rebound tenderness and muscular rigidity, and a palpable mass. Abdominal ultrasonography and computed tomography scans demonstrated a cystic lesion in the right iliac fossa, adherent to the cecum, suggesting an abdominal abscess. An emergency operation was performed, during which a diagnosis of a mucocele of the appendix was made. Surgical treatment included appendicectomy, partial resection of the ileum, and resection of the cecum. Histopathologic examination confirmed the operative diagnosis. The role of imaging and clinical approach is emphasized in the treatment of an appendiceal mucocele, especially in emergency settings.
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PMID:A case of giant appendiceal mucocele. 1475 91

The true value of ultrasound in acute abdominal pain lies in its ability to detect gynecologic disorders and effectively rule out other causes of acute abdominal pain that require surgical repair. Although the emergent gynecologic indications discussed in this article are few in number, this does not suggest that the nonpregnant patient presenting to the ED with abdominal pain should not receive an ultrasound examination. On the contrary, the author believes that in a "perfect world," ultrasound should be the initial imaging study in most of these patients. The reality is that it is difficult to convince radiology colleagues to call in a sonologist in the middle of the night for any indication other than ovarian torsion when CT scans can diagnose ovarian cysts and tubo-ovarian abscess. As was pointed out in the section on ovarian torsion, even adequate ovarian blood flow does not rule out this diagnosis.Ideally, an ultrasound of the pelvis could be undertaken at the time of the pelvic examination, adding as little as 5 to 10 minutes. If a gynecologic disorder could be confirmed, other imaging studies might be unnecessary,thereby reducing cost (potential savings on laboratory tests, cervical cultures, or CT scans), length of stay, and adverse complications of CT(contrast material reactions, and radiation exposure).Emergency medicine ultrasound continues to grow at a rapid pace. We are working toward a time when most EPs will be competent and comfortable performing bedside ultrasound examinations in a limited number of applications. The gynecologic application of ultrasound,however, requires skill beyond the level of the primary applications of emergency medicine ultrasound-specifically, mastering Doppler ultra-sound. Although ultrasound has proved to be a valuable imaging modality in the nonpregnant patient with acute abdominal pain when performed by a seasoned sonographer, the role of ED ultrasound has been limited to those EPs with significantly more training. The author believes that even limited expertise in gynecologic ultrasound is valuable in helping direct the management of these patients. Further research by skilled EP sonographers eventually will help define the role of EPs in this particular application of ultrasound. EPs should not be discouraged from developing expertise in this examination when a confirmatory study in radiology will be performed. Miles on the "ultrasound odometer" will not only sharpen sonographic skills but also will help the EP to better communicate with nonpregnant patients presenting with abdominal pain. There is a fairly specific barometer already in place to gauge one's gynecologic ultrasound skills: a seasoned EP sonographer never skips over the chart of a young woman with right lower quadrant pain.
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PMID:Gynecologic ultrasound in emergency medicine. 1530 46

Recurrent right lower quadrant pain in young women can be a diagnostic dilemma. Chronic appendicitis is often mistakenly excluded from the differential diagnosis. In the present case, pelvic inflammatory disease was diagnosed in a 19-year-old woman with bilateral lower abdominal pain (greater on the right than the left), fever, and elevated white blood cell count. She was treated with intravenous antibiotics until resolution of symptoms. The pain recurred 1 month later, and the patient presented to our emergency department. At that time, she was afebrile and all laboratory results were normal or negative, aside from an elevated white blood cell count. Computed tomography suggested a right ovarian dermoid. At laparoscopy, however, the right tube and ovary were normal, and chronic appendicitis was confirmed. Although computed tomography is often accurate for delineating the cause of pelvic abnormality, it also may be misleading.
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PMID:Chronic appendicitis diagnosed preoperatively as an ovarian dermoid. 1560 84

In this short report, we describe a small series of adult patients with chronic appendicitis presenting with chronic right lower quadrant abdominal pain. The clinical presentation was unusual and atypical for classic appendicitis because of the absence of fever, peritoneal tenderness on focused graded compression of the abdomen, and leukocytosis. Computed tomography (CT) findings included the presence of an appendicolith and appendiceal thickening, without mesenteric infiltration, abscess, or collection. In this series, the appendicolith appeared to represent a marker rather than an actual cause of appendicitis. Focused CT scans with additional lung and bone windows proved optimal in detecting appendicoliths, which were not visible on the scout localizer scans, despite windowing modifications. Our findings suggest that chronic appendicitis may be a phenomenon unique to adults and should be included in the differential diagnosis of chronic right lower quadrant pain in patients seen in the emergency room setting. Surgery is curative in such patients, although expectant management is an alternative when tolerated by the patient.
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PMID:Chronic appendicitis "syndrome" manifested by an appendicolith and thickened appendix presenting as chronic right lower abdominal pain in adults. 1640 25

Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain and, in particular, is frequently indistinguishable from acute appendicitis preoperatively. Because of the problems concerning preoperative diagnosis and controversies in the management, the choice of the best therapy on the surgeon's part is still open. A total of 1150 patients with a clinical diagnosis of right acute abdomen observed in our surgical department from 1995 to 2003 was analysed. Three patients had a pathologically confirmed diagnosis of caecal diverticulitis. The mean age of the patients was 37 years. Right lower quadrant pain and local tenderness were the only clinical findings in 95.3% of the cases, with a preoperative diagnosis of acute appendicitis in 2 of 3 patients. The operative findings were an inflammatory mass in the caecum and the presence of a minimal amount of free peritoneal fluid. Two patients underwent laparoscopic ileocecectomy and one had a diverticulectomy. The postoperative course was uneventful. Because of the difficulties in diagnosis and surgical treatment, caecal diverticulitis has been the subject of much discussion in the literature and many questions remain unanswered. Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than sigmoid diverticulitis. Caecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. Diverticulectomy should be performed in patients with small diverticula with a limited inflammatory reaction. Right colectomy should be performed in patients with perforation of the diverticulum, caecal phlegmon or abscess formation. A correct intraoperative diagnosis is therefore crucial for selection of the surgical procedure. Laparoscopic treatment of a solitary, acutely infected colon diverticulum is feasible in this setting. A minimally invasive procedure could be performed, therefore, in patients with right acute abdomen, allowing not only the right diagnosis but also the treatment of the commonest pathologies responsible for this clinical picture.
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PMID:Laparoscopic treatment of caecal diverticulitis. 1672 10

Sacral meningoceles are typically asymptomatic. When they are symptomatic, patients commonly present with signs and symptoms of nerve root compression and back pain. The authors report the case of a 10-year-old girl with an intraspinal sacral meningocele who presented initially only with severe right lower quadrant pain. The patient underwent successful surgical treatment of the meningocele and experienced subsequent resolution of the abdominal pain. This is the first reported case of an intraspinal sacral meningeal cyst in which the only presenting symptom was abdominal pain and which was successfully treated with surgery. It is postulated that the sacral meningocele caused severe abdominal pain secondary to compression of the sacral parasympathetic fibers that pass through the sacral plexus on each side of the cord corresponding to the S-2 and S-3 levels.
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PMID:Sacral intraspinal meningocele in a patient presenting with abdominal pain. Case report. 1764 21

Diverticulitis has long been regarded as a disease of the elderly, but its incidence has been increasing in those under age 40. Younger patients with diverticulitis are more likely to be male and obese. They often have atypical presentations, and 25% may have right lower quadrant pain. Not surprisingly, the condition is often misdiagnosed, resulting in unnecessary surgery. An abdominal CT scan is the modality of choice for diagnosis, but the most important diagnostic step is simply to include diverticulitis on the differential diagnosis of a young person with lower abdominal pain.
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PMID:Case series: diverticulitis in the young. 1797 49


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