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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 the case of a 28-year-old man with a cystic dystrophy of aberrant pancreatic tissue (C.D.A.P.T.) presenting with a history of major abdominal pain. First diagnosis was chronic pancreatitis because of clinical presentation, alcoholic intoxication, and the results of medical imaging techniques. A vagotomy associated with a gastroenterostomy was performed. Several years later the abdominal pain relapsed and failed to be cure by means of medical treatment. A duodenopancreatectomy was performed. Histology demonstrated the diagnosis of C.D.A.P.T. C.D.A.P.T. is a benign disease of the pancreas, limited to its cephalic portion, without demonstrated pathogenesis. C.D.A.P.T. can be either isolated or associated with a chronic pancreatitis. Clinical diagnosis can be particularly difficult as indicated by a literature review. Abdominal pain is the main symptom. Clinical presentation is rarely related to a complication (stenosis). Endoscopy, sonogram, and CAT scan are three techniques of diagnosis value, but intraluminal-sonography is more efficient. Tumor excision is not recommendable. Treatment of C.D.A.P.T. by duodeno-pancreatectomy (D.P.) is often indicated because of concurrent chronic pancreatitis or suspected pancreatic carcinoma. In case of clinical diagnosis of C.D.A.P.T., fenestration of the cysts under endoscopic control is the only local treatment that can avoid D.P.
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PMID:[Cystic dystrophy of aberrant pancreatic tissue in the duodenal wall. Diagnostic and therapeutic problems]. 136 86

We present our experience in the diagnosis-through-image with 25 primitive retroperitoneal tumours over a period of 17 years. The histological type most frequently found was that derived from mesodermal tissue (64%). Abdominal pain and mass were the typical symptoms of the presentation. The paper analyzes the radiological studies used (except NMR) with regard to the diagnostic value they have in this sort of pathology. UIV continues to be the initial examination when a retroperitoneal tumour is suspected, obtaining a diagnostic orientation of 70%. The remaining diagnostic techniques (except arteriography and CAT) should be used as a diagnostic supplement or to assess the disease progression, unless the initial clinical symptoms make their use advisable, since the diagnostic orientation provided is usually below 50%. The use of CAT together with monitored aspiratory puncture provided a diagnostic reliability over 90%, so we conclude this should be the examination technique of choice when retroperitoneal tumour is suspected.
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PMID:[Image diagnosis in primary retroperitoneal tumors]. 180 10

Eighteen years after having a duodenal leiomyosarcoma resected, a patient presented with weight loss, pruritus, and abdominal pain. ERCP was consistent with a cholangiocarcinoma with proximal hepatic duct stricture and nonfilling of the cystic duct. CAT scan revealed no extrinsic masses compressing the gallbladder or biliary tract. At surgical exploration, the patient was found to have a suture granuloma with surrounding fibrosis within the common bile duct. There was no evidence of malignancy.
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PMID:Suture granuloma masquerading as malignancy of the biliary tract. 216 28

We present eleven patients diagnosed of giant hepatic hemangioma in the last 20 years. The diagnosis was confirmed in all the cases during laparoscopy or laparotomy. The mean age of the patients was 44.9 +/- 8.99; nine of them were women. Only two of the patients complained of abdominal pain. Five patients showed abnormal liver function tests; the most common finding was increased levels of alkaline phosphatase. We have reviewed the diagnostic tools employed: isotopic study of the liver with 99Tc, and labeled erythrocytes, abdominal ultrasonography, CAT, hepatic arteriography, laparoscopy, laparotomy and liver biopsy. Usually we employed more than one of these diagnostic methods. In the last years there has been a shift to employ less invasive procedures.
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PMID:[Presenting forms and diagnostic procedures in gigantic hemangioma of the liver]. 263 35

The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.
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PMID:[Pancreatic abscess. Extraperitoneal drainage]. 277 79

Within seven years 506 patients with blunt abdominal trauma were included into a prospective trial. The aim of the study was checking of the validity of clinical parameters, routinely performed laboratory examinations and of the initial circulatory situation in relation to an abdominal organ lesion. Three groups were separated out of the total collective: Group 1: Patients without abdominal lesion (N = 274). Group 2: Patients with abdominal lesion, verified by operation, sonography or CAT scan (N = 232). Group 3: Patients with rupture of the spleen (N = 107) (subgroup of 2). Among the clinical parameters: spontaneous abdominal pain, contusions marks, abdominal tenderness, shoulder pain, and abdominal palpation, the latter does have a high validity (92%). However, in group 1, more than half of the cases also had palpation pain. Shoulder pain has a high sensitivity. Of the laboratory parameters: hemoglobin, hematocrit and leucocytes, only the leucocyte count provided a certain importance: 83% of group 2 had values above 10,000. The circulatory parameters blood pressure and pulse as initial spot picture are of minor validity. Continuous registration of these values at clinical observation has much higher relevance indicating trends towards improvement or deterioration.
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PMID:[The value of clinical aspects, laboratory and circulatory parameters in blunt abdominal trauma]. 321

A proportion of abdominal aortic aneurysms are found at laparotomy to have thick white walls and extensive peri-aneurysmal adhesions. Graft replacement in these patients is often difficult and associated with an increase in morbidity and mortality. In this study 103 patients with a clinical diagnosis of aortic aneurysm were scanned with computerized tomography to determine whether this condition could be diagnosed preoperatively. Of these, 15 showed diagnostic radiological criteria of peri-aortic fibrosis. Laparotomy revealed no false negatives and only one false positive. Clinical, serological and pathological findings have been compared to those with 'normal' aneurysms. In view of the similarities between this condition and retroperitoneal fibrosis, 5 patients were treated with Prednisone 5 mg twice daily for up to 18 months and a CAT scan technique developed to monitor the degree of thickening quantitatively. Abdominal pain disappeared rapidly, and sequential scanning showed a decrease in peri-aortic fibrosis. Measurements showed the fibrosis only to disappear, with no increase in the diameter of the aortic lumen. In some cases, the lumen was only minimally dilated, although clinical examination suggested an aneurysm. Consequently we suggest that the term peri-aortic fibrosis is a better description of this condition whose aetiology is still obscure, and in which aneurysm formation, when present, may simply be consequent upon the fibrotic reaction in the wall.
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PMID:The diagnosis and treatment of peri-aortic fibrosis ('inflammatory' aneurysms). 686 Sep 15

The diagnosis of cytomegalovirus intestinal disease in patients with HIV (human immunodeficiency virus) infection frequently raises diagnostic problems in view of the absence of definite pathological, serological or virological markers of active CMV infection. We describe the case of a 47-year-old man with a CMV colitis which illustrates several diagnostic and therapeutic problems and that was complicated by an intestinal perforation. We emphasize that in HIV+ patients with chronic diarrhea, the presence of abdominal pain should suggest the possibility of a CMV colitis and that in such cases a colonoscopy with biopsies of the right colon should be performed, in view of the higher frequency of the typical histopathological changes at this level. On the other hand, this case presented a marked thickening of the colon wall, simulating pseudotumoral images on CAT scans, as recently described in literature. The therapeutic possibilities as well as the complications of CMV colitis are discussed in the context of the occurrence of an ileal perforation, which represents the first report of this complication in Portuguese literature and which had the particularity of having a long survival after surgery in comparison with the previous cases described in international literature.
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PMID:[Cytomegalovirus-induced colitis in HIV infection. Considerations on its diagnosis, treatment and complications]. 762 21

Papillary cystic tumor of the pancreas is a rare low grade carcinoma, with only 130 cases reported in the English literature. We report a 22 years old female presenting with a palpable mass and abdominal pain. Abdominal ultrasound and CAT scan showed a solid-cystic lesion in the head of the pancreas. The patient was subjected to a partial pancreatoduodenectomy and the histological study of the surgical specimen disclosed a papillary cystic carcinoma. Post op course was uneventful and the patient is well at 8 months follow up.
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PMID:[Papillary cystic tumor of the pancreas: an infrequent carcinoma of good prognosis]. 773 34

In Australia, physicians admitted a 31-year-old woman with a 1-year history of right upper quadrant abdominal pain that had recently radiated to her right shoulder and a 6-week history of swelling over the right lower ribs. She had used an IUD for a total of 10 years. She had a fever and a fast pulse rate. She had a 20 x 20 cm tender, hot, fluctuant mass over the anterior right costal margin with induration nearby. Air entry was minimal at the right lung base. She had low hemoglobin, a high white blood cell count, and a high platelet count. Liver enzyme levels were high. A chest X-ray revealed minor atelectasis of the right lower lobe and a small right pleural effusion. A CAT scan revealed an 8 x 3 cm fluid collection in the extrapleural space beneath the ribs and a 10 x 5 cm collection of fluid indenting the right lobe of liver. Signs of pelvic inflammation were evident. Prior to surgery, intravenous ampicillin, gentamicin, and metronidazole therapy were started. A surgeon incised the abscess, draining 600 ml pus. A catheter was inserted postoperatively to irrigate the area with normal saline so as to complete the drainage. No sulphur granules were seen in the sinus between the ribs. Many neutrophils and a mix of Gram-positive branching bacilli (Actinomyces israellii) and Gram-negative filamentous bacteria (Porphyromonas asaccharolytica) were in the pus. Actinomyces-like organisms were present on a Papanicolaou stained vaginal smear and on a Gram stain of material on the removed IUD. No cultures grew from blood samples. From 2 days to 6 months after surgery, she underwent therapy of amoxycillin/ clavulanic acid 500/125 mg 3 times a day. P. asaccharolytica is usually part of the anaerobic flora of the urogenital and intestinal tracts. Chest wall actinomycosis was a result of distant spread from an IUD-related pelvic infection.
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PMID:Chest wall actinomycosis in association with the use of an intra-uterine device. 785 30


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