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

The value of a high-fiber diet in preventing and treating colonic diverticula is firmly established. Although the diagnosis of diverticulosis is usually made with colonoscopy or barium enema examination, computed tomography has become the test of choice during acute diverticulitis, when the diagnosis cannot be confidently made clinically. Recently developed surgical principles for diverticulitis include radiographically directed drainage with delayed operation for peridiverticular abscess, resection of the site of disease in patients with general peritonitis, and primary anastomosis in most cases requiring urgent intervention. Diverticulosis accompanied by abdominal pain or irregular bowel habits is by itself rarely an indication for surgery. Diverticular bleeding usually resolves spontaneously, but persistent bleeding can usually be successfully treated with segmental colectomy after localization of the bleeding site with colonoscopy or arteriography.
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PMID:Colonic diverticula. When complications require surgery and when they don't. 133 12

A 10-year-old girl who had a pelvic and femoral osteotomy for congenital dislocation of her right hip was immobilized with a hip spica. On the 28th postoperative day, she had upper abdominal pain, distention and bilious vomiting. An upper GI series demonstrated complete obstruction of the duodenum at the third portion of the duodenum in a supine position; however, the barium passed the obstruction site slowly when the patient assumed a lateral or prone position. She was successfully treated conservatively with nasogastric decompression, fluid replacement, proper positioning and hyperalimentation. Superior mesenteric artery syndrome is a rare complication in patients immobilized in a body cast or hip spica. Early diagnosis and proper treatment usually leads to an uneventful convalescence.
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PMID:Superior mesenteric artery syndrome as a complication in hip spica application for immobilization: report of a case. 136 Mar 6

Intussusception is one of the leading causes of bowel obstruction in early infancy and childhood. From 1984-1989, 67 patients under 2 years of age with intussusception were diagnosed and treated in our institution. There were 48 boys and 19 girls ranging in age from 2 months to 2 years with a mean of 7.4 months. Presenting symptoms and signs included abdominal pain (96%), vomiting (93%), rectal bleeding (60%) and a palpable mass (67%). Symptoms and signs were present for less than 24 hours in about 80% of cases. Most of the intussusceptions were of the ileocolic type (75%). The overall success rate of hydrostatic barium enema reduction was 49%. The highest rate of reduction by enema was among patients between 9 and 16 months of age (83%). The success rate of barium enema reduction was negligible after 24 hours of cardinal symptoms. Five children underwent surgical exploration without contrast studies because of delayed presentation and signs of an acute abdomen. A pathological lead point was found in only four cases, the commonest being Meckel's diverticulum. The average length of hospitalization was 2.57 days after barium enema reduction and 7.55 days after surgical reduction. There were no deaths. There was no case of perforation during enema reduction. Three children had recurrence within 3 months of initial presentation. The best outcome is associated with early diagnosis and barium enema reduction, or selected surgical intervention when indicated.
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PMID:Intussusception in children under 2 years of age in the State of Qatar : analysis of 67 cases. 137 79

A case of a rare recurrent lipoma originating from the perirenal fat is reported. Onset of symptoms (abdominal pain, weight loss, appetite loss, abdominal swelling, nausea, constipation) is late and the treatment is surgical, but postoperative radiation or chemotherapy may be indicated. Ultrasound, CT and NMR scans, pyelograms and barium enemas are the most important diagnostic investigations. Follow-up in these patients is important.
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PMID:Recurrent benign retroperitoneal lipoma. 141 Sep 12

We present the results from 233 consecutive patients treated for intussusception at the Children's Hospital of Coimbra over a 13-year period (between 1/6/77 and 31/5/90). Males outnumbered females (66.5% vs 33.5%) and 87.9% of the cases occurred within the first year of life. Among the presenting signs and symptoms, abdominal pain occurred in 87.9% and vomiting in 81.5%. The presence of currant-jelly stools was less common, but noted in 67.3%. Hydrostatic barium enema was performed in 94.4% of the patients with the aim being both diagnostic and therapeutic, successful reduction was achieved in 57.7%. One hundred and twenty-one patients were operated on with specific pathologic lesion found in 11.5% of them. Complications occurred only in the group submitted to surgery. Six children were reoperated on. Most intussusceptions were of the ileocecocolic variety. The overall recurrence rate was 3.8% (3% recurrent intussusceptions followed barium enema reduction and 0.8% followed manual reduction). Mortality rate was 2.5% (1.7% related to intussusception).
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PMID:[Intussusception in the Pediatric Hospital of Coimbra. 13-year results]. 144 15

We report the first known case of syphilitic gastritis in an HIV-infected person. The presentation of nonspecific abdominal pain and weight loss in a 48-yr-old former intravenous drug user previously treated for asymptomatic syphilis led to a barium swallow which demonstrated linitis plastica. Upper endoscopy reinforced a suspicion of carcinoma, but biopsy made the diagnosis of syphilis by silver staining. Further testing revealed a positive serology for syphilis as well as HIV infection with a depressed CD-4 lymphocyte count. Treatment with parenteral penicillin led to a rapid resolution of symptoms. This case represents a rare complication of late syphilis, and is another example of the unusual manifestations of syphilis seen in the HIV-infected population.
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PMID:Syphilitic gastritis in an HIV-infected individual. 144 50

The diagnosis of acute appendicitis can be difficult. Barium enemas, computed tomography (CT) scans, ultrasound examinations and Indium scans are used to aid in making the diagnosis with varying degrees of success. This blinded, prospective study reports the use of a Technetium 99-m Hexamethylpropyleneamineoxide (HMPAO) labelled white blood cell scan in 30 patients with suspected appendicitis. Autologous white blood counts from 25 cc of whole blood labelled with Tc-99 HMPAO were reinjected into patients. Abdominal imaging was performed at a half hour postinjection and repeated at 2 to 4 hours postinjection. A positive study showed an increased isotope uptake in the right lower quadrant. Nineteen patients had histologically proven appendicitis. Three of these patients were excluded because they were operated on before scan completion. Thirteen of the remaining 16 patients with appendicitis had positive studies (false negative rate = 19%). All patients without appendicitis had either negative scans or scans that detected other intra-abdominal diseases, such as diverticulitis, tubo-ovarian abscess, or small bowel infarction (false positive rate = 0%). Overall, this Tc-99 HMPAO study had a sensitivity of 81 per cent, a specificity of 100 per cent and an overall accuracy of 89 per cent. The 4-hour Tc-99 HMPAO WBC scan is a useful, noninvasive test for confirming the clinical diagnosis of acute appendicitis, but it may prove more valuable as a diagnostic study to rule out appendicitis in patients that have abdominal pain of unclear etiology.
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PMID:Detection of acute appendicitis by technetium 99 HMPAO scanning. 145 3

Crohn's disease is a rare cause of gastrocolic and duodenocolic fistulas. Only 83 examples (27 gastric, 52 duodenal, four both) have been described. Weight loss, abdominal pain, and diarrhea are common features but fail to distinguish a fistula from active inflammatory bowel disease. Fecal vomiting is pathognomic but is present in one third of gastrocolic and only 2% of duodenocolic fistulas. Diagnosis is most readily made by contrast radiography, with barium enema being more sensitive than barium meal. Although several gastrocolic fistulas have been successfully treated with long-term 6-mercaptopurine, surgery is the mainstay of therapy. An isolated duodenocolic fistula should not be regarded as the primary indication for operation because most are asymptomatic. Ileocolonic resection with simple gastric or duodenal repair is safe and effective in most cases. An ileocolonic anastomosis should be positioned away from the stomach or duodenum or protected with omentum to prevent recurrent fistulization. A number of fistulas appear to have arisen from gastric or duodenal Crohn's, but the vast majority originate from diseased colon.
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PMID:Gastrocolic and duodenocolic fistulas in Crohn's disease. 147 63

We established an open-access, flexible, fiberoptic sigmoidoscopy service in an outpatient clinic in Kiriat-Shmona, Northern Israel. Twenty-eight general physicians in the city and in 41 surrounding rural residences (population 40,000) were encouraged to refer patients for sigmoidoscopy. In the first operative year, flexible sigmoidoscopy was performed on 255 patients (age range 10-90 years, mean 54). The male to female ratio was 123:132; women were slightly older than men (mean age 55.9 years vs. 51.1). Rectal bleeding and change in bowel habits were the most common indications. The sidmoidoscope was passed to the splenic flexure in 156 patients (61%). In five patients (2%) the instrument could not be inserted beyond the rectosigmoid junction. Excluding hemorrhoids and anal lesions, abnormalities were detected in 69 patients (27%). In 29 patients (11.4%) a cancer or polyp was found. Analysis of referral indications showed an increased positive predictive value for neoplastic lesions in patients referred for anemia (22.2%), weight loss (20.0%), abdominal pain (17.8%), and positive fecal occult blood test (15.4%). There were only two patients with polyp or cancer of 55 (3.6%) < 40 years of age, in contrast to 27 of 200 (13.5%) > 40 (p < 0.05). Sixty-six patients underwent further investigation, and 26 had positive results: colonic lesions were confirmed in 20 patients, sigmoid colon cancer was found on barium enema in one, and lesions outside the colon were detected in seven. Such open-access, flexible sigmoidoscopy gave higher yield for colorectal polyps or cancers than open-access or hospital-initiation barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Open-access, flexible, fiberoptic sigmoidoscopy in a regional primary-care clinic. 147 65

In a retrospective study the use of imaging modalities in the diagnosis of non-specific abdominal pain in patients under 31 years was evaluated. 253 patients with primarily non-specific abdominal complaints were analysed. For further investigation one of the following methods had to be applied: abdominal sonography and/or upper gastrointestinal tract roentgenograms and/or enteroclysis and/or barium enema. In 66% (167/253) of all cases abdominal pain remained non-specific. Clinical history and physical examination led to the final diagnosis in 66/86 (76.7%) of patients with pathologic findings. 21/561 (3.7%) radiographic examinations revealed abnormalities of clinical importance. In 10/253 (4%) patients the final diagnosis could be established only with the help of radiologic and/or endoscopic examinations. The low efficacy of conventional radiology justifies the demand for a stricter indication in the young patient suffering from non-specific abdominal pain.
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PMID:[The value of imaging techniques in the diagnosis of non-specific abdominal pain in young patients]. 150 23


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