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Infestation with Ascaris lumbricoides (roundworm) is very common in the tropics and subtropics. Patients with ascariasis can be asymptomatic or may present with different clinical features in the form of simple nausea, decreased appetite, abdominal pain or more severe bowel obstruction, perforation, intussusception, biliary colic etc. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms and also evaluating response to treatment (1, 2, and 3). Here we present four cases of roundworm infestation presenting with acute abdomen in the emergency department, which were diagnosed by USG and further imaging features of ascariasis on USG is described.
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PMID:Roundworm infestation presenting as acute abdomen in four cases--sonographic diagnosis. 1640 53

Internal hernia is an unusal cause of intestinal obstruction. Herniation related to epiploic appendix is a very rare entity. We herein report a case of internal herniation due to an adhesion between epiploic appendixes and the greater omentum. A 71-year-old woman complaining of abdominal pain and intermittent nausea was operated on with the pre-operative diagnosis of intestinal obstruction. Three epiploic appendixes of the left side of the transverse colon and the corresponding part of the greater omentum had created a tunnel and a loop of small bowel 25 cm in length was strangulated. No resection was required after releiving the strangulation. However, the patient died due to massive myocardial infarction in the postoperative period. Internal herniation must be included in the differential diagnosis of patients with acute abdomen or intestinal obstruction. A high index of suspicion with prompt surgical intervention may be the key to the reduction of morbidity and mortality.
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PMID:Internal herniation with fatal outcome: herniation through an unusual apertura between epiploic appendices and greater omentum. 1661 30

Jejunogastric intussusception is a rare complication of gastric surgery. It usually presents with abdominal pain, nausea, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate diagnosis. An early diagnosis and urgent surgical intervention is mandatory. We herein report two cases of patients with jejunogastric intussusception who presented with acute abdomen and hematemesis.
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PMID:Jejunogastric intussusception, a rare complication of gastric surgery: report of two cases. 1686 19

Schwannomas are benign neurogenic tumors that arise from Schwann cells that line the sheaths of peripheral nerves. Schwannomas are commonly located in the soft tissues of the head and neck, extremities, mediastinum, retroperitoneum, and pelvis, but they are very rare in the mesentery. A 56-y-old man was admitted to the emergency service with nausea, vomiting, acute abdominal pain, and constipation. He reported weight loss and an intra-abdominal mass. On physical examination, the abdomen was distended, and a mass that was approximately 15 cm in diameter was palpated at the middle abdomen. Generalized abdominal tenderness and muscle spasm were noted. Air-fluid levels were seen on plain radiographs. Ultrasonography identified an intra-abdominal mass with intra-abdominal hemorrhage or perforation. Clinical signs and laboratory findings suggested an intra-abdominal mass, mechanical bowel obstruction, and an acute abdomen. The patient underwent surgery. The mass was completely excised and included a 4-cm-long intestinal segment that was densely adherent to the mass. Histopathologic and immunohistochemical examination revealed a mesenteric schwannoma. The patient was well 11 mo after surgery. Although schwannomas are very rare and generally asymptomatic, these tumors can become quite large and may cause acute abdominal problems such as mechanical bowel obstruction.
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PMID:Case report: mesenteric schwannoma. 1714 3

Severe abdominal colic because of lead poisoning is an uncommon condition in adults. The diagnosis of lead toxicity is often delayed and abdominal pain is mistaken for acute abdomen. We describe three blood brothers who were involved in pottery glazing and suffered from repeated episodes of severe abdominal pain, nausea, vomiting, constipation and anemia due to lead toxicity. The patients had a history of several hospitalizations and one or two unnecessary laparotomies. One patient had wrists drop and weakness of the fingers extensors. All three patients had microcytic microchromic anemia with basophilic stippling of the erythrocytes, lead lines in X-ray of the knee joint and high blood lead levels. A diagnosis of lead poisoning was made and a course of chelating treatment started. Motor neuropathy, anemia and all gastrointestinal symptoms disappeared. Our report highlights the importance of taking a detailed occupational history and considering lead poisoning in the differential diagnosis of acute abdominal colic of unclear cause.
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PMID:Lead poisoning and recurrent abdominal pain. 1763 99

Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.
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PMID:Acquired jejunoileal diverticulosis and its complications: a review of the literature. 1880 76

A 19-year-old woman presented to the emergency department with intermittent and progressively worsening abdominal pain, nausea, and vomiting. A computed tomographic scan revealed findings consistent with distal small bowel obstruction of unknown etiology. In the operating room, a torsed and gangrenous Meckel's diverticulum with extension of ischemia to adjacent small bowel was discovered and immediately resected. Pathology confirmed the diagnosis of gangrenous Meckel's diverticulum. Torsion and gangrene of a Meckel's diverticulum is a rare complication and often presents with vague and poorly localized signs and symptoms. The preoperative diagnosis is often difficult and presumed to be appendicitis or small bowel obstruction of unclear etiology. Complications of Meckel's diverticulum should be considered in patients with lower abdominal pain and acute abdomen.
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PMID:Torsion and gangrene of a Meckel's diverticulum. 1927 65

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in 2-3% of the population. Enterolith formation associated with MD is a rare entity. We present the case of a 35-year-old active duty sailor who presented with a 24-hour history of worsening abdominal pain and nausea. His exam revealed lower abdominal peritonitis. An abdominal and pelvic CT scan revealed a fluid-filled structure in the pelvis adjacent to the distal small bowel with associated calcifications. Exploratory laparotomy was performed, which revealed an acutely inflamed MD associated with enterolith formation. Consideration of this condition in the differential upon presentation of an acute abdomen is essential, secondary to the morbidity that can accompany it when misdiagnosed.
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PMID:Meckel's diverticulitis with associated enterloith formation: a rare presentation of an acute abdomen in an adult. 1935 4

Retrograde Jejunogastric Intussusception (RJGI) is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. It was first described by Bozzi in 1914 in a patient with gastrojejunostomy. Clinically it is of two types acute and chronic. Anatomically it is of three types. The acute form is a surgical emergency. In the acute form there is chance of strangulation of the intussuscepted loop if early intervention is not done. To avoid mortality, early diagnosis and prompt surgical intervention is mandatory. There is no medical treatment for jejunogastric intussusception and surgical intervention is required for the definite treatment. It usually presents with abdominal pain, nausea, vomiting, haematemesis and a palpable diffuse lump in the upper abdomen. A history of gastric surgery can help in making a diagnosis. X-ray can occasionally be diagnostic. Endoscopy performed by someone familiar with this rare entity, is certainly diagnostic. We herein report a case of jejunogastric intussusception who presented with acute abdomen, haematemesis and abdominal lump.
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PMID:Jejunogastric intussusception. 1962 57

We report the case of an elderly patient with diastolic heart failure and renal insufficiency admitted to hospital as he complained of having a history of hypogastric pain and dysuria without fever due to renal lithiasis and urinary infection. Because the pain was persistence, and considering the presence of renal dysfunction, it was administered a single low dose of paracetamol/codein (500/30 mg). After about 1 hour of the administration, he suddenly complained of the onset of a lancinating epigastric pain radiating to the whole abdomen and retrosternum accompanied by nausea. The electrocardiogram (EKG) was negative for myocardial infarction and computed tomography excluded aortic dissection and other causes of acute abdomen. Laboratory tests showed instead liver and pancreatic damage. The symptomatology was relieved 3 hours later of the onset after antispastic treatment with anticholinergics (floroglucine). The likely underlying pathophysiological mechanism is the codein-induced spasm of the sphincter of Oddi combined with dysfunction of the same sphincter and reduced bile storage capacity related to a previous cholecystectomy. When a similar event does not regress, it may lead to more severe conditions such as acute pancreatitis. Since codein is a widely used drug, this report may suggest cholecystectomy as a contraindication during administration for the risk of occurrence of these complications.
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PMID:Sudden severe abdominal pain after a single low dose of paracetamol/codein in a cholecystectomized patient: learning from a case report. 1982 93


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