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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of spontaneous expulsion of a lipoma in a 32 year old male patient who presented with recurrent attacks of subacute intestinal obstruction. During one such episode the patient developed unusually severe abdominal pain and expelled a fleshy mass per rectum which, on histopathology, was found to be a lipoma attached to a necrosed portion of the small intestine. The pain disappeared immediately; a subsequent barium meal examination revealed normal appearances and the patient has remained completely symptom free 10 months after the incident.
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PMID:Spontaneous expulsion per rectum of an ileal lipoma. 325 Dec 32

We describe five patients who had chronic recurrent gastroduodenal ulcers and pain, intestinal obstruction, bleeding, or a combination of these symptoms. Four patients required surgical intervention because of a poor response to medical therapy. The ulcers recurred in all patients, despite evidence of achlorhydria in two of them. Although the patients denied the use of salicylates, all of them had therapeutic blood levels of salicylates. A salicylate level should be determined in patients with severe ulcer disease that is resistant to medical therapy or that is recurrent after appropriate surgical therapy when the presence of hypergastrinemia or hyperchlorhydria has been definitely excluded. A low serum level of uric acid can also be a clue to the abuse of salicylates.
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PMID:Surreptitious use of salicylates: a cause of chronic recurrent gastroduodenal ulcers. 291 Dec 12

Six cases of metastatic germ cell tumors of the testis involving the gastrointestinal (GI) tract are reported. Three cases were primary seminomas, and three were nonseminomatous. All six cases involved the upper GI tract, three occurring at presentation and three at relapse, with a disease-free interval of 3 months to 10 years. Isolated GI involvement did not occur. The presumed mode of spread was by haematogenous dissemination in three and direct extension from paraaortic lymph nodes in three. Symptoms suggestive of involvement were severe abdominal pain secondary to high intestinal obstruction or mucosal ulceration, severe lumbar pain, and symptoms of anemia as a result of clinically evident or occult blood loss. Four patients were now disease-free after chemotherapy, one died of an unrelated illness, and one patient was receiving treatment for relapsing disease.
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PMID:Involvement of the gastrointestinal tract by metastases from germ cell tumors of the testis. 336 76

Obturator hernias are relatively rare. In the past 15 years at the Mayo Clinic, eight patients underwent nine operations for repair of 11 obturator hernias, which represented 0.073 per cent (11 of 15,098) of all hernias repaired at this institution. Elderly women with chronic disease were most frequently affected. Symptoms were usually intermittent; mechanical small intestinal obstruction was the most common presenting condition, followed by pain in the thigh or groin area. The Howship-Romberg sign was found in only two patients, and a correct preoperative diagnosis was made in only one patient. Midline abdominal incisions were made in all patients. Incarcerated ileum was the most frequently encountered organ in the hernia sac. Surprisingly, foci of endometriosis in the obturator defect accounted for symptoms in two patients with three obturator hernias. Right-sided obturator hernias outnumbered left, and bilateral obturator hernias were found synchronously in two instances and metachronously in one instance. The often debilitated state of the patients with obturator hernia and the frequent delay of diagnosis combined to produce significant operative morbidity and mortality rates.
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PMID:Obturator hernia. 341 51

Early postoperative small bowel obstruction is a rare (0.69 percent incidence) but serious postoperative complication with a relatively high mortality rate (17.8 percent). Operations performed below the transverse mesocolon impose an increased risk, whereas those limited to the upper abdomen are virtually free of risk. The clinical picture of a patient who initially manifests a return of gut function and advances to a diet, but then has loss of bowel function with distention and pain is most characteristic of early postoperative small bowel obstruction. Any patient in the high-risk group demonstrating this clinical picture should be presumed to have a mechanical small bowel obstruction, and early operation should be considered.
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PMID:The incidence and risk of early postoperative small bowel obstruction. A cohort study. 342 11

Most abdominal wall incisional hernias can be repaired by primary closure. However, where the defect is large or there is tension on the closure, the use of a prosthetic material is indicated. Expanded polytetrafluoroethylene (PTFE) patches were used to repair incisional hernias in 28 patients between November 1983 and December 1986. Twelve of these patients (43%) had a prior failure of a primary repair. Reherniation occurred in three patients (10.7%). Wound infections developed in two patients (7.1%), both of whom had existing intestinal stomas, one with an intercurrent pelvic abscess. The prosthetic patch was removed in the patient with the abscess, but the infection was resolved in the other without sequelae. Septic complications did not occur after any operations performed in uncontaminated fields. None of the patients exhibited any undue discomfort, wound pain, erythema, or induration. Complications related to adhesions, erosion of the patch material into the viscera, bowel obstruction, or fistula formation did not occur. Based on this clinical experience, the authors believe that the PTFE patch appears to represent an advance in synthetic abdominal wall substitutes.
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PMID:Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). 368 12

Forty-three patients with deep-seated pelvic malignancy have been treated at the University of Utah on a pilot protocol involving regional hyperthermia (HT) produced by the BSD-1000 HT system and the annular phased array applicator (AA) usually driven at 60 MHz. Acute toxicity consisted primarily of pain within the AA aperture (74%), pain outside the aperture (33%), and bladder spasm (26%) or systemic stress (25%). Systemic stress only infrequently was power limiting. The most common power-limiting factors were pain (33%) and excessive heating of normal tissues (23%). In 9 patients (21%), there was no power-limiting factor. Treatment-related complications were uncommon and consisted of superficial second degree burns (3 patients), small bowel obstruction (1 patient), and rectal fistula (1 patient), all of which resolved with supportive nonsurgical therapy. Detailed thermal mapping and thermal dosimetry were performed on 36 patients. Thermal dosimetry parameters were all rather disappointing; however, the protocol prioritized the prevention of complications, and patients with acute toxicity or other power-limiting factors were not pushed to achieve high thermal doses. A logistic regression analysis was performed to determine if any factors were correlated with response (PR + CR). "Concurrent radiation dose" and "number of satisfactory heat treatments" were highly and independently correlated with response (p = 0.002). Responders (median survival = 10 months) survived significantly longer (p = 0.0014) than nonresponders (median survival = 4 months). Four of the responders are alive and currently without evidence of disease.
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PMID:Regional hyperthermia for clinically advanced deep-seated pelvic malignancy. 371 83

Palliative terminal care of patients with malignant bowel obstruction is a major clinical and ethical challenge. These patients are often mentally alert and ambulatory, but are kept in the hospital for hydration, nasogastric suction, and pain control. Parenteral nutrition requires frequent metabolic monitoring, is expensive, and is ethically questionable. We have used an alternative method of home management for 27 patients who met the following criteria: inoperable bowel obstruction due to untreatable cancer, an estimated life expectancy of between 2 weeks and 3 months, and understanding of the goals and limits of therapy. Hydration was provided by 10 percent dextrose and electrolyte solutions administered as overnight infusions through long-term central venous catheters. Thirteen patients with complete bowel obstruction required a venting gastrostomy which, when connected to passive drainage, relieved nausea and vomiting. The mean duration of survival was 64 days (range 9 to 223 days). Acceptance by patients and families was excellent, although most acknowledged increased costs due to limited insurance coverage for outpatient care. Seven patients returned to the hospital for terminal care (average stay 3.2 days), and 20 chose to die at home. The mean daily expense for fluids and supplies was +73.50, with an overall cost decrease of $900,000 compared with inpatient care. Home support with fluids and gastric venting is a humane, cost-effective alternative to in-hospital care for selected patients.
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PMID:Home support of patients with end-stage malignant bowel obstruction using hydration and venting gastrostomy. 372 1

During the past 30 years, authors observed and followed 5 patients with Peutz-Jeghers' syndrome. Four of them had diffuse polyposis of stomach, small bowel and colon. They also had severe clinical presentation of the disease, with recurring colicky pain, haemorrhage, anaemia and intussusception, all of which necessitated frequent surgical treatment. Excised polyps presented as benign hamartomas, without malignant alteration. Mucocutaneous pigmentations were present in 4 patients. Family history was revealing in only 2 cases. One patient, a girl aged 2 years, died due to the complications of the surgical intervention (intestinal obstruction). She has had the most severe form of the disease with diffuse polyposis.
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PMID:Peutz-Jeghers' syndrome--juvenile intestinal polyposis--review of five cases. 373 31

The case of a 32-year old woman (gravida 3 para 2) in whom a Copper-7 IUD perforated the uterus, lodging both within the myometrium and the lumen of the small intestine is described. The patient presented in the emergency room 18 months after IUD insertion with heavy vaginal bleeding and passage of tissue. A diagnosis of spontaneous abortion was made. In this case, the small bowel had to be resected and side-to-side anastomosis was performed. This patient was asymptomatic until 3 weeks prior to admission. Other cases demonstrate acute symptoms of peritonitis and intestinal obstruction or more chronic complaints of vague abdominal pain and diarrhea. An IUD string that is not visible at the external os of the cervix generally reflects upward retraction of the string or unnoted spontaneous expulsion of the IUD. However, on occasion it can be associated with uterine or even intestinal perforation, as occurred in this case. Pain on insertion, also noted in this case, can serve as a warning sign of perforation. In this patient, the device was inserted 5 weeks after delivery, lending support to the recommendation that puerperal insertion be avoided. It is important to know the exact location of an ectopic IUD to prevent dangerous attempts at removal through the vagina. Laparoscopy and ultrasound are generally helpful in localizing the IUD and preparing the patient for laparotomy and possible bowel resection.
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PMID:Asymptomatic perforation of the small intestine by a copper-7 intrauterine device. 386 28


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