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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This is a case of a 34 years old male Hispanic patient with history of AIDS who presented to the ER with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. Acute appendicitis, Clostridium Difficile Colitis and Ischemic Colitis were the most important clinical conditions to consider in the differential diagnosis. Abdominal CT with IV contrast demonstrated thickening of the ascending colonic wall a finding highly suggestive of a transmural inflammatory necrotizing colitis of infectious etiology. Broad-spectrum antibiotic therapy, cancidas and ganciclovir were started with mark clinical improvement. IgG antibodies against CMV were elevated. Typhlitis is a serious illness that affects patients with impairment in immunity. It is important to include it in the differential diagnosis of an HIV/AIDS patient that presents with RLQ pain and fever. Contrast enhanced CT-Scan is mandatory to establish the diagnosis and to differentiate typhlitis from other intra-abdominal pathologies. Therapy needs to be individualized.
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PMID:Right lower quadrant abdominal pain in an immunocompromised patient: importance for an urgent diagnosis and treatment. 2169 4

The classifications of acute uncomplicated diverticulitis and complicated diverticulitis have served us well for many years. However, in recent years, we have noted the prevalence of variations of uncomplicated diverticulitis, which have not precisely fit under the classification of 'acute resolving uncomplicated diverticulitis', which manifests itself with the typical left lower quadrant pain, fever, diarrhea, elevated white blood count, and CT findings, such as stranding, and which resolves fairly promptly and completely on oral antibiotic therapy. For these other variations, we would suggest we use the term chronic diverticulitis, as a subset of uncomplicated diverticulitis, meaning there is no abscess, stricture, or fistula, but the episode does not respond to the usual antibiotic treatment, and there is a rebound symptomatology once the treatment has stopped, or there is continuing subliminal inflammation that continues, typically, for several weeks after the initial episode without complete resolution. This variation could also be termed 'smoldering' diverticulitis. A second variation of uncomplicated diverticulitis should be termed atypical diverticulitis, since this variant does not manifest all of the usual components of acute diverticulitis, particularly an absence of fever, and even white blood count elevation, and there may be a lack of diagnostic evidence of acute diverticulitis. This diagnosis must be compared with diarrhea-predominant irritable bowel syndrome, and it is sometimes very difficult to distinguish between these two entities. The character of the pain in irritable bowel syndrome is typically cramping intermittently, compared with the more constant pain in smoldering diverticulitis. In our study by Horgan, McConnell, Wolff and coworkers, 5% of 930 patients who underwent sigmoid resection fit into this category of atypical uncomplicated diverticulitis. These 47 patients all had diverticulosis, and 76% that had surgery had evidence of acute and chronic inflammation, and 15% had an unsuspected pericolonic abscess. There was no mortality and a low complication mortality rate (4.2%). Complete resolution of symptoms was achieved in 76.5 with 80% being pain free. Therefore, this is mostly a diagnosis of exclusion, and clinicians must be careful to perform a thorough workup and evaluation before proceeding to surgery with this as a diagnosis. Ischemic colitis is also in the differential diagnosis, and many patients who have diverticulitis, have irritable bowel syndrome as well, so caution must be used in predicting positive outcomes after surgery in these patients.
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PMID:Prophylactic resection, uncomplicated diverticulitis, and recurrent diverticulitis. 2257 96

Febrile pain in the right iliac fossa is one of the most common reasons for consulting at an emergency service. Within this framework, the main diagnosis that is considered is appendicitis, the main complication of which is perforation. However, a certain number of other conditions can be responsible for this clinical picture, primarily including digestive tract and mesentery disorders including mesenteric lymphadenitis, Crohn's disease, infectious enterocolitis, small intestine or colonic diverticulitis, ischaemic colitis or cancer of the caecum. This article illustrates the imaging semiology of the various right colonic, iliac, mesenteric and appendicular conditions that could potentially cause an infection of the right iliac fossa. It specifies the indications of ultrasound and CT scans, respectively, which depend on the age of the patient and the clinical signs and symptoms. Though the CT scan is commonly used in abdominal emergencies in general, and particularly in clinical pictures of infection of the right iliac fossa, ultrasound remains recommended as first line imaging when confronted with suspected appendicitis or lymphadenitis in a young subject or in the monitoring of Crohn's disease.
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PMID:Infection of the right iliac fossa. 2265 41

We present the case of an adolescent with ischemic colitis, an infrequent pathology in this age group, worsened in the presence of systemic lupus erythematosus (SLE). The patient, aged 20, was diagnosed SLE at 6. She consulted for fever, abdominal pain in the side and right iliac fossa and diarrhea lasting 48 hours. It was assumed as acute gastroenteritis but given the persistent pain, incoercible vomiting and abdominal distension she was hospitalized. The abdominal X-ray showed distended loops, abundant feces, without air-fluid levels. The ultrasound showed erosions and ulcerations, edema and bleeding in the descending colon submucosal layer. The CT scan evidenced an ischemic lesion in the right colon. Ischemic colitis is a severe condition, infrequent in young individuals. Signs, symptoms, abdominal CT scan and colonoscopy are the elements of choice for the diagnosis.
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PMID:[Ischemic colitis: an uncommon manifestation in systemic lupus erythematosus]. 2356 76

Primary malignant melanoma of the esophagus is an uncommon tumor, with approximately 300 cases having been reported thus far. The purpose of this study was to describe a case of a 60 year-old man with a 10 month history of progressive dysphagia and thoracic pain, the investigations of which led to a diagnosis of primary malignant melanoma of the esophagus. The patient underwent a transhiatal esophagectomy with subcarinal lymphadenectomy, and isoperistaltic gastric tube replacement of the esophagus. Nine months after surgery, he developed ischemic colitis, and metastasis in the mesentery was diagnosed. His disease progressed and he died one year after the esophagectomy. A review of the literature was performed.
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PMID:Primary malignant melanoma of the esophagus: a rare and aggressive disease. 2397 96

Ischemic colitis is a common cause of hospital admissions; however it is frequently confused intellectually with mesenteric ischemia and often misdiagnosed as infectious diarrhea or Clostridium difficile colitis. Ischemic colitis is caused by non-occlusive insult to the small vessels supplying the colon without a clear precipitating factor. It is more common in females and in patients above 60 years of age. The classic presentation includes sudden onset of lower abdominal pain followed by the urge to defecate and bloody diarrhea. Focal right-sided ischemic colitis has more pain and a worse prognosis. Choosing the correct diagnostic studies is challenging and requires proficient knowledge of the disease. Management is usually conservative, however around 10-20% of the patients will require surgery. Acute ischemic colitis usually resolves; nevertheless some patients may develop chronic segmental colitis or a stricture. One ischemic colitis caveat is that it may be the first sign of undiagnosed cardiac disease. A firm grasp on this common yet little discussed condition is valuable to a gastrointestinal consultant and hospitalist alike.
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PMID:A review of ischemic colitis: is our clinical recognition and management adequate? 2407 Jan 52

The diagnosis of irritable bowel syndrome (IBS) should be considered when patients have had abdominal pain/discomfort, bloating, and change in bowel habits for 6 months. Patients may experience variation between periods of constipation and diarrhea. When evaluating patients with IBS, physicians should be alert for red flag symptoms, such as rectal bleeding, anemia, nighttime pain, and weight loss. Physicians also should consider other medical conditions that manifest similarly to IBS. Clinicians who are confident in diagnosing IBS based on symptoms typically do not obtain many tests unless the patient has red flag symptoms. Various etiologic mechanisms have been proposed for IBS, including abnormal bowel motility, inflammation, altered mucosal permeability, genetic predisposition, and visceral hypersensitivity. Lack of certainty about the etiology makes it difficult to develop effective management approaches; thus, management is directed toward symptom relief. Dietary changes, such as avoiding fermentable carbohydrates, may benefit some patients, especially those with bloating. Constipation-dominant IBS can be managed with antispasmodics, lubiprostone, or linaclotide, whereas diarrhea-dominant IBS can be managed with loperamide or alosetron, though the latter drug can cause ischemic colitis. For long-term therapy, tricyclic antidepressants or selective serotonin reuptake inhibitors have good efficacy. Peppermint oil and probiotics also may provide benefit.
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PMID:Common gastrointestinal symptoms: irritable bowel syndrome. 2412 3

In colonoscopic study, benign colorectal strictures with or without symptomatic pain are not rarely encountered. Benign colorectal stricture can be caused by a number of problems, such as anastomotic stricture after surgery, inflammatory bowel disease, postendoscopic submucosal dissection, diverticular disease, ischemic colitis, and so on. There are various modalities for the management of benign colorectal stricture. Endoscopic balloon dilatation is generally considered as the primary treatment for benign colorectal stricture. In refractory benign colorectal strictures, several treatment sessions of balloon dilatation are needed for successful dilatation. The self-expandable metal stent and many combined techniques are performed at present. However, there is no specific algorithmic modality for refractory benign colorectal strictures.
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PMID:Endoscopic management of refractory benign colorectal strictures. 2414 5

Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice. In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT3 antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern.
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PMID:Treatment of abdominal pain in irritable bowel syndrome. 2484 49

Partial necrosis of the cecum is a rare form of ischemic colitis with unknown etiology. A 68-year female patient was admitted due to a severe pain in the right lower quadrant of the abdomen for one week. One month ago, she had coronary artery bypass graft surgery with carotid endarterectomy. During physical examination, tenderness and rebound tenderness at the right lower quadrant were detected. Computed tomography showed a 7-mm tubular structure extending from the back of the cecum to the lower border of the liver. Laparoscopic appendectomy was planned with a preoperative diagnosis of acute appendicitis. During laparoscopy, a 3x3 cm necrotic area was noticed on the lateral wall of the cecum. After conversion to open surgery, partial cecum resection and ileocolostomy with appendectomy were performed. She was discharged on the 6th postoperative day, uneventfully. An isolated non-occlusive mesenteric ischemic event should be thought as a differential diagnosis in elderly patients who have right lower quadrant pain with atypical presentation, if there is chronic cardiac or renal failure.
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PMID:Partial Cecum Necrosis as a Rare Cause of Acute Abdominal Pain in an Elderly Patient. 2986 28


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