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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 64-year-old woman came to the emergency room complaining of vomiting and abdominal pain; appendicitis was suspected and surgery ordered. A blood work up showed a significantly low platelet count (39,000/microliter) and 6 units were transfused before surgery. The only observations during surgery were ileitis and Meckel's diverticulum. Thrombocytopenia persisted over the first 48 hours after surgery in spite of another transfusion of platelets, with worsening awareness and acute renal failure. After diagnosis of thrombotic thrombocytopenic purpura (TTP), the patient was admitted to the intensive care unit and treatment with fresh plasma and corticoids was started. Two weeks later, after complex evolution and ten sessions of plasmapheresis, the patient was transferred to the hematology ward. TTP must be considered a medical emergency. Platelet transfusions are contraindicated, as they can cause serious clinical deterioration. A low platelet count before surgery should lead to differential diagnosis to determine the cause, with the aim of judging whether platelet transfusion is warranted or not. In some etiological processes, such as in the case we report, platelet transfusion may be life-threatening; corrective measures must be taken early in the process and such transfusion avoided.
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PMID:[Preoperative thrombocytopenia with a postoperative diagnosis of thrombotic thrombocytopenic purpura]. 1130 41

In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1-60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1-7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.
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PMID:The management of appendiceal mass in children: is interval appendectomy necessary? 1151 Jun 1

Nineteen cases of surgically proven symptomatic pediatric small bowel intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and small bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.
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PMID:Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases. 1191 Apr 76

We report a case of a female patient with a picture of "atypical appendicitis," with 3 days of abdominal pain, localized to the right lower quadrant with no nausea, vomiting, diarrhea, or anorexia. On examination she was febrile to 38.4 degrees C, had tenderness at McBurney's point, and a leukocyte count of 11,200. A computerized axial tomography (CAT) scan was obtained showing changes consistent with appendicitis. On laparoscopic exploration the patient was found to have cecal masses. Definitive surgical treatment was deferred until after adequate evaluation of the colon. Postoperative colonoscopy demonstrated cecal diverticulitis. Management of cecal diverticulitis found during laparotomy for presumed appendicitis has included right hemicolectomy, ileocolic resection or appendectomy, and conservative treatment with antibiotics. The laparoscopic approach in a patient with an equivocal history and physical examination allows for definitive workup of inflammatory cecal masses found during surgery for appendicitis.
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PMID:Cecal diverticulitis: a case report and review of the current literature. 1199 78

We review the clinical report of 110 patients that were operated on by a laparoscopic appendectomy in our hospital since January 1992 until december 2000. In 66 patients the reason was an acute appendicitis, and recurrent abdominal pain in 44. The age of them was between 4 and 19 year old with a mean of 10.8; there were 44 males (39%) and 66 females (61%). The maximum weight was 70 kg and the minimum 15, with a mean of 41. In 23% of them vomiting was present in the postoperative period. The hospital stay was 2 or 3 days in 73% of the patients. In acute appendicitis patients 66.1% were with acute inflammation, in 29% complicated and 4.8% negative appendicitis. Of recurrent abdominal pain patients in 50% we found pathological alterations. Finally we had complications in 13% of cases. As conclusion we achieve a reduction in hospital stay, the patients and parents appreciate it, this approach allow a better exploration of abdominal cavity and in those patients with recurrent abdominal pain we obtained a clinical improve.
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PMID:[Nine years of experience with laparoscopic appendectomy in children]. 1260 80

Acute abdominal pain in children presents a diagnostic dilemma. Although many cases of acute abdominal pain are benign, some require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common medical cause is gastroenteritis, and the most common surgical cause is appendicitis. In most instances, abdominal pain can be diagnosed through the history and physical examination. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the pediatric age spectrum. In the acute surgical abdomen, pain generally precedes vomiting, while the reverse is true in medical conditions. Diarrhea often is associated with gastroenteritis or food poisoning. Appendicitis should be suspected in any child with pain in the right lower quadrant. Signs that suggest an acute surgical abdomen include involuntary guarding or rigidity, marked abdominal distention, marked abdominal tenderness, and rebound abdominal tenderness. If the diagnosis is not clear after the initial evaluation, repeated physical examination by the same physician often is useful. Selected imaging studies also might be helpful. Surgical consultation is necessary if a surgical cause is suspected or the cause is not obvious after a thorough evaluation.
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PMID:Acute abdominal pain in children. 1280 Sep 60

Vomiting or its lesser stages-anorexia, nausea-is a prime symptom of the most serious surgically curable diseases of childhood. In the newborn, when vomitus is green, abdomen scaphoid, and erect roentgen view shows air-fluid levels in stomach and duodenum with gas beyond, partial duodenal obstruction is present and midgut volvulus with malrotation is likely enough to justify immediate exploration. In infancy, vomiting is a clear sign of intussusception when associated with intermittent colicky pain, palpable mass and "currant-jelly" feces. These symptoms are not always present, and if there is blood in the feces, barium enema study must follow. In further doubt, exploration may be justified. In childhood, a common early symptom of appendicitis is vomiting accompanied by pain without any complete remission. Constipation is frequent but diarrhea may occur and contribute to an impression of gastroenteritis. Complete and repeated physical examination, with a history of the above symptoms, should lead to correct diagnosis.
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PMID:Vomiting as a symptom of serious disease in infants and children. 1382 64

Gastrointestinal symptoms, including vomiting, are caused by a variety of infective organisms in children, many of which are self-limiting and resolve within a week, but others are potentially much more serious in their consequences. Diarrhea, vomiting and abdominal pain are common but nonspecific symptoms. Investigation is dictated by the likely causative organism, given the age and presentation of the child. The role of bacteria in the pathogenesis of necrotizing enterocolitis, recognition that Yersinia, Campylobacter and Salmonella may produce symptoms difficult to distinguish clinically from appendicitis, the viral causes of idiopathic intussusception, the occurrence of intussusception after administration of rotavirus vaccine, and the evidence incriminating mycobacterium avium subspecies paratuberculosis in the aetiology of Crohn disease are discussed.
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PMID:Infection and the gut. 1465 66

Neonatal appendicitis (NA) is a very rare surgical condition. The aim of this study is to once again draw attention to this subject by collecting our cases with NA and cases of NA reported separately in English-language literature over the period from 1901 to 2000. We performed a retrospective chart review of patients admitted to our hospital, with the clinical diagnosis of NA from 1990 to 2000. A survey of the English-language literature together with our own 7 cases revealed a total of 141 cases of NA during the period of 1901-2000. 128 cases had sufficient information for analysis. The patients are grouped and discussed according to these 3 time- periods: 1901-1975, 1976-1984 and 1985-2000. The incidence, etiology, and presenting signs and symptoms of appendicitis in newborns are discussed. Despite the similar perforation rates in the 3 time- periods (73%, 70%, 82%), mortality rate in NA has decreased from 78% in the 1901-1975 period, to 33% in the 1976-1984 period, and to 28% in the 1985-2000 period. A newborn baby presenting with continuous vomiting, refusal to feed, and, showing signs of pain through irritability, restlessness, sleep disturbance, and a distended abdomen; one should strongly suspect an abdominal disorder, perhaps appendicitis.
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PMID:Seven cases of neonatal appendicitis with a review of the English language literature of the last century. 1468 9

Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 degrees C or more (21), abdominal distension (18), Leukocytosis (<12.0 x 10(3)/mm(3)) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3-5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.
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PMID:Appendicitis in children less than 3 years of age: a 28-year review. 1473 Mar 82


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