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

This is the case of a 63 years old female that was admitted with abdominal pain mainly localized in the left lower quadrant, with diffuse radiation to the rest of the abdomen. It persisted for two days and worsened on the day of admission. It was associated with two episodes of vomiting and fever. She had no urinary symptoms or lumbar zone tenderness. There was no familial history of dextrocardia. The physical examination showed discrete abdominal distention; bowel movements diminished in the left lower quadrant with guarding and rebound tenderness at this site. The reminder of the physical examination was normal. The ECG findings in Lead I: P, QRS and T waves inverted or upside down. Lead II: represented the usual lead III and vice versa. AVR and AVL were reversed and prominent negative deflections were seen in AVL rather than in AVR. AVF was unaffected. The V1-V6 complexes showed decreasing amplitude. V1 was the equivalent of the usual V2 and vice versa. The differential diagnosis included dextroposition of the heart, dextroversion of the heart and misplaced electrodes. The chest X-Ray findings were consistent with dextrocardia. Abdominal and pelvic CT showed situs inversus, inflammatory process at the cecum and proximal ascending colon located on the left side of the abdomen, compatible with perforated appendicitis. No abscess or free intraperitoneal air was seen. The patient was started on empiric antibiotic coverage with cleocin and cipro. Surgical intervention was performed with the findings of a perforated and gangrenous appendix and severe inflammation at the left side of the abdomen. The surgical wound was closed by second intention 3 days later without complications. The patient recovered and was discharged home to continue with oral antibiotic therapy. The incidence of dextrocardia with situs inversus is 1:5,000 to 1:10,000. A review of the American medical literature from 1965 to the present revealed only 18 acute presentations of situs inversus with the following distribution: appendix (4 cases), trauma (4 cases), cardiovascular (3 cases), gastrointestinal (3 cases), gallbladder (3 cases), spleen (1 case). The case presented is a typical "after-the-facts-findings" were the initial evaluation overlooked a typical presentation, just side-reversed.
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PMID:Acute abdominal symptoms as the first presentation of a patient with mirror-image dextrocardia with situs inverus. 1961 May 64

A previously fit and well 18-year-old woman presented to the accident and emergency department following referral by her general practitioner with a provisional diagnosis of appendicitis. The history obtained from the patient revealed the presence of a bitemporal headache with associated neck stiffness, photophobia and vomiting for approximately 1.5 weeks. The patient complained of abdominal pain localised to her right iliac fossa and anorexia for approximately 1 week. She also noted the presence of a cough productive of green sputum for 3 weeks. A chest radiograph was obtained which showed a large area of consolidation in the right lower lobe consistent with infection and a linear density in keeping with a metallic foreign body. Following review of the chest radiograph, the patient was interviewed further and recalled having inhaled a pushpin approximately 1 year before her presentation. Aspiration of foreign bodies is relatively common in children and is often associated with delayed diagnosis and high morbidity. To prevent delayed diagnosis, characteristic symptoms and clinical and radiological signs of foreign body aspiration should be checked in all suspected cases and a low index of suspicion for ordering additional imaging or using bronchoscopy for diagnostic purposes should be employed.
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PMID:Delayed presentation following accidental inhalation of a pushpin. 2002 18

Meckel's diverticulum is the most prevalent abnormality of the gastrointestinal tract seen in approximately 2% of the population. Diagnosing complicated diverticulum is difficult, for its capacity to mime multiple disorders such as appendicitis, ulcer disease, enterocolitis, Chron disease, sigmoid diverticulitis, cholecystitis, and it should be considered in all patients with unexplained chronic abdominal pain, nausea, vomiting, gastrointestinal bleeding, unexpected cause of intestinal obstruction or acute abdomen. Herewith we provide an illustrative presentation, emphasizing the difficulties in preoperative diagnosis of complicated Meckel's diverticulum and underlining the nonspecific nature of the subjective and objective findings. Both cases were admitted to our clinic with acute abdomen diagnoses--first case as a intestinal obstruction and in second case was acute appendicitis. Laparatomy ascertain that the cause of symptoms was the complicated Meckel's diverticulum.
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PMID:[Complicated Meckel's diverticulum in adult pathology]. 2018 76

Omental torsion is an underdiagnosed cause of abdominal pain in children. It resembles appendicitis, and the diagnosis is often made surgically. We review the presentation, treatment, and outcomes in the largest reported series to date. We recorded demographics, diagnostics, treatment, and histopathology in 18 children with omental torsion between May 2000 and 2007. We found a 4:1 male to female ratio and 85 per cent met criteria for obesity based on Centers for Disease Control and Prevention body mass index-for-age growth chart calculations. Fourteen of 18 (78%) presented with right lower quadrant pain concerning for appendicitis and seven of 18 (39%) with fever, nausea, or vomiting. Mild leukocytosis was found in 78 per cent of patients. All but one was taken to surgery with a diagnosis of appendicitis. Partial omentectomy, either open (50%) or laparoscopic (50%), was performed in all cases. The appendix, resected in 17 patients, was grossly normal. However, 30 per cent of specimens had histopathologic findings of appendicitis. Hospital discharge, after symptom resolution, averaged 33 hours. Surgeons should have a high index of suspicion for omental torsion when evaluating obese children for right lower quadrant pain. Both surgical approaches provide the diagnosis and treatment with minimal morbidity and rapid recovery. We advocate simultaneous appendectomy because appendicitis is often encountered with the torsion.
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PMID:Clinical presentation and treatment considerations in children with acute omental torsion: a retrospective review. 2042 Feb 48

Two girls, aged 8 months and 3 years respectively, presented with dehydration, vomiting and fever. The youngest girl was diagnosed first with gastroenteritis and was treated accordingly. Her condition deteriorated however, and she showed symptoms of a high bowel obstruction. Laparotomy revealed a perforated inflamed appendix. An intestinal invagination was suspected in the older girl, yet laparotomy revealed a perforated appendix. Appendicitis can be difficult to diagnose in very young children due to atypical presentation and age-related difficulties in communication. Most importantly, physicians must be aware that appendicitis may also occur in very young children. Although the Paediatric Appendicitis Score (PAS) is a helpful tool in diagnosing appendicitis in young children, a solid physical examination is most important. When in doubt, early surgical consultation is necessary to limit the delay in diagnosis and to prevent complications.
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PMID:[Acute appendicitis in very young children]. 2045 2

The aim of this study was to investigate the relationship between the frequency of common signs and symptoms and the histopathologic findings of resected appendix to identify factors that might be useful for judging the necessity for surgery in patients with acute appendicitis. The association of preoperative clinical characteristics, including age, sex, physical findings, gastrointestinal symptoms, body temperature, and white blood cell count, with histopathologic findings of the appendix was evaluated in 128 patients, who underwent appendectomy for clinical symptoms of acute appendicitis. The frequency of periumbilical pain as the initial symptom was significantly high in patients with catarrhal appendicitis (P < 0.01 versus those with phlegmonous appendicitis, P < 0.01 versus those with gangrenous appendicitis), and vomiting occurred less frequently in these patients (P < 0.05 versus those with phlegmonous appendicitis, P < 0.01 versus those with gangrenous appendicitis). A history of periumbilical pain and vomiting was useful for judging the necessity of appendectomy.
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PMID:Profile of signs and symptoms in mild and advanced acute appendicitis. 2048 Aug 44

Internal herniations through broad ligament defects are very rare. We present the first report of the triad of broad ligament defect, internal herniation of the caecum and appendicitis. A 36-year-old woman with phocomelia presented with right iliac fossa pain and vomiting. The patient had no previous history of trauma or surgery. Abdominal ultrasound showed a small amount of free fluid. At laparoscopy, bilateral broad ligament defects were found, with herniation of the caecum and an inflamed appendix through the right-sided defect. A laparoscopic salpingo-oophorectomy was required for reduction of the herniated bowel, and an appendicectomy was performed. Broad ligament defects may be congenital or acquired. In this case, in light of the limb abnormality and absence of previous surgery, a congenital aetiology is more likely. Ultrasound scan is not reliable and, although computed tomography may be of help, a diagnostic laparoscopy is the best investigation.
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PMID:Unexpected findings at diagnostic laparoscopy: caecal incarceration with concurrent appendicitis in a patient with bilateral broad ligament defects. 2056 32

This is a case of a 3-year-old boy with a sunflower-seed rectal bezoar who presented to our emergency department with fever, abdominal pain, leukocytosis, vomiting, and an examination concerning for appendicitis. A failed diagnostic imaging attempt ultimately led to the diagnosis. Children with rectal bezoars typically present with diarrhea, rectal pain, and tenesmus. Our patient presented atypically and developed significant colitis secondary to the bezoar. We discuss bezoars and the uncommon rectal seed bezoar. This case illustrates an atypical complication (colitis) of an unusual condition (rectal bezoar) mimicking a relatively common illness (appendicitis).
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PMID:Sunflower rectal bezoar presenting with an acute abdomen in a 3-year-old child. 2083 86

Dobrava-Belgrade hantavirus infection mimicked acute appendicitis in a patient suffering from hemorrhagic fever with renal syndrome in Hungary. The 27-year-old man was admitted to the local hospital with severe abdominal pain localized mainly at the right lower quadrant of the abdomen and with fever, nausea, vomiting and bloody diarrhea. Based on these findings supported by computerized tomography acute perforated appendicitis was suspected and an explorative laparatomy was performed, which did not confirm the diagnosis. Next day he developed acute oliguric renal failure raising the possibility of hantavirus infection. Specific serum IgG and IgM antibodies against hantavirus were identified, and by molecular methods the presence of Dobrava-Belgrade virus was proven. This report describes a rare clinical manifestation of hemorrhagic fever with renal syndrome (HFRS), and shows that HFRS might be difficult to diagnose especially when symptoms mimick those of an acute abdominal inflammation.
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PMID:Dobrava-Belgrade hantavirus infection mimics acute appendicitis. 2107 78

In a relatively high percentage of patients with a clinically suspected diverticulitis a different diagnosis is established after imaging tests, such as 'appendicitis' or 'intestinal obstruction'. The clinical diagnosis 'acute diverticulitis' is correct for between 43% and 68% of suspected patients. Strongly predictive variables for the diagnosis are tenderness in the left lower abdomen only, CRP > 50 mg/l and absence of vomiting. This triad has a positive predictive value of 97% (95% CI: 83-99) for the final diagnosis 'diverticulitis'. The negative predictive value is much lower, namely 47%: the absence of 1 of the 3 factors does not (sufficiently) exclude 'diverticulitis'. This triad can be an easy-to-use decision rule to rule in diverticulitis.
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PMID:[Accurate predictors for acute diverticulitis]. 2126 29


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