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

Six children with acute intestinal obstruction from sigmoid volvulus (SV) (n=2) and ileosigmoid knotting (ISK) (n=4) are reported. The median age at presentation was 4.5 years (range 2 weeks-15 years). Abdominal pain, distention, vomiting, and constipation were the main features. Two patients with ISK had bowel gangrene. In three children there was no identifiable cause; two had a narrow attachment of the sigmoid mesocolon with redundant colon and one had adhesive bands. Treatment was by resection and colostomy in five cases and derotation of the torted colon in one. One child with SV died following a wound infection. There was no recurrence. SV and ISK are uncommon in children. There are usually no features specific for these conditions, and the diagnosis is established at laparotomy. The prognosis is good when there is aggressive resuscitation and prompt surgery.
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PMID:Sigmoid volvulus and ileosigmoid knotting in children. 1172 56

A retrospective analysis of nine consecutive cases of ileosigmoid knotting (ISK) that were seen at Gondar hospital from 1993 to 1995 is presented. Ileosigmoid knotting is a condition in which the ileum and the sigmoid entangle each other to form a knot and become gangrenous. It was found that the clinical features of ISK were the results of combination of symptoms and signs of small and large bowel obstruction. The presentations were so dramatic that the majority of patients deteriorated rapidly with 44% (4/9) developing shock because of gangrene of both the ileum and the sigmoid. Abdominal cramps, vomiting and absolute constipation occurred in all patients. Five patients were in shock at the time of presentation and six had peritonitis at the time of surgery. Release of the knot could easily be attained by needle deflation of the sigmoid colon. Hartman's procedure with resection of the sigmoid and ileotransversostomy by closing the distal viable stump of the ileum is recommended. Four patients out of the nine patients died.
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PMID:Ileosigmoid knotting in Gondar teaching hospital north-west Ethiopia. 1195 1

Isolated infection and/or gangrene of the round and falciform liver ligaments is among the rarest causes of acute abdomen. The diagnosis is based on demonstrating localized or patchy inflammatory or gangrenous changes in the ligaments without apparent etiology. We report the case of an 18-year-old male who presented with a 24-hour history of generalized abdominal pain and distention, nausea, and vomiting. With a preoperative diagnosis of probable perforated duodenal ulcus and generalized peritonitis the patient underwent emergency surgery. Multiple patchy gangrenous areas of the round and falciform ligaments were found starting from the umbilicus up to the hepatic hilum. The ligaments were resected in toto. The patient's postoperative course was unremarkable. No apparent etiology of the condition was found. We provide the first extensive review of the world literature. Isolated infection and/or gangrene of the round and falciform liver ligaments should be suspected in patients with upper abdominal complaints when imaging studies demonstrate ligament abnormality, tumor, or fluid. Treatment is only surgical. Depending on surgeon's expertise, patient's condition, and severity and extent of disease either open or laparoscopic surgery may be performed.
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PMID:Isolated gangrene of the round and falciform liver ligaments: a rare cause of peritonitis: case report and review of the world literature. 1235 42

Non-operative management by pressure reduction is now the preferred treatment for uncomplicated intussusception in children. However, in many developing countries, laparotomy is routinely performed for such cases. This is a retrospective anlaysis of 24 children who had operative reduction of intussusception. The age range was 3 months--10 years (median 7 months) and duration of symptoms 12 hours--7 days (median 2 days). The main features were abdominal pain, vomiting and rectal bleeding. Ten (42%) patients had varying degrees of dehydration, which were corrected. At laparotomy, the intussusceptions were reduced without difficulty. Thirteen (54%) patients developed 15 procedure related complications including wound infection 6(25%), ileus 2(8%), stitch sinus 2(8%), incisional hernia 2(8%), intestinal obstruction from adhesions resulting in intestinal gangrene 2(8%) and aspiration pneumonia 1 (4%). Mortality was 2( 8%) from aspiration pneumonia and overwhelming infection due to intestinal gangrene from adhesive intestinal obstruction respectively. Laparotomy for uncomplicated intussusception in children is attended by significant morbidity and mortality. Many of such intususceptions, may be successfully managed by pressure reduction and children should not be denied the benefits of this form of treatment.
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PMID:The morbidity and mortality of laparotomy for uncomplicated intussusception in children. 1240 31

The records of 19 patients with sigmoid colon volvulus (SCV) who were treated surgically in a 36.5-year-period were reviewed. Seven of them (37 %) had ileosigmoidal knotting (ISK). The age range was between 10 weeks and 17 years (mean 10 years), and 17 patients (90%) were male. In two cases (11%) there was previous SCV history. The mean symptom duration was 57 h (range 24-96), and three patients (16%) were in shock. The main symptoms were abdominal pain (90%), distention (79%), vomiting (74%), and obstipation (58%), and the main signs were abdominal tenderness (90%), distention (79%), absence of stool in the rectum and hypo- or akinetic bowel sounds (58%), muscular rigidity (53%), hyperkinetic bowel sounds (32%), and melanotic stool in the rectum (21%). The torsion was found in a clockwise direction in 47%, and the torsion degree was 360 in 42%. In four patients (21%) there was no gangrene (one with ISK), whereas in 15 (79%) sigmoid colon was gangrenous (six with ISK, in whom small bowel was also gangrenous). In nongangrenous cases, detorsion (11%) or sigmoidopexy (11%) was performed. In gangrenous cases, gangrenous sigmoid colon was resected, and Hartmann's procedure (74%) or primary anastomosis (5%) was performed. In those with associated gangrene of the small bowel, resection and enteroenteric anastomosis were done. Four patients (21%) died, with the most common cause of death being toxic shock. In 11 patients, including five with SCV and six with ISK, no recurrence was seen in a mean 18-year follow-up period (range 8-39). As a result, preoperative resuscitation, prompt surgery, and postoperative support are important in emergent SCV in children.
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PMID:Sigmoid colon volvulus in children: review of 19 cases. 1524 18

Vascular calcification is common among hemodialysis (HD) patients and contributes to the development of peripheral arterial disease. A 57-year-old Japanese man who had been on HD for 30 years was referred to us for severe pain with multiple ulcers on his toes and fingers. He was an ex-smoker and had no diabetes mellitus. On admission, he had ulcers on his big toes bilaterally and right 2nd - 4th fingers. Peripheral pulses were strong and his ankle-brachial pressure index was above 1.3. Laboratory data were as follows: calcium 9.9 mg/dl, albumin 3.3 g/dl, phosphate 3.0 mg/dl, Ca x P product 30, and parathyroid hormone 98 pg/ml. He had a parathyroidectomy in 1998 and 1999. X-rays of his hands and legs showed diffuse subcutaneous arteriolar calcification. Angiography revealed no local stenotic lesions. Despite intensive therapies including hyperbaric oxygen therapy, painful gangrene developed on his right big toe and the pain was so intense that he could not go to sleep in a supine position. We infused intravenous sodium thiosulfate (20 g) 3 times weekly, based on previous reports. Within 4 - 5 days, he experienced rapid and dramatic symptom relief. The score of the visual analogue pain scale improved from 10/10 - 2/10. The signs of ischemia, measured by transcutaneous partial oxygen pressure and thermography, improved significantly. During the infusion of sodium thiosulfate, the patient complained of nausea, vomiting and hyperosmia. These adverse symptoms were resolved after discontinuation of the infusion. Pain relief was sustained and he could walk after 2 weeks of infusion. Our case supports the use of sodium thiosulfate as a novel therapeutic choice for critical limb ischemia with severe vascular calcification in chronic HD patients.
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PMID:Successful management of critical limb ischemia with intravenous sodium thiosulfate in a chronic hemodialysis patient. 1693 72

A 53-year-old male was admitted with a two-day history of abdominal pain, anal bleeding, fever, diarrhea, vomiting, and mental confusion. A diagnosis of thrombosis of very large hemorrhoids (Grade 4) was made. On the day of admission, he underwent an exploring laparotomy followed by abdominoperineal resection. The peritoneal cavity was filled with pus and blood clots. Because rectal necrosis was involved, sigmoid colostomy was imperative. Twenty-eight hours after surgery, the patient demonstrated signs of soft-tissue perineal necrosis associated with progressive pain and fever. He developed a rapidly progressive gangrene of the lower limbs and scrotum followed by acute renal and respiratory failure, and he died of sepsis. At autopsy, the cadaver showed jaundice and a large gangrene of the perineum and lower limbs. The internal organs showed features secondary to sepsis complications. To the best of our knowledge, this is the first autopsy study of a patient who died because of complications of hemorrhoids.
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PMID:Death resulting from fournier gangrene secondary to thrombosis of very large hemorrhoids: report of a case. 1784 38

Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis.
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PMID:Acute kidney injury due to rhabdomyolysis-associated gangrenous myositis. 1926 Mar 87

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

Traditional healers contribute significantly to the level of health-care systems in Africa. They could play an important role in the prevention and care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community. The traditional healing system deals with psychosocial stress associated with HIV/AIDS as well as herbal medications. Sometimes, herbal medicine causes serious life-threatening complications. Two case reports are presented in this article. The first is a 48-year-old woman with HIV who was made to drink a large volume of a herbal decoction to stimulate vomiting in the belief that cleansing the bowel would rid the system of the disease. The second is a 25-year-old young man who had a herbal enema, which resulted in gangrene of the large bowel. The case histories, mechanism of action and causes of death are discussed.
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PMID:HIV/AIDS and traditional healers: a blessing in disguise. 2113 68


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