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

In the majority of patients in this series of 1,000, acute abdominal pain was due to conditions that required neither surgical intervention nor hospitalization. Eleven of the 1,000 patients had an early missed diagnosis in the emergency clinic for which a subsequent operation was needed, and twenty underwent an operation which subsequent diagnosis showed was not required. All false-negative evaluations occurred in patients with early appendicitis or small bowel obstruction. Most false-positive results were due to acute infections of the female genitourinary tract in patients operated on to exclude appendicitis or a tubo-ovarian abscess. The following factors help identify the high risk patient with an acute surgical abdomen: (1) pain for less than 48 hours; (2) pain followed by vomiting; (3) guarding and rebound tenderness on physical examination; (4) advanced age; (5) a prior surgical procedure. The presence of these features demands careful evaluation and a liberal policy of admission and observation. White blood cell counts, body temperature, and abnormal abdominal roentgenograms may add confirmatory evidence but are not particularly helpful as screening devices.
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PMID:Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. 125 63

A 46-year-old woman presented with abdominal pain, nausea vomiting and abdominal distention. Small bowel x-rays and CT scan of the abdomen revealed small bowel obstruction due to malignant melanoma. The diagnosis of cutaneous melanoma was performed 8 years prior to admission on one lesion in the back. Patient received surgical treatment. Completed resection of an involved jejunal [correction of ileal] segment was performed. Three tumor masses were found at laparotomy. Metastasis from malignant melanoma at the gastrointestinal tract occurs frequently though rarely are these intestinal lesions symptomatic. The efficacy of surgical treatment for symptomatic metastatic melanoma is justified to relief symptoms and prolonged survival.
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PMID:[Symptomatic malignant melanoma of the small intestine]. 134 Nov 16

Intussusception is one of the leading causes of bowel obstruction in early infancy and childhood. From 1984-1989, 67 patients under 2 years of age with intussusception were diagnosed and treated in our institution. There were 48 boys and 19 girls ranging in age from 2 months to 2 years with a mean of 7.4 months. Presenting symptoms and signs included abdominal pain (96%), vomiting (93%), rectal bleeding (60%) and a palpable mass (67%). Symptoms and signs were present for less than 24 hours in about 80% of cases. Most of the intussusceptions were of the ileocolic type (75%). The overall success rate of hydrostatic barium enema reduction was 49%. The highest rate of reduction by enema was among patients between 9 and 16 months of age (83%). The success rate of barium enema reduction was negligible after 24 hours of cardinal symptoms. Five children underwent surgical exploration without contrast studies because of delayed presentation and signs of an acute abdomen. A pathological lead point was found in only four cases, the commonest being Meckel's diverticulum. The average length of hospitalization was 2.57 days after barium enema reduction and 7.55 days after surgical reduction. There were no deaths. There was no case of perforation during enema reduction. Three children had recurrence within 3 months of initial presentation. The best outcome is associated with early diagnosis and barium enema reduction, or selected surgical intervention when indicated.
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PMID:Intussusception in children under 2 years of age in the State of Qatar : analysis of 67 cases. 137 79

Amongst 876 cases suffering from ascariasis 662 cases were managed conservatively and 214 cases were treated by surgery. Surgical complications were found to be more common in males in the age group of 6-10 years. Principal clinical features included pain abdomen (99.54%), constipation (80.25%), vomiting (67.46%), abdominal distension (47.03%), palpable worm masses in abdomen (35.50%), visible peristalsis (27.63%), worms in vomitus (24.20%) and palpable worm clumps on rectal examination (20.09%). Principal clinical diagnosis were worm colics (48.74%), sub-acute intestinal obstruction (27.74%), acute intestinal obstruction (11.42%) and acute intestinal obstruction with strangulation (5.71%); rest of the cases included worm cholecystitis (2.63%), obstructive jaundice (1.71%), bile peritonitis (0.91%), intestinal perforation (0.68%) and acute appendicitis (0.46%). Surgical procedures performed were milking of worms (34.12%), resection anastomosis of small intestine (23.36%), enterotomy with removal of worms (16.36%), cholecystectomy with T-tube drainage (12.15%), cholecystectomy (8.41%), appendectomy (1.87%), resection anastomosis with excision of Meckel's diverticulum (1.40%), repair of intestinal perforation with peritoneal toilet (1.40%) and cholecystectomy with choledochoduodenostomy (0.93%). In surgically managed patients 35 cases died of septicaemia and in conservatively managed cases 3 died of encephalitis with an overall mortality of 4.34%.
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PMID:Surgical manifestations and management of ascariasis in Kashmir. 140 71

Fifty-one children under the age of 10 years admitted to a general hospital in Trinidad had a confirmed diagnosis of malrotation of the intestines. This was the primary diagnosis in 20 cases. Analysis of the records of these 20 revealed that one-half were less than 1 month of age at first presentation. Vomiting was a universal complaint, and nearly two-thirds were malnourished. Disturbed bowel habit, anorexia and abdominal pain were also reported. In 30% (six of 20) there were signs of dehydration; an equal number had features of intestinal obstruction. Radiological investigation provided the diagnosis in all but one child, who underwent surgical exploration with a provisional diagnosis of appendicitis. Although a volvulus was found in 35% of cases, no resections were necessary. A high rate of morbidity and a mortality rate of 15% highlight the problems involved in the surgical care of young infants.
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PMID:Intestinal malrotation in Trinidad. 140 41

Intestinal obstruction is a rare but serious complication of pregnancy with significant maternal and fetal mortality. The reported incidence of intestinal obstruction complicating pregnancy varies widely, from 1 in 66,431 to 1 in 1,500 deliveries. A retrospective review of 66 cases of intestinal obstruction complicating pregnancy and the puerperium, including 2 cases from our institution, revealed that the most common causes of mechanical obstruction were adhesions (58%), volvulus (24%), and intussusception (5%). Seventy-seven percent of the patients with obstruction due to adhesions had undergone previous abdominal or pelvic surgery. Presenting symptoms and signs were similar to those of the nonpregnant patient; abdominal pain was present in 98% of patients, vomiting in 82%, and tenderness to palpation in 71%. In 82% of patients, obstruction was evident on radiographic evaluation. Prompt management of obstruction is essential; the median length of time from admission to laparotomy in the 66 patients was 48 hours. Bowel strangulation requiring resection was present in 23% of patients. Thirty-eight percent of patients completed term pregnancies after operative resolution of obstruction; total maternal mortality was 6%, and total fetal mortality 26%. Thus, both mother and fetus are at risk when intestinal obstruction complicates pregnancy. Clinical suspicion of the presence of obstruction and aggressive intervention are required to decrease the morbidity and mortality of this rare complication of pregnancy.
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PMID:Intestinal obstruction complicating pregnancy. 141 49

A 3-week-old boy presented with repeated episodes of vomiting and constipation. At laparotomy a jejunal diverticulum arising from its antimesenteric border and extending retroperitoneally was found. The narrow neck of diverticulum caused a situation similar to a Richter's hernia. The fundus of diverticulum was attached to the upper pole of left kidney. A retroperitoneal jejunal diverticulum is a new addition to the cause of neonatal intestinal obstruction.
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PMID:Retroperitoneal jejunal diverticulum: cause of intestinal obstruction. 146 85

This retrospective study evaluated predisposing factors, clinical picture and the methods of treatment related to morbidity and mortality of 19 small bowel volvulus (SBV) who underwent operation at Belen Hospital (Trujillo-Peru) during the last 26 years (1966-1992). The SBV was 1.6% of all cases of intestinal obstruction in this period and 10.8% of all intestinal volvulus. The median age was of 43 +/- 20.5 years (range, 6 to 78 years) and the majority of them were between 41 and 60 years. Sixteen cases (84.2%) were men from Indian and Spanish extraction and most of them were farmers and came from the Sierra of the Department of La Libertad. Two cases (10.5%) had non-related antecedents previous surgery. In six patients (31.6%) the volvulus was less than seven day's duration and in thirty (68.4%) it was more eight day's duration with previous attacks of obstruction (median: 19.3 days, range: 17 hours to 94 days). Pain, vomiting and distention were present in almost all of these cases. The most frequent abdominal finding was distention. The location of the volvulus was: ileum, 12 cases (63.2%), root of mesentery, 4 cases (21%) and jejunum, 3 cases (15.8%). Gangrenous bowel was present in six patients (31.5) and gangrenous intestine with perforation in two cases (10.5%) who underwent resection of the involved segment with primary anastomosis. In this group one patient (5.2%) died of sepsis and the wound infection rate was of 37.5%. There was no statistically significant correlation with the duration of illness and the presence of gangrenous loops or the mortality rate (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Predisposing factors, clinical picture and mortality in volvulus of the small intestine]. 147 87

Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.
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PMID:[Intestinal volvulus in pregnancy]. 149 64

Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.
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PMID:Malrotation of the intestine in children. 154 4


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