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Query: UMLS:C0740577 (acute abdominal pain)
 1,982 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present the case of a woman in her 50s presenting with acute abdominal pain and absolute constipation. Subsequent investigations revealed large bowel obstruction which was shown on computed tomography scan to be secondary to a rare volvulus of the splenic flexure of her colon. The patient was taken for an urgent laparotomy with resection of 45 cm of large bowel and formation of a primary anastomosis. Though she initially made a good postoperative recovery, she unfortunately later developed complications as a result of her surgery requiring further laparotomies. She later died of multiple organ failure, 2 months following her admission.
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PMID:Splenic flexure volvulus. 2224 51

Intestinal obstruction (IO) is a common cause of acute abdominal pain. The recent increased use of sonography in the initial evaluation of abdominal pain has made point-of-care ultrasound a valuable tool for the diagnosis of IO. Sonography is as sensitive, but more specific, than plain abdominal X-ray in the diagnosis of IO. Point-of-care ultrasound can answer specific questions related to IO that assist the acute care physician in critical decision making. Sonography can also help in the resuscitation of patients by serial measurement of the IVC diameter. We review the sonographic findings of IO and the role of point-of-care ultrasound in the management of patients having IO.
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PMID:The role of ultrasound in the management of intestinal obstruction. 2241 63

This is the case report of an 85-year-old woman who on two consecutive occasions presented with acute abdominal pain. The first presentation was large bowel obstruction. CT abdomen revealed this was due to a cholecystocolic fistula, allowing a large gallstone to pass and obstruct in the sigmoid colon. The second presentation was after laparotomy; the second CT abdomen revealed another gallstone causing small bowel obstruction. This case is interesting because cholelithiasis rarely leads to sigmoid colon obstruction (gallstone coleus)1 and gallstone ileus. Unfortunately, this patient had both. A gallstone causing obstruction in either the small or large bowel is rare, but occurrence of both in the same patient has not been reported to date. This case also shows how the elderly unwell surgical patient was mismanaged and she could have been spared surgery and irradiation if she was managed appropriately from the start.
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PMID:Large bowel and small bowel obstruction due to gallstones in the same patient. 2269 74

Several studies have demonstrated that a diagnosis based solely on a patient's medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice.
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PMID:Plain abdominal radiography in acute abdominal pain; past, present, and future. 2280 40

Cystic fibrosis (CF) is an inherited disease of the secretory glands caused by mutations of the cystic fibrosis transmembrane regulator (CFTR) gene. The clinical manifestations of CF are repetitive lung infections, biliary cirrhosis, pancreatic abnormalities, and gastrointestinal disorders. We report a 21-year-old Taiwanese man with CF who had abdominal pain for 2 days. The diagnosis of CF had been confirmed by peripheral blood analysis of the CFTR gene 5 years before admission. He presented to the emergency department with nausea, vomiting, abdominal distension, and crampy abdominal pain, which is atypical for acute appendicitis. The physical examination and a series of studies revealed intestinal obstruction, but acute appendicitis could not be ruled out. After conservative treatment, together with empiric antibiotics, the refractory abdominal pain and leukocytosis with a left-shift warranted surgical intervention. A diagnostic laparoscopy revealed a swollen, hyperemic appendix, a severely distended small intestine, and serous ascites. The laparoscopic procedure was converted to a laparotomy for open disimpaction and appendectomy. He was discharged on the eighth postoperative day. The histologic examination of the appendix was consistent with early appendicitis. In conclusion, acute abdominal pain in adult CF patients is often associated with intestinal obstruction syndrome. The presentation of concurrent appendicitis may be indolent and lead not only to diagnostic difficulties, but also a number of therapeutic choices.
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PMID:Acute appendicitis mimicking intestinal obstruction in a patient with cystic fibrosis. 2308 94

Radiologists at a large teaching hospital felt that plain radiograph imaging was being performed inappropriately for patients admitted with acute abdominal pain. They felt requests were either not indicated or CT was a more appropriate first line radiological investigation in certain circumstances.An audit was performed looking at plain radiograph imaging requests for emergency admissions under general surgery, using Royal College of Radiologists (RCR) guidelines as the standard. The audit revealed that only 80% of plain radiograph requests met RCR guidelines. It also showed that 33% of acute admissions undergoing plain radiograph imaging proceeded to CT within forty-eight hours. These findings lead to the development of a plain radiograph algorithm. This aimed to improve plain radiograph imaging requests and to increase the use of CT as an earlier or first line radiological investigation where appropriate.Outcome of discussion at local and regional clinical governance meetings was that earlier CT would be useful in specific circumstances. The algorithm provides a framework for appropriately expediting CT in patients presenting with acute abdominal pain where bowel obstruction or perforation was suspected. However, consultant surgeons felt that in patients presenting with acute abdominal pain, the plain abdominal radiograph often demonstrates findings associated with specific diagnoses not specifically indicated by RCR guidelines. If RCR guidelines for plain radiograph imaging are broadened, radiological interpretation would examine for a broader range of findings and, when combined with other clinical information, diagnoses can be made, thus avoiding the need for further imaging or explorative surgery.
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PMID:Development of a plain radiograph requesting algorithm for patients presenting with acute abdominal pain. 2328 83

The incidence of acute abdominal pain ranges between 5-10% of all visits at emergency department. Abdominal emergencies of hospital visits may include surgical and non-surgical emergencies. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation, pancreatitis, peritonitis, salpingitis, mesenteric adenitis and renal colic. Good skills in early diagnosis require a sound knowledge of basic anatomy and physiology of gastrointestinal tract, which are reflected during history taking and particularly, physical examination of the abdomen. Advanced diagnostic approaches such as radiography and endoscopy enhance the treatment for acute abdomen including pharmacological and surgical treatment. Therapeutic endoscopy, interventional radiology treatment and therapy using adult laparoscopy are the common modalities for treating patients with acute abdomen.
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PMID:Diagnostic approach and management of acute abdominal pain. 2331 78

Intussusception is a common cause of intestinal obstruction and colicky abdominal pain in the children, particularly infants, the commonest being the ileocolic variety with colocolic variety being a very rare entity. We present a case of colocolic intussusception in a 13-year-old boy which is otherwise seen in adults, precipitated by colonic malignancies. The patient presented with acute abdominal pain and bleeding perrectum with obstipation for 7 days. Preoperative USG abdomen was normal, and abdominal X-rays showed multiple air fluid levels. Intraoperative findings included a polypoidal growth in the descending colon as the leading point with the formation of a colo-colic intussusception. Following reduction and segmental resection, histopathology reported mucinous adenocarcinoma of colon which is also a rarity in pediatric age group. This case has been compared with previous cases reported in the literature.
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PMID:Colocolic intussusception in an older child: a rare case report and a literature review. 2353 8

A 57-year-old man with a history of laparoscopic loop colostomy presented with acute abdominal pain. An abdominal CT-scan demonstrated a closed-loop bowel obstruction. On exploratory laparotomy, we encountered an ischemic small bowel segment herniating through a mesocolic defect. After reposition, the bowel appeared viable. Internal herniation is a rare cause of small bowel obstruction and has a high mortality rate due to strangulation and bowel ischemia.
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PMID:[Severe abdominal pain after colostomy]. 2367 32

Appendicitis is a common cause of acute abdominal pain in children and is treated by an open or laparoscopic appendicectomy. Well documented post-operative complications include wound infection, intra-abdominal collection, and adhesional bowel obstruction. We present the rare case of right sacro-iliitis and iliac bone osteomyelitis in a 13 year old boy following an open appendicectomy for a perforated appendicitis.
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PMID:Sacro-iliac osteomyelitis in a 13 year old boy following perforated appendicitis. 2370 94


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