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

The successful endovascular exclusion of a ruptured 3-cm diameter atherosclerotic abdominal aortic aneurysm (AAA) in a high-risk patient with renal failure is reported. An 82-year-old man with chronic renal failure and other comorbidities was admitted for acute abdominal pain. Duplex scan and computed tomography showed a ruptured 3-cm diameter atherosclerotic AAA. As a consequence of the patient's high surgical risk combined with signs of rupture, despite the progressively decreasing renal function, an emergency exclusion of the AAA was performed by means of a bifurcated Excluder (W. L. Gore and Associates) endovascular graft. The procedure was performed by minimizing administration of iodinated contrast medium using a guidewire into the lowest renal artery as a marker of proximal deployment. Intravascular ultrasound was used to confirm correct deployment. The postoperative recovery was characterized by acute renal insufficiency and bowel ischemia, which were treated with ultrafiltration and medical therapy, respectively, with complete resolution.
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PMID:Small ruptured abdominal aortic aneurysm with renal failure: endovascular treatment--a case report. 1289 71

Metformin, an anti-hyperglycaemic drug, reduces mortality in obese patients with a non-insulin-dependent diabetes mellitus type II (United Kingdom Prospective Diabetes Study) and is therefore recommended as the first line therapy. A metformin-associated lactic acidosis due to accumulation or intoxication is a rare but severe complication with a mortality rate of up to 50%. The main clinical symptoms are unspecific and the patient may present with acute abdominal pain and reduced consciousness. This can easily be misinterpreted and may lead to a wrong diagnosis. Only a thorough clinical examination and exact analysis of laboratory values in combination with the medical history and chronic medication will allow a correct diagnosis. We report a case of a 79-year-old female patient whose clinical symptoms were initially interpreted as an acute intestinal ischemia. A progressively deteriorating haemodynamic state led to an exploratory laparotomy. Postoperatively, the correct diagnosis of a metformin-associated lactic acidosis due to acute renal failure was made. In the course of the ICU stay the condition improved after bicarbonate haemodialysis and the patient was discharged 11 days after admission.
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PMID:[Lactic acidosis and acute abdomen from biguanide intoxication]. 1499 Nov 92

A 51 year-old man presented with acute abdominal pain in our emergency room. The first examination revealed no pathological findings except coprostasis and after an enteroclysis the patient was sent home without any complaints. During a recent episode of abdominal pain a computer tomography was performed, showing dissection of the superior mesenteric and the celiac artery. Without any signs of mesenteric ischemia additional examinations like laboratory studies, x-rays, and abdominal ultrasound might be normal and therefore not helpful for diagnosis. In patients presenting with persistent abdominal pain and unspecific clinical and laboratory findings rare causes of abdominal symptoms should be considered. Despite the rarity of visceral artery dissection, awareness of this pathology is crucial because of its possible lifethreatening complications. Appropriate diagnostic imaging tests may avoid postmortem diagnosis by the pathologist.
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PMID:[Spontaneous dissection of visceral blood vesssels--a rare cause of epigastric pain]. 1503 39

Acute abdominal pain in children is a frequent symptom of a wide spectrum of abdominal and extra-abdominal pathologies. Some of them are more common in specific age groups. Prompt diagnosis and treatment are facilitated by a good knowledge of the etiologies. Although surgery is mandatory in most of the cases of perforation, torsion, ischemia or necrosis, a medical treatment will prevent an unnecessary laparotomy in some circumtances.
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PMID:[Paroxystic abdominal pain in children]. 1526 86

Anatomical abnormalities of the liver are extremely rare. Although the majority of cases with an accessory liver are not detected, it can give rise to various clinical symptoms like recurrent abdominal pain and impaired liver function. Here we present the first case of orthotopic liver transplantation in a patient with hepatic ischemia caused by complete vascular occlusion due to a twisted accessory liver lobe. Although rare, an accessory liver lobe may cause serious and life-threatening problems and should therefore be kept in mind in patients presenting with acute abdominal pain.
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PMID:Complete hepatic ischemia due to torsion of a large accessory liver lobe: first case to require transplantation. 1577 69

The authors analyze the structure of acute abdominal pain in the general surgeon "s practice. The article contains the results of an analysis of the frequency of various causes of pain, as well as a description of the most frequent causes of death in acute pancreatitis, cholecystitis, appendicitis, bleeding and perforative ulcer, ileus, strangulated hernia, and acute mesenterial ischemia.
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PMID:[The cause of acute abdominal pain]. 1675 16

Marfan syndrome is an autosomal dominant inherited disorder of connective tissue, with various complications manifested primarily in the cardiovascular system. It potentially leads to aortic dissection and rupture, these being the major causes of death. We report a patient who complained of acute abdominal pain, which presented as acute mesenteric ischemia combined with abdominal aortic dissection. Echocardiography showed enlargement of the aortic root and mitral valve prolapse. Abdominal computed tomography scan revealed acute mesenteric ischemia due to abdominal aortic dissection. Finally, the patient underwent surgery of aortic root replacement and had a successful outcome. Therefore, we suggest that for optimal risk assessment and monitoring of patients with Marfan syndrome, both aortic stiffness and the diameter of the superior mesenteric vein compared with that of the superior mesenteric artery are useful screening methods to detect acute mesenteric ischemia secondary to abdominal aortic dissection. Early diagnosis and early treatment can decrease the high mortality rate of patients with Marfan syndrome.
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PMID:Abdominal aortic dissection with acute mesenteric ischemia in a patient with Marfan syndrome. 1690 47

Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly benign, even with catastrophic conditions such as abdominal aortic aneurysm rupture and mesenteric ischemia. Changes that occur in the biliary system because of aging make older patients vulnerable to acute cholecystitis, the most common indication for surgery in this population. In older patients with appendicitis, the initial diagnosis is correct only one half of the time, and there are increased rates of perforation and mortality when compared with younger patients. Medication use, gallstones, and alcohol use increase the risk of pancreatitis, and advanced age is an indicator of poor prognosis for this disease. Diverticulitis is a common cause of abdominal pain in the older patient; in appropriately selected patients, it may be treated on an outpatient basis with oral antibiotics. Small and large bowel obstructions, usually caused by adhesive disease or malignancy, are more common in the aged and often require surgery. Morbidity and mortality among older patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation.
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PMID:Diagnosis of acute abdominal pain in older patients. 1711 93

We reviewed the clinical manifestations of mesenteric vasculitis due to giant cell arteritis (GCA) and considered features of the mesenteric anatomy in relationship to disease expression. We compiled and reviewed a case series by systematic identification of patients previously reported in the English-language literature to have mesenteric involvement from known GCA. Included in the analysis was a detailed case review of a patient with GCA and small bowel infarction seen at our institution. Twelve patients were identified with mesenteric ischemia attributed to GCA. Concomitant cranial and abdominal symptoms were present in 7 of the 12 patients, and cranial symptoms were absent in 5 patients who presented with abdominal complaints. The abdominal symptoms fell within a spectrum ranging from chronic postprandial symptoms to acute abdominal pain. Survival was observed in only 6 of the 12 cases, 3 of whom required bowel resection and were treated with high-dose corticosteroids. Review of the anatomic features of the specialized splanchnic circulation reveals an extensive collateral network that may protect against early disease expression from ischemia, despite mesenteric arteritic involvement. Mesenteric vasculitis resulting in small bowel infarction has only rarely been described in GCA but represents a serious and potentially treatable complication. We propose an explanation, based on mesenteric vascular anatomy, for the infrequency of symptomatic expression of this entity and suggest that occult mesenteric GCA may be present far more often than recognized.
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PMID:Mesenteric involvement in giant cell arteritis. An underrecognized complication? Analysis of a case series with clinicoanatomic correlation. 1820 70

Bowel ischemia, an uncommon but devastating complication of systemic lupus erythematosus (SLE), poses a significant clinical challenge. A 52-year-old female with SLE presented with recurrent abdominal pain for two months which culminated in acute, severe pain with vomiting. Abdominal CT scan revealed ischemia of multiple segments of bowel. She responded slowly to methylprednisolone alone and eventually responded to methylprednisolone combined with cyclophosphamide. A high index of suspicion for bowel ischemia is required in patients with SLE presenting with acute abdominal pain.
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PMID:Intestinal ischemia in systemic lupus erythematosus. 1859 76


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