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

Eight patients over age 60 years had sudden onset of acute abdominal pain and rectal bleeding in the absence of prior inflammatory bowel disease. Several improved on medical therapy alone; those who required surgery suffered no recurrence up to 6 years. Although the pathologic specimens on these patients were first considered to represent ulcerative colitis or Crohn's disease, their histories and clinical courses are much more consistent with ischemic colitis. Since there are only a limited number of reactions that the bowel can muster against a host of damaging processes, histologic criteria alone are usually not sufficient to separate ischemic disease of the colon from ulcerative colitis and Crohn's disease. This is also true of radiographic features. Thus the diagnosis of ischemic colitis rests on clinical onset and course after treatment.
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PMID:Colitis in the elderly: ischemic colitis mimicking ulcerative and granulomatous colitis. 11 2

A case report of subacute, reversible ischemic colitis associated with use of oral contraceptives (OCs) is reported. A 19-year-old woman was admitted to the hospital with chief complaints of abdominal cramps, nausea, vomiting, diarrhea, and rectal bleeding of 2 days' duration. Past medical history and family history were noncontributory. The patient was receiving no medication other than Norinyl 2 (2 mg of norethindrone and .1 mg of mestranol), which she had been taking for 6 months. 2 days before admission the patient had taken 100 mg of dimenhydrinate and 2 ExLax tablets (90 mg of phenolphthalein) for constipation. Colonic roentgenograms revealed impaired mesenteric circulation and bowel ischemia; OC-induced ischemic bowel disease was diagnosed. Patient symptoms subsided within 96 hours of discontinuing the OC and initiating supportive therapy (including intravenous fluid infusion, nasogastric suction, analgesics, and antiemetics). When a repeat barium enema was performed, it showed resolution of the ischemia. In a short review following the case report, these drugs were indicted in causation of colitis-like syndrome: amoxicillin, ampicillin, cephazolin, chloramphenicol, chlorpropamide, clindamycin, cloxacillin, cotrimoxasole, cyclophosphamide, digitalis, ergotamine tartrate, flucytosine, fluorouracil, gold salts, laxative and cathartic abuse, mercurous chloride, methyldopa, penicillin V, and tetracycline. Ischemic bowel disease secondary to OC use is a rare but important complication because of its significant morbidity and potential mortality, and because of the widespread use of the drugs. The case report emphasizes the need to consider the differential diagnosis of acute vascular insult with bowel ischemia when acute abdominal pain progressing to bloody diarrhea occurs in young women taking OCs.
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PMID:Oral contraceptive-induced ischemic bowel disease. 48 72

Eighteen hemodialysis patients with the diagnosis of mesenteric ischemia (MI), admitted to the Renal Service in the last 5 years, were retrospectively reviewed. All patients, 10 males and 8 females, average age 66.3 +/- 8.6 years, were complaining of acute abdominal pain without other specific clinical or laboratorial findings, had their diagnosis confirmed during laparatomy, with ischemic involvement of the ileocecal/ascendant colon area in 14 cases and the small bowel in 4. Noteworthy was the high incidence of previous dialysis-induced hypotensive episodes (10/18), the presence of leukocytosis (13/18), the high average hemoglobin level of 9.4 gr/dl, and the constant finding of non-occlusive MI. Average time in-hospital was 15.4 days (2 to 30) and the mortality--88% (16 patients). The growing incidence of MI mostly of the non-occlusive type, and its grim prognosis, calls for an early diagnosis of functional ischemic colitis, and the adoption of preventive action to avoid bowel infarction.
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PMID:[Mesenteric ischemia in hemodialysis]. 160 63

Abdominal pain is quite common in sickle cell crisis, although the cause of abdominal pain is seldom determined and remains controversial. We have recently seen an 18-yr-old man with sickle cell disease who developed acute abdominal pain during a crisis. Rebound tenderness on physical exam and "thumbprinting" on barium enema examination suggested possible colon infarction. Histopathologic review of the resected ascending colon demonstrated mucosal necrosis and submucosal edema consistent with ischemic colitis. Hypotheses regarding the cause of abdominal pain in sickle crises are reviewed; the pathophysiology of sickle-cell induced vasocclusion and its relation to the development of ischemic colitis in our patient is discussed.
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PMID:Ischemic colitis complicating sickle cell crisis. 684 44

To understand the surgical approach to acute abdominal pain, the internist must be familiar with common presentations of most abdominal emergencies; these emergencies include acute appendicitis, acute gall bladder disease (biliary colic, acute cholecystitis, and acute pancreatitis), ischemic bowel disease and ischemic colitis, abdominal aortic aneurysm, and intestinal obstruction. Nothing compares to experience; this article reviews the salient points that deserve consideration.
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PMID:An internist's approach to acute abdominal pain. 837 23

The aim of this study was to evaluate the contribution of colour Doppler sonography in the diagnosis of acute intestinal ischaemia. In a two years experience, all patients admitted for acute abdominal pain in our emergency department were evaluated with colour Doppler sonography of the abdomen. The final diagnosis based on clinical evolution, endoscopic or surgical findings and further radiological investigations was compared to the sonographic results. Therapy and final outcome of the patients with acute intestinal ischaemia were also evaluated. In twenty-one patients a final diagnosis of acute intestinal ischaemia (mesenteric ischaemia (n = 13) and ischaemic colitis (n = 8)) was made. Intestinal ischaemia was correctly diagnosed by initial clinical and biological data and further confirmed by sonography in eight cases (mesenteric ischaemia (n = 2) and ischaemic colitis (n = 6)). Eleven other cases were detected by suggestive colour Doppler sonography features (mesenteric ischaemic (n = 10) and ischaemic colitis (n = 1)). Sixteen of the 21 patients had a final favourable outcome (mesenteric ischaemia (10/ 13) and ischaemic colitis (6/8)). We conclude that sonography has a place in the diagnosis of acute intestinal ischaemia and has to be integrated in the diagnostic algorithm of this acute condition. By this way, this diagnosis may be suspected earlier and may allow a prompt and adapted treatment with possible improvement in survival rate.
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PMID:Early diagnosis of acute intestinal ischaemia: contribution of colour Doppler sonography. 938 99

A healthy, middle-aged Japanese man with no family history of thrombotic disorders presented with acute abdominal pain due to ischemic colitis. Two months later, he developed left leg pain and swelling. A venogram of the lower limbs, computed tomography, and a scintigram of pulmonary blood flow revealed deep vein thrombosis of the left lower limb extending to the inferior vena cava and emboli of both pulmonary arteries with bilateral pleural effusions. The responsible coagulation disorder was not detected in this case. Since these thrombi were refractory to the thrombolytic therapy with urokinase and anticoagulant therapy with warfarin, prednisolone was chosen for the suppression of accompanying thrombophlebitis. Two months following the initiation of prednisolone (20 mg/day), the venous thrombosis, abnormal pulmonary shadows, and pleural effusions had completely resolved. This case demonstrates the successful treatment of idiopathic venous and pulmonary thrombosis with glucocorticoids.
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PMID:A case of idiopathic deep vein thrombosis improved with glucocorticoid therapy. 1043 71

The clinical diagnosis of acute colonic diverticulitis (ACD) is at times difficult and an early detection by a non-invasive method as ultrasonography (US) is required. The aim of this study is to evaluate the diagnostic sensibility of US performed on admission in patients with ACD, its value in monitoring assessment of severity and its influence on surgical decision. The Authors have carried out a retrospective study on 22 patients (8 men and 14 women, median age 58 years) admitted from January 1997 to June 1999 for ACD. In 21 cases the diagnosis was made on admission by US. The diagnostic sensibility was 95.5% (false-negative: 1 case). The true diagnosis in 2 false-positive patients was: ischemic colitis (1 case), aspecific thickening of colonic wall in patient with left renal carcinoma (1 case). The sensibility of clinical evaluation on admission was 68% (false-negative: 7 cases). The clinical diagnosis was unequivocal in only 36.4% of cases. In 14 patients, successfully treated conservatively, the US gave monitoring the reduction of hypoechogenic thickening of the colonic wall. Seven patients who underwent urgent surgery: in 3 cases for generalized peritonitis, but in 4 patients (18.2%) the immediate management was influenced by US detection of a clinical misdiagnosed abscess. The Authors conclude that, in the hands of an expert investigator, the extensive use of US in acute abdominal pain facilitate an accurate diagnosis of ACD and its appropriate management.
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PMID:[Ultrasonography of acute colonic diverticulitis. Effect on surgical treatment]. 1091 53

A 42-year-old woman came to the emergency department with acute abdominal pain. CT-scan showed an isolated dissection of the A. mesenterica superior and signs of ischaemic colitis. The patient was treated with endovascular stent placement in the artery and partial small bowel resection.
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PMID:[A woman with acute upper abdominal pain]. 2177 73

Pneumatosis intestinalis (PI) is an uncommon condition and can be associated with a wide spectrum of diseases, ranging from life-threatening to innocuous conditions. We report the case of a 46-year-old women coming to our attention for an acute abdominal pain, nausea, vomiting, constipation, and increased inflammatory marks, with a CT showing pneumoperitoneum and pneumatosis intestinalis. The previous diagnosis was advanced neoplasia of unknown origin. Despite the surgical intervention, which excluded an ischemic colitis, the patient died in the early postoperative period. The postmortem diagnosis was carcinoma of thymus gland, and the presence of pneumatosis was put down to metastasis nodes in the pulmonary parenchima. This case demonstrates the wide spectrum of presentation of pneumatosis intestinalis, the importance of a careful radiologic evaluation beside the clinical history, since the identification of correct pathogenesis and treatment can be very difficult.
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PMID:The dilemma of pneumatosis intestinalis with pneumoperitoneum: nonoperative or surgical management-analysis of a case. 2365 55


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