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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 report on a six-year prospective study to determine the presentation and outcome of acute abdominal TB at Komfo Anokye Teaching Hospital. Between January 1998 and December 2003, material for biopsy including resected bowel was taken from all cases of acute abdomen, which at laparotomy were suspected as one or other form of abdominal TB. TB-positive cases were then retrospectively analysed for clinical presentation and outcome of surgical treatment. There were 96 histologically proven cases of abdominal TB, 60 in women and 36 in men. Seventy patients (72.9%) were admitted as acute intestinal obstruction with acute abdominal pain, vomiting, constipation, distension and fluid levels on abdominal X-ray. Twenty-two (22.9%) patients were admitted as acute diffused peritonitis - with generalized abdominal tenderness, guarding and rebound - and four (4.2%) as acute appendicitis. There were 74 emergency bowel resections (77% resection rate) for 34 ileocaecal masses, 16 strictures, 10 perforations and 14 adhesions, with a mortality of 4.2%. Previous series from our subregion have reported similar emergency resection mortality rates for other abdominal conditions. All the patients received postoperative anti-TB therapy. This paper notes that acute intestinal obstruction is the most common acute presentation of abdominal TB in our environment. The results of emergency resection compare favourably with resection for other acute abdominal conditions.
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PMID:Case series of acute presentation of abdominal TB in Ghana. 1703 7

Schwannomas are benign neurogenic tumors that arise from Schwann cells that line the sheaths of peripheral nerves. Schwannomas are commonly located in the soft tissues of the head and neck, extremities, mediastinum, retroperitoneum, and pelvis, but they are very rare in the mesentery. A 56-y-old man was admitted to the emergency service with nausea, vomiting, acute abdominal pain, and constipation. He reported weight loss and an intra-abdominal mass. On physical examination, the abdomen was distended, and a mass that was approximately 15 cm in diameter was palpated at the middle abdomen. Generalized abdominal tenderness and muscle spasm were noted. Air-fluid levels were seen on plain radiographs. Ultrasonography identified an intra-abdominal mass with intra-abdominal hemorrhage or perforation. Clinical signs and laboratory findings suggested an intra-abdominal mass, mechanical bowel obstruction, and an acute abdomen. The patient underwent surgery. The mass was completely excised and included a 4-cm-long intestinal segment that was densely adherent to the mass. Histopathologic and immunohistochemical examination revealed a mesenteric schwannoma. The patient was well 11 mo after surgery. Although schwannomas are very rare and generally asymptomatic, these tumors can become quite large and may cause acute abdominal problems such as mechanical bowel obstruction.
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PMID:Case report: mesenteric schwannoma. 1714 3

Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease to surgical emergencies. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. The location of pain is a useful starting point and will guide further evaluation. For example, right lower quadrant pain strongly suggests appendicitis. Certain elements of the history and physical examination are helpful (e.g., constipation and abdominal distension strongly suggest bowel obstruction), whereas others are of little value (e.g., anorexia has little predictive value for appendicitis). The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain. It is also important to consider special populations such as women, who are at risk of genitourinary disease, which may cause abdominal pain; and the elderly, who may present with atypical symptoms of a disease.
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PMID:Evaluation of acute abdominal pain in adults. 1844 63

Acute ovarian torsion is an uncommon yet important diagnostic consideration in any female pediatric patient presenting with acute abdominal pain. A 2-month-old infant presented to the emergency department with a several-day history of constipation. Evaluation with plain radiographs demonstrated a subtle yet persistent soft tissue mass in the right pelvis. Follow-up ultrasound revealed characteristic findings for ovarian torsion and subsequent salpingo-oophorectomy was performed confirming the diagnosis. Acute ovarian torsion is an uncommon and frequently overlooked diagnosis in female infants presenting with gastrointestinal or urinary tract symptoms. Careful assessment of plain radiographic findings may aid in the further management of this difficult diagnosis in female infants. Ultrasound is recommended to confirm the diagnosis.
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PMID:Acute ovarian torsion in an infant: diagnostic clues on supine and decubitus abdominal radiographs confirmed by ultrasound. 1999 52

This study evaluate the need for general practitioners referrals and self referrals of acute abdominal pain patients to emergency surgical service, the appropriateness of GP referral diagnosis and their attitudes dealing with abdominal pain. In three months period all acute abdominal pain patient referrals to our hospital emergency surgical service were audited. Data on final diagnosis, surgical treatment, admission to hospital and surgery performance were recorded. Self referral or GP referral, referring GP diagnosis, referral letters indicating presenting complaint or history, axillar and rectal temperature measurement, laboratory checking and abdominal radiography checking by GP were recorded as well. Also, GPs examination details as palpation, auscultation and digit-rectal checking were recorded. We calculated sensitivity, specificity, positive and negative predictive value (PV) for referring diagnosis. Self referrals and GP referrals differences were evaluated. During the study 318 patients were admitted. A total of 163 (51.25%) referrals were deemed inappropriate; 102 (52.6% of GP referrals) and 61 (49.2% of self referred) (p < 0.05). There were no differences in general treatment, hospital admission and operative treatment in self referred and GP referred groups (p < 0.05 for all three categories). Sensitivity, specificity, positive and negative predictive values for most frequent GP referral diagnoses were: abdominal colic/abdomen in observation 0.78; 0.66; 0.74; 0.70; acute appendicitis 0.37; 0.92; 0.44; 0.90; acute abdomen/peritonitis 0.30; 0.97; 0.54; 0.92; constipation 0.95; 0.98; 0.85; 0.99; and ileus 0.83; 0.97; 0.50; 0.99. Data on GP including clinical examination, patient history and running basic diagnostics were poor. Our results suggest that a general agreement within the profession about what constitutes a necessary hospital referral is necessary. GP consultation quality must be improved by booking more time per patient and by giving more medical/technical attention to patients.
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PMID:Abdominal pain patient referrals to emergency surgical service: appropriateness of diagnosis and attitudes of general practitioners. 2010 75

An 11-yr-old boy was admitted to the hospital with gradually aggravating acute abdominal pain along with nausea, vomiting and constipation for 5 days. The pain started after blunt trauma on the superior abdomen. He had normal laboratory tests and abdominal examination, but his chest radiograph showed infiltration in the right lung and an abnormal mass on the left diaphragm. Further investigation like computed tomography (CT) and magnetic resonance MR angiography, revealed an abnormal para-aortic mass located a mass located para-aortic above posterior to the left diaphragm with a well-defined margin. The abnormal mass was finally confirmed to be a hematoma with exploratory thoracotomy. The rarity of this kind of presentation is discussed for making an early and correct diagnosis.
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PMID:An unusual presentation of thoracic para-aortic hematoma due to blunt trauma. 2058 78

We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case, a massive constipation of the small bowel was most likely a contributing factor. In the second case, the cause was a kink of the entero-entero anastomosis leading to obstruction and finally perforation of the biliary limp. Late perforations are among the rarely reported complications associated with gastric bypass but as our two cases illustrate they are important to keep in mind.
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PMID:[Late perforation following laparoscopic gastric bypass]. 2082 30

Cholelithiasis is rarely seen in toddlers and school-aged children, even in the setting of sickle cell anemia. In addition to more common etiologies, such as gastroenteritis, constipation, and urinary tract infection, the differential diagnoses of acute abdominal pain in young children with sickle cell disease include vaso-occlusive pain crisis and splenic sequestration. We describe a case of a toddler with sickle cell disease initially presenting with abdominal pain who was found to have symptomatic cholelithiasis.
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PMID:Cholelithiasis in a toddler with sickle cell disease. 2164 88

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

Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided.
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PMID:Management of sigmoid volvulus avoiding sigmoid resection. 2275 89


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