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

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosing appendicitis in children with acute abdominal pain. 318 19

A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.
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PMID:Abdominal pain in neutropenic cancer patients. 394 98

Two hundred and fourteen patients with Crohn's disease (CD) consecutively admitted during a 5-year period were observed for a mean of 9 years (range, 0-35 years). Sixty-five per cent had their initial symptoms between 10 and 30 years of age and 9.2% after the age of 50 years. The CD diagnosis was delayed for more than 10 years in 8% (mean, 4.5; range, 0-31 years). Large-bowel involvement was seen in 82.5% and was the only localization of the disease in a fourth of the patients. Recurrent abdominal pain occurred in two-thirds of patients with ileal or ileocolic disease. Acute abdominal pain was the cause of laparotomy in 14% of the patients with ileocolic CD. Diarrhea and rectal bleeding occurred significantly more often in colonic CD, whereas fistula complicated ileocolic disease more often than isolated involvement of small or large bowel. Associated extraintestinal diseases were seen in 117 patients (55%), most frequently related to colonic involvement (joint disease, 21%; eye, 12%, skin, 8%). Of 26 patients (12%) with liver pathology, 10 patients had amyloid deposits. Amyloidosis was diagnosed in altogether 12 patients (6%).
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PMID:Crohn's disease. Clinical manifestations. 403 86

A case of mesenteric vascular occlusion is detailed. The 30-year-old female had abdominal pain, bloody diarrhea, and small bowel changes seen on x-ray. She had begun taking the oral contraceptive Ovral (.5 mg norgestrel, .05 mg ethinyl estradiol) 3 years prior to hospital admission. Symptoms began to disappear when her oral contraception was discontinued on the ninth hospital day. Over the next 5 days abdominal signs and symptons subsided progressively. A follow-up small bowel series showed complete disappearance of previous abnormalities. In the differential diagnosis of acute abdominal pain progressing to bloody diarrhea, especially in young women or oral therapy, acute vascular insult with small bowel ischemia must be considered.
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PMID:Reversible mesenteric vascular occlusion associated with oral contraceptives. 470 Oct 37

2 cases of midgut infarction in patients taking oral contraceptives are reported. Case 1 was a 38-year-old married woman with 3 children. After 2 isolated bouts of severe abdominal pain and diarrhea, examination revealed only minimal epigastric and left loin tenderness. Blood counts were normal. Other tests were negative. She had been taking cyclical tablets of 2.5 mg norethynodrel and .1 mg mestranol (Con ovid-E) for 48 months and continued after 8 days in the hospital. 18 weeks later severe abdominal pain, vomiting, and diarrhea occurred with abdominal tenderness and rigidity. The white-cell count was 25,000 with 85-90% segmented forms. Other blood tests were normal. At operation the superior mesenteric artery was found to be occluded distal to the origin of the middle colic artery. The thrombus was removed and the circulation to the gut seemed adequate. Intravenous heparin was given. Reoperation at 12 and again at 36 hours revealed viable intestine. 8 days after hospital admission ileus symptoms occurred. Reoperation revealed gangrene of almost all of the small intestine and part of the large intestine. The patient died 3 days later. Autopsy showed thrombosis of the superior mesenteric artery which was apparently not associated with local atheroma. Minimal atheroma in the aorta and an infarct of the spleen were noted. Case 2 was a 45-year-old married woman with 2 children who complained of severe abdominal pain and vomiting of 8 hours duration. A similar attack 1 week earlier had subsided in 6 hours. She had been taking tablets of 5 mg ethinyl-esternol (lynestrenol) and .15 mg mestranol (Noracyclin) for 11 months. There was no fever. The white-cell count was 19,500 with 85% segmented forms. Other laboratory tests and X-ray were normal. A loud bruit was heard over the upper abdomen. Bowel sounds were hyperactive. A diagnosis of acute small-bowel obstruction was made. At operation a definite diagnosis could not be made. Symptoms became worse. Reoperation 10 days later revealed gangrenous small intestine and part of the large intestine. The gangrenous parts were removed. After a complicated convalescence the patient recovered, but has moderate steatorrhea. Histologic examination of the resected intestine showed no evidence of atheroma in the mesenteric vessels. Considering these 2 cases with premonitory warning symptoms and without evidence of an atheromatous cause but associated with oral contraceptive therapy the immediate discontinuance of such therapy in women who develop acute abdominal pain is irecommended.
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PMID:Infarction of the midgut associated with oral contraceptives. Report of two cases. 568 97

Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with methotrexate (250 mg/m2) followed 1 hour later by 5-FU (600 mg/m2). One patient had a complete response and four had partial responses, for an overall response rate of 16%. The response rate in patients with no prior chemotherapy was 21%. Toxic effects included neutrophenia in ten patients, with one associated death from infection; severe mucositis in three patients; and severe diarrhea in seven patients. Three patients had acute abdominal pain requiring hospitalization, with one associated death. The combination of methotrexate and 5-FU as given in our study was not superior to methotrexate alone and had substantial toxicity.
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PMID:Use of methotrexate and 5-FU for recurrent head and neck cancer. 675 74

Campylobacter fetus ss. jejuni has been recently recognized as a common human enteric pathogen; however, the pathology and pathophysiology of the enteritis caused by this agent are still largely obscure. We report 4 patients who presented with acute abdominal pain and bloody diarrhea and who had C. fetus ss. jejuni isolated from fecal cultures. Each patient showed a fourfold rise in serum IgG titer to the organism isolated. In all 4 patients colonic involvement was noted on sigmoidoscopic examination. Biopsy specimens showed acute colitis with inflammatory infiltrates of the lamina propria and crypt abscesses. Clinical improvement was complete in all patients after therapy with erythromycin. These results suggest that clinicians should consider Campylobacter enteritis in the differential diagnois of acute colitis.
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PMID:Acute colitis caused by Campylobacter fetus ss. jejuni. 735 Dec 84

Three episodes of illness outbreak, with major symptoms of acute abdominal pain and diarrhea, occurred in 1990 to 1991 in the army forces stationed in Beijing. Bacillary dysentery outbreak caused by Shigella dysentariae were confirmed with epidemiological investigations and pathogen identification. Drug sensitivity tests with Kirby-Bauer method for the strain isolated showed it had obvious resistance to 13 of 14 kinds of antibiotics tested. Detection of plasmid with Birnboim method showed most of the strains had R-plasmid of 120-140 Md and few had small plasmid. It suggested inherent connection between drug-resistance of the strains and plasmid.
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PMID:[Epidemiologic studies on three episodes of acute bacillary dysentery outbreak]. 764 49

The case records of 43 patients with acute mesenteric ischaemia who presented to the Professorial Surgical Unit, Aberdeen Royal Infirmary between January 1982 and December 1992 were examined. Principal presenting clinical symptoms were acute abdominal pain (100%) with diarrhoea in 44% of patients. Abdominal examination revealed diffuse non-specific tenderness in 48%, with signs of peritonitis in 52% of patients. In 22 of the 43 (51%) patients there was a delay in diagnosis (greater than 12 h from the onset of pain). The overall mortality was 70%, and three significant prognostic factors were identified--surviving patients had a delay in diagnosis of less than 12 h, a normal chest radiograph and a higher arterial paO2, (10.0 +/- 1.0 vs 7.7 +/- 1.2, P < 0.05, vs non-survivors), on admission to the surgical unit. Twenty-five of the 29 non-surviving patients had extensive infarction of small and large intestine, compared with only 1 of the 14 surviving patients (P < 0.05).
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PMID:Mesenteric ischaemia: prognostic factors and influence of delay upon outcome. 777 72

Two cases of intestinal spirochetosis in two children are reported. The first patient, a 7 1/2-year-old boy, presented with diarrhea and rectal bleeding. After the diagnosis was made by a rectal biopsy, he was given metronidazole and neomycin. Symptoms persisted despite a further rectal biopsy that showed clearance of the organisms. Appendiceal spirochetosis was an incidental finding in our second patient, an 8-year-old girl who presented with acute abdominal pain and in whom mesenteric adenitis was diagnosed clinically at laparotomy. The possible pathogenic mechanisms causing clinical symptoms are discussed.
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PMID:Intestinal spirochetosis in children: report of two cases. 800 82


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