The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.

Adolescent↗

PubMedDate not supplied

Upper gastrointestinal bleeding from uncommon causes in patients with concomitant peptic ulcer: a clinical, diagnostic and therapeutic pitfall.

In the majority of cases, massivm a peptic ulcer arises from the ulcer. On rare occasions, the bleeding emanates from other sites in the gastrointestinal tract. Four patients, all of whom had suffered from peptic ulceration for lengthy periods, and who were referred to hospital with severe bleeding from sources other than peptic ulcer, are presented. This group of patients poses particular diagnostic and therapeutic problems, which are discussed. The need for performing emergency gastroscopy and/or selective angiography, in an attempt to localize the source of bleeding preoperatively, is stressed. In doing so, one is taking into consideration the many difficulties sometimes encountered during operation in locating a bleeding point in a bowel filled with blood clots. In those patients in whom the source of the hemorrhage cannot be ascertained, early surgical intervention is advised, because the bleeding may possibly be coming from a tumor of the small bowel.

Adult↗

PubMedDate not supplied

Long-term survival following repeated resections of the colon for multiple or recurrent carcinoma.

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Adenocarcinoma↗

PubMedDate not supplied

Factors influencing delay in treatment of cancer of rectum and colon in Israel.

One hundred cases of malignant tumor of the colon and rectum were reviewed to determine the delay interval from onset of symptoms to operation and the factors contributing to the delay. The mean overall delay interval was 7.43 months, which is relatively long as compared with findings reported in the Western literature during recent years. In 35%, there was a mean delay of six months because of failure of the patient to consult a physician in the early stages of the disease. More serious was the finding in 62% of the patients of a doctor-caused delay of six months, because of hasty, erroneous diagnosis made without comprehensive investigation. Administrative factors caused a delay of about two months in 24% of the patients. Our findings indicated a direct correlation between duration of the delay and spread of the malignancy, with an evident tendency for a shorter delay interval among patients with carcinoma classified as Dukes' stage A. Both the public and the general physician must be educated as to the importance of early consultation and careful consideration of the patient's complaints so as to reach the correct diagnosis as soon as possible.

Adult↗

PubMedDate not supplied

"Spontaneous" pneumoperitoneum.

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Aged↗