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PubMed2005

Multi-detector computed tomography of acute abdomen.

Acute abdominal pain is one of the most common causes for referrals to the emergency department. The sudden onset of severe abdominal pain characterising the "acute abdomen" requires rapid and accurate identification of a potentially life-threatening abdominal pathology to provide a timely referral to the appropriate physician. While the physical examination and laboratory investigations are often non-specific, computed tomography (CT) has evolved as the first-line imaging modality in patients with an acute abdomen. Because the new multi-detector CT (MDCT) scanner generations provide increased speed, greater volume coverage and thinner slices, the acceptance of CT for abdominal imaging has increased rapidly. The goal of this article is to discuss the role of MDCT in the diagnostic work-up of acute abdominal pain.

Abdomen, Acute↗
PubMed2002

Ruptured adrenocortical carcinoma as a cause of paediatric acute abdomen.

Adrenocortical carcinoma (ACC) is rare in children. Its presentation is usually related to hormonal activity of the tumour. We report a case of childhood ACC that presented as an acute abdomen due to tumour rupture. This is the first reported case of a ruptured ACC as a cause of paediatric acute abdomen.

Abdomen, Acute↗
PubMed2003

Omental infarction: an unusual cause of acute abdomen in children.

Acute abdomen is caused by a wide variety of etiologies, many of which require surgical intervention. Two boys were hospitalized for acute abdominal pain and low-grade fever. Physical examination revealed epigastric and right upper abdominal fullness, and laboratory studies showed elevated erythrocyte sedimentation rates, with normal leukocyte counts and coagulation profiles. Abdominal ultrasound and computerized tomography revealed pseudotumor in both cases. Symptomatic treatment and cefazolin were administered, and pain and fever subsided after 6 to 10 days. Pseudotumor due to omental infarction can present as acute abdomen in children. A high index of suspicion and the use of both ultrasonography and computerized tomography will help avoid unnecessary surgical intervention in such cases.

Abdomen, Acute↗
PubMed2004

Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen.

Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.

Abdomen, Acute↗
PubMed2005

Ultrasound of the abdomen and total bone scintigraphy in patients with cancer of the head and neck.

In this prospective study, the patients with head and neck cancer admitted to the Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, underwent examination with ultrasound of the abdomen (112 patients) and total bone scintigraphy (118 patients) in the primary staging of the disease and before the start of treatment. In only one patient did we find metastases of head and neck cancer in the liver by these additional investigations, and one patient was found to have bone metastases. No second primary cancers were found by these extra examinations. One patient was found to have an asymptomatic aorta aneurysm and was in need of urgent surgical treatment. Based on these findings, we nowadays only use ultrasound of the abdomen and total bone scintigraphy as part of the general examination of new head and neck patients in selected cases.

Abdomen↗
PubMed2000

Diagnostic laparoscopy for the acute abdomen and trauma.

BACKGROUND: We set out to investigate the potential benefits of routine diagnostic laparoscopy (DL) in cases of acute abdomen. METHODS: A prospective study of 120 DL in acute abdominal cases was performed in comparison with 310 similar acute abdominal cases treated without DL. The diagnostic accuracy, hospital stay, therapeutic delay, and convalescence time were then evaluated. RESULTS: DL established the indications for intervention in 96% of cases, yielded a diagnosis in 90%, and changed the treatment in 14%. The sensitivity achieved was 99.3%, specificity was 83.3%, and accuracy was 88.6%. There were two false positives, one false negative, and three results insufficient to make a diagnosis. Morbidity was one (0.8%), and mortality was one (0.8%). Seventy-nine patients (66%) were managed by laparoscopy and 24 by open interventions. The hospital stay in DL groups was shorter (median, 5 days vs 6 days in controls, p<0.0003), as was the effective treatment time (median, 5 days vs 6 days, p<0.0012). The convalescence time was also shorter in DL groups (median, 14 days vs 14 days, p<0.04). Therapeutic delay occurred in 16% of the control group cases, doubling the morbidity rate, increasing mortality by 50%, and prolonging hospital stay (median, 9 days vs 6 days, p>0.3 (NS). CONCLUSIONS: DL in the acute abdomen is a safe and accurate procedure that enables laparoscopic interventions and helps avoid nontherapeutic surgery. DL and appropriate treatment reduces hospital stay, therapeutic delay, and convalescence time.

Abdomen, Acute↗
PubMed2000

Non-traumatic gas gangrene in the abdomen: report of six autopsy cases.

Six autopsy cases of non-traumatic gas gangrene in the abdomen are reported. Five of the six were caused by clostridia, as identified by culture or histology. There were associated underlying diseases, such as alcoholism, liver cirrhosis, diabetes mellitus, and malignant disease. Three of the six patients had gas gangrene in the liver. Bacterial proliferation and gas accumulation were found in the sinusoids of the liver, and congestion and edema with extensive gas embolism were found in the lungs. Pulmonary gas embolism was considered to be the direct cause of death in these three patients. The other three patients had intestinal clostridial gas gangrene, with alcoholism as an underlying condition. None of the six patients was clinically diagnosed as having gas gangrene. We suggest that gas gangrene should be considered in any patient with abdominal infection. A review of 19 autopsy cases of gas gangrene in the abdomen reported in the Japanese literature is also presented.

Abdomen↗
PubMed2004

Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature.

Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.

Abdomen, Acute↗
PubMed1991

Acute abdomen as the first presentation of pseudomembranous colitis.

Acute abdomen was the presenting manifestation of pseudomembranous colitis in six men who had previously been treated with antibiotics and presented with abdominal distention, pain, fever, and leukocytosis with absent or mild diarrhea. Plain abdominal radiographs revealed megacolon in two, combined small and large bowel dilation in three, with one of them showing volvuluslike pattern, and isolated small bowel ileus in one. Emergency colonoscopy was performed successfully in all patients and revealed pseudomembranes in five and nonspecific colitis in one. All patients had positive latex test results for Clostridium difficile, and two tested positive for cytotoxicity. All patients were treated with IV metronidazole, resulting in resolution of symptoms and abdominal findings. In addition, two patients underwent colonoscopic decompression with improvement. Endoscopically, complete resolution of the pseudomembranes occurred at 4 weeks in all cases. No patient had a recurrence. It is concluded that (a) pseudomembranous colitis may present as abdominal distention mimicking small bowel ileus. Ogilvie's syndrome, volvulus, or ischemia; (b) in such cases, emergency colonoscopy is safe and useful for diagnosis and therapeutic decompression and may obviate the need for surgery; and (c) treatment with IV metronidazole is effective. Colitis due to C. difficile should be considered in the differential diagnosis of acute abdomen in patients previously treated with antibiotics.

Abdomen, Acute↗
PubMed1983

Enzymatic and hemolytic properties of brown recluse spider (Loxosceles reclusa) toxin and extracts of venom apparatus, cephalothorax and abdomen.

Loxosceles reclusa venom apparatus extract, toxin, cephalothorax and abdomen extracts were tested for six activities. Protease, lipase, nonspecific hydrolase and direct hemolytic activities were found primarily in abdomen extracts while sphingomyelinase activity appeared predominantly in the toxin. Appreciable complement-mediated hemolysis was not observed.

Abdomen↗
PubMed1979

Catheter-related injuries as cause of acute surgical condition within abdomen.

Three cases of an acute surgical condition within the abdomen secondary to complications of chronic urethral catheters are reported. Common factors in the history and varying mechanisms for the injuries are discussed. Need for including catheter-related injuries in the differential diagnosis of an acute surgical condition of the abdomen is emphasized.

Abdomen, Acute↗
PubMed1988

Hyperfractionation of whole-abdomen radiation therapy: salvage treatment of persistent ovarian carcinoma following chemotherapy.

Whole-abdomen radiation therapy has been utilized as primary adjunctive therapy in the management of epithelial ovarian carcinomas with encouraging results. The results reported when using standard fractionation protocols in patients with recurrent or persistent ovarian carcinoma have been poor and treatment-related toxicities have been severe. There are reported theoretical and clinical advantages of hyperfractionation of ionizing radiation in treating malignancies. Fifteen patients have been treated with a twice-a-day whole-abdomen, open-field radiation technique delivering 80 cGy per fraction, to a total dose of 3040 cGy in 19 treatment days. All patients had Stage III epithelial ovarian carcinoma with persistent disease detected at pretreatment laparotomy after cis-platinum-based chemotherapy. All patients had moderately to poorly differentiated tumors with residual disease less than 1 cm. Acute side effects of treatment included mild to moderate nausea and diarrhea. Thrombocytopenia (less than 50,000) was noted in five patients. No bleeding or infectious complications were noted, and no patient required hospital admission for side effects. Disease recurred in nine patients with two still alive 13 and 52 months after starting irradiation. Six patients are currently alive without evidence of disease at follow-up, ranging from eight to 48 months. The mean survival to date is 20 months with four patients alive more than 2 years, and two patients alive for greater than 3 years from their radiation therapy. Patient tolerance has been acceptable, and both the short and long-term toxicities are minimal. Late side effects of treatment have not been noted. This technique offers a chance for a long, disease-free interval and possible cure in well-defined cases of chemotherapy-treated patients with persistent ovarian carcinoma.

Abdomen↗
PubMed1989

Whole-abdomen radiation as a second-line therapy for epithelial ovarian cancer.

Whole-abdomen irradiation was delivered to 11 patients with persistent epithelial ovarian cancer after chemotherapy. Ten of the eleven patients have recurred and subsequently died of disease. The median time to recurrence was 5.5 months. All 10 recurrences were within the irradiated field. All 6 patients with microscopic disease at second-look laparotomy recurred. Four of the five patients with minimal residual disease (less than or equal to 5 mm) at second-look laparotomy recurred. One patient is alive with no evidence of recurrence at 14 months. Four patients developed small bowel obstruction, three of which were associated with recurrence. During therapy, 4 patients developed significant enteritis and 5 patients developed significant bone marrow suppression. All 11 patients completed radiation therapy, although in 4 there were interruptions of 1 to 3 weeks. Whole-abdomen irradiation does not appear to be an effective second-line regimen for epithelial ovarian cancer, even in the presence of microscopic or minimal residual disease.

Abdomen↗
PubMed1986

The acute abdomen and Murphy's signs.

The history of the acute abdomen describes a shift from emphasis on prognosis to treatment through correlation of clinical and pathological findings. John B. Murphy was an acclaimed leader of American surgery whose name is associated with several diagnostic maneuvers used in the evaluation of the acute abdomen. These include deep-grip palpation used in examination for suspected biliary disease.

Abdomen, Acute↗
PubMed1991

The acute abdomen: the role of laparoscopy.

The ability to improve surgical decision-making in the acute abdomen using selective laparoscopy is now established. When the decision to operate is uncertain laparoscopy not only identifies those patients who do not require laparotomy, but also reveals those who need surgery which might otherwise have been delayed. Furthermore, the high error rates in diagnosing acute appendicitis in young women provides overwhelming support to the current view that all women with suspected appendicitis should undergo laparoscopy before appendicectomy, irrespective of clinical 'certainty'. Improvements in the management of the acute abdomen can also be achieved by other techniques such as computer-assisted diagnosis (McAdam et al, 1990) and peritoneal cytology (Stewart et al, 1988), and a combination of these with selective laparotomy would be appropriate. Initial patient assessment using a structured proforma would appear to be one of the most significant factors in the improvement of diagnostic accuracy associated with the use of computers (Gunn, 1976), and their combination with a policy of selective laparoscopy has been shown to be beneficial (Paterson-Brown et al, 1989). The ability to detect which patients are likely to benefit from laparoscopy by performing peritoneal cytology first (Vipond et al, 1990) has been shown to be helpful in reducing the number of patients who undergo a 'negative laparoscopy' (Baigrie et al, 1990). It is now time for laparoscopy to return to the bosom of general surgery from where it was conceived almost a century ago. When it does, as the developments in laparoscopic cholecystectomy would predict it will, so surgeons in training must take the earliest opportunity to become as familiar and proficient with the technique as their gynaecological colleagues have done, even if this means attending the gynaecological operating lists to do so. It is only then that the undoubted benefits of laparoscopy will be spread more widely in general surgery and particularly for the patient with acute abdominal pain.

Abdomen, Acute↗
PubMed2003

Anesthesia for the acute abdomen patient.

Patients with acute abdomen often have marked physiologic and pathologic changes, making anesthesia both challenging and potentially hazardous for the patient. A thorough understanding of the pathophysiologic mechanisms of cardiovascular function under anesthesia and selection of appropriate anesthetic protocols are critical to a successful anesthetic outcome. The goal is to produce anesthesia while minimizing depression of the cardiovascular system. Monitoring and management of acid-base and cardiovascular function serve to ensure appropriate oxygen delivery to the tissues during anesthesia. Postoperative management can significantly influence patient outcome following anesthesic recovery, and must therefore be considered in the anesthetic plan. Finally, pain management in all patients is an important aspect of case management, and should not be overlooked. This article serves to educate the clinician in the above-described areas in regard to the acute abdomen patient.

Abdomen, Acute↗
PubMed2006

[Acute abdomens of parasitic origin: retrospective analysis of 135 cases].

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

Abdomen, Acute↗
PubMed2005

Longitudinal reference charts for growth of the fetal head, abdomen and femur.

OBJECTIVES: The aims of the present study were to establish improved reference charts for growth of the fetal head, abdomen and femur, and to determine the effect of fetal and maternal factors. STUDY DESIGN: This prospective longitudinal study included 650 low-risk pregnancies. Outer-outer biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC) and femur length (FL) were measured by ultrasound, and the statistical analysis was based on regression analysis and multilevel modeling. RESULTS: Reference percentiles for the growth of MAD, AC and FL showed continuous growth in gestational week 10-40, while BPD and HC showed a slightly blunted growth toward the end of pregnancy. FL was the only variable that was not influenced by gender. There was a significant negative association between breech presentation and all five biometrical variables, while maternal weight was positively associated with all five variables. Cephalic index significantly influenced BPD and HC. Maternal height had a positive effect on BPD, HC, AC and FL, and parity had a positive effect on MAD and AC, while smoking influenced negatively HC, MAD, and FL. Terms for calculating conditional reference values and customisation for individualised growth assessment are presented. CONCLUSIONS: New reference charts for the growth of fetal head, abdomen and femur are suggested for assessing fetal size and growth, and can be adjusted for maternal and fetal factors to suite individual pregnancies.

Abdomen↗