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PubMed1986

The distended gasless abdomen: a fertile field for ultrasound.

Ultrasonography has proven to be a helpful imaging modality in evaluating the child with a distended gasless abdomen. The presence of an unsuspected mass can easily be detected as well as the presence of ascites and/or abnormally dilated loops of small bowel. Thickened loops of bowel can also be easily detected in the abdomen with very little gas. Closed loop obstruction and intussusception, as well as meconium ileus equivalent (distal intestinal obstruction syndrome), are described.

Abdomen↗
PubMed1976

[Acute renal failure and acute abdomen].

A series of patients with acute renal failure (ARF) and acute abdomen collected by the St. John the Baptist Hospital's Nephrology and Dialysis Division over the period 1970-75 is examined. A high rate of mortality was noted, due to causes that were mostly independent of ARF Death was often related to failure to resolve acute abdomen. The progression of ARF appeared to be related to that of the abdominal affection with prompt resolution of the latter. These findings suggest that constriction of the afferent arteriole may offer a partial, functional basis for ARF with the corollary that it has a good chance of being reversed, even after protracted periods of anuria. Renal complications associated with disseminated or localised intravascular coagulation appear to be rare. Treatment was best directed to early and frequent dialysis, with surgical resolution whenever indicated, irrespective of the presence of ARF.

Abdomen, Acute↗
PubMed1999

[Visceral pain in acute abdomen].

Visceral pain is caused by either distension or contraction of the visceral muscular wall or obstruction of hollow gastrointestinal organs. Unlike the somatic pain due to peritonitis, visceral pain is diffuse, epigastric, periumbilical and is often accompanied by nausea, vomiting and restlessness. We demonstrate the significance of visceral pain in the differential diagnosis of the acute abdomen presenting five cases of appendicitis and cholecystitis. A correct early diagnosis of the acute abdomen while signs of local peritonitis are still absent (appendicitis in atypical location, recurrent acute appendicitis, spontaneous reopening of an occlusion) is facilitated by the awareness for the characteristics and symptoms of visceral pain, and therefore careful taking of the patient's history. A history lacking visceral pain on the other hand represents an important clue for the diagnosis of other conditions (gynecological, diverticulititis, etc.) with acute pelvic peritonitis.

Abdomen, Acute↗
PubMedDate not supplied

Acute abdomen caused by inflammatory colonic non-parasitic pathology: staging by CT.

A staging classification is proposed by CT findings in 27 patients with acute abdomen, caused by inflammatory colonic non-parasitic pathology. Of the 17 patients with diverticular disease, 4 were stage A (edema/ischemia on thickness of the abdominal wall), 2 were stage B (partial intramural infarction on the abdominal wall) and 3 were stage C (abscess/peritonitis and obstruction/vascular strangulation). None of the patients in the series were stage D (ischemia/infarction of the colonic wall with dilatation). Of the 4 patients with ulcerative colitis, 3 were stage A and 1 in stage C. Of the 3 patients with Crohn's disease, 2 were stage A and 1 was in stage C. Classified as stage D were 1 pseudomembranous colitis, 1 volvulus and 1 idiopathic megacolon. Clinical severity was in parallel with CT stages that gave better information on the progression of the pathology. Staging by CT in acute abdomen caused by inflammatory colonic non-parasitic pathology could be useful in therapeutics.

Abdomen, Acute↗
PubMed1999

Acute vascular abdomen. General outlook and algorithms.

Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.

Abdomen, Acute↗
PubMed2000

[Value of laparoscopy in acute abdomen].

The correct and early diagnosis and treatment are essential for the outcome of the patient with an acute abdomen. In 520 patients with the initial diagnosis of acute abdomen early laparoscopy revealed certain advantages. 183 (35.2%) patients with 11 different diseases could be treated laparoscopically, 129 (24.8%) underwent a laparotomy. In 96.7% of our patients the initial diagnosis was correct, so that these patients received a suitable therapy. The method is economically justified because we have equal costs both with CT/szintiscanning and laparoscopy, whereas the costs of MRI are nearly 400 DM higher.

Abdomen, Acute↗
PubMed2000

[Acute abdomen: consider also the thorax].

Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acute abdomen. While infiltrative signs were described on radiodiagnostic images two patients underwent laparotomies. In all three subsequently the diagnosis of pneumonia was established and the patients made full recovery after antibiotic therapy. When a patient presents with symptoms of an acute abdomen, the possibility of an existing pneumonia should always be borne in mind. It is therefore recommended to make a chest radiograph with frontal and lateral view. In the presence of infiltrative signs the existence of pneumonia as the cause of abdominal symptoms should be considered in order to avoid unnecessary laparotomy.

Abdomen, Acute↗
PubMed2000

Ruptured metastatic ovarian carcinoma presenting as acute abdomen.

Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.

Abdomen, Acute↗
PubMed2000

Magnetic resonance imaging of the abdomen: applications in the oncology patient.

Cross-sectional imaging of the abdomen in oncology patients presents unique challenges and opportunities. A close working relationship between the oncologist and radiologist is essential for the exchange of the clinical and imaging information necessary for optimizing patient diagnosis and management. Compared to helical computed tomography (CT), magnetic resonance imaging (MRI) of the abdomen and pelvis offers important advantages, including superior soft-tissue contrast. The multiplanar capabilities of MRI allow for direct coronal or sagittal imaging, providing a truer anatomic presentation of abdominal and pelvic masses. Recent advances in MRI, including the use of intravenous (i.v.) and oral contrast agents, the development of high-performance imagers, and improved surface coil designs, facilitate more rapid abdominal imaging with superior image quality. All of these features combine to produce a versatile imaging examination with exquisite sensitivity for depicting abdominal and pelvic tumors. In this article, we will review the clinical applications for hepatic and extrahepatic abdominal MRI in the oncology patient. The MRI techniques and protocols described can be applied to most commercially available high-field magnetic resonance imagers.

Abdomen↗
PubMed2000

Adult Wilms' tumor presenting as acute abdomen with elevated serum lactate dehydrogenase-4 and -5 isoenzymes: case report.

Wilms' tumor, an embryonic neoplasm, is the most frequent renal tumor in childhood but is rare in adults. The prognosis of adult Wilms' tumor is worse than pediatric Wilms' tumor. The preoperative diagnosis of adult Wilms' tumor is extremely difficult to make because diagnostic imaging techniques, such as intravenous pyelography, computed tomography, ultrasound, renal angiography, and nuclear magnetic resonance imaging, only confirm the presence of a renal mass. Diagnosis usually depends on histological characteristics, such as the presence of blastemic, epithelial, and mesenchymal components. A 27-year-old female presented with acute abdomen and with elevated serum lactate dehydrogenase (LDH) at 212 U/l (normal range: 47-140), and 2 of 5 LDH isoenzymes, namely LDH-4 at 13.6% (normal range: 6.8%-10.2%) and LDH-5 at 20% (normal range: 6.5%-9.7%). In this patient, stage I Wilms' tumor was managed by radical nephrectomy. The levels of LDH returned to its normal range. In conclusion, in cases of acute abdomen with a renal mass in young adults, the possibility of Wilms' tumor should be considered. Serum LDH and its isoenzymes, LDH-4 and LDH-5, could be used as tumor markers for either differential diagnosis or monitoring the response of treatment.

Abdomen, Acute↗
PubMed1999

Forgotten rubber drain in the abdomen (case report).

Forgotten rubber drain in the abdomen is a rarely seen situation after the abdominal operations. In this article, a case of "forgotten rubber drain in the abdomen after a liver hydatid cyst operation" was presented. The clinical significance of the case was discussed by surveying all literature.

Abdomen↗
PubMed2000

Characterization of muscles associated with the articular membrane in the dorsal surface of the crayfish abdomen.

The anatomy, physiology, and biochemistry of the dorsal membrane muscle (DMA) and the superficial extensor muscle accessory head (SEAcc) in the abdomen of the crayfish, Procambarus clarkii and lobster, Homarus americanus, are reported. These muscles have not been previously characterized physiologically or biochemically. The anatomy was originally described by Pilgrim and Wiersma (1963. J Morph 113:453-587). The arrangement of these muscles varies depending on the abdominal segment. The function of the dorsal membrane muscle is to retract the thin articulating membrane joining the cuticular segments so that the dorsal membrane does not evert during extension of the abdomen. Consequently, the articular membrane does not protrude, and thus potential damage to the membrane is minimized. Examination of nerve terminal morphology revealed strings of varicosities, usually only associated with tonic terminals. The electrophysiological data indicate that there are at least four tonic excitatory and one inhibitory motor neuron innervating these muscles. Facilitation indices and fatigue-resistance indicate physiologically the tonic nature of innervation. Anti-GABA antibodies demonstrate the anatomical presence of an inhibitor motor neuron. The SDS electrophoretic analysis of myofibrillar proteins and Western blots of key protein isoforms for these muscles in crayfish and lobsters also indicate that the DMA and SEAcc muscles are tonic phenotype. J. Exp. Zool. 287:353-377, 2000.

Abdomen↗
PubMed2001

[Diffusion-weighted echo-planar sequences for the evaluation of the upper abdomen: technique optimization].

PURPOSE: To optimize the technique for the evaluation of molecular diffusion in the abdomen. MATERIAL AND METHODS: Fifteen healthy volunteers, 6 males and 9 females, ranging in age between 24 and 31 years underwent an MRI evaluation of the upper abdomen, using a superconductive 1.5T magnet (maximum gradient strength, 25 mT/m; minimum rise time 600 ms), equipped with phased array abdominal multicoil. Diffusion study was performed with a single-shot Inversion Recovery Spin-Echo Echo-planar sequence (IR-SE-EPI) with the following parameters: TR = infinite; TE=101 ms; matrix 128 yen 128; receiver bandwidth 2080 Hz/pixel; slices: n.20; slice thickness: 8 mm; acquisition time: 5.41 s. For diffusion weighting the following b values were employed: b=30 mm/s2, b=300 mm/s2 e b=500 mm/s2. Both qualitative and quantitative (calculation of linear regression analysis and of apparent diffusion coefficient) image analysis was performed. RESULTS: Image quality was graded as diagnostic in all the cases. Image quality decreased with the increase of b values: at low b values, the anatomy of upper abdominal organs was easily recognized, whereas, at high b values, the same organs could not be adequately assessed unless the images were compared with those obtained with low b values. Magnetic susceptibility artifacts were observed in all the cases; no significant chemical-shift artifacts were observed as the fat saturation pre-pulse was employed. Quantitative analysis demonstrated an apparent diffusion coefficient of 1.58 s/mm2 for the liver, 1.61 s/mm2 for the spleen and 5,14 s/mm2 for the gallbladder. A statistically significant difference (p<0.001) was observed between parenchymatous organs (liver and spleen) and gallbladder, presenting as a stationary fluid. CONCLUSIONS: Diffusion-weighted MR sequences may be implemented for abdominal studies, but the optimization of same parameters is slightly different compared with neuroradiologic applications. The potential applications are interesting above all as regards the characterization of focal liver lesions. Further developments are awaited in both sequence optimization (greater stability and lower sensitivity to magnetic susceptibility artifacts) and data analysis, with more complex algorithms able to better quantify the real diffusion coefficient.

Abdomen↗
PubMedDate not supplied

Experience of laparoscopic management in 100 patients with acute abdomen.

BACKGROUND/AIMS: The decision to operate on a patient with acute abdominal pain comes to the mind of the surgeon if routine investigations fail to identify the cause. A negative laparotomy may have complications, while laparoscopy appears to be a valuable way to improve the accuracy of diagnosis of acute abdominal pain and offers a promising modality of treatment. METHODOLOGY: The study included 100 patients with provisional diagnosis of acute abdomen after clinical examination and conventional diagnostic aids. All the patients have been subjected to diagnostic laparoscopy. RESULTS: Eight cases (8%) were managed by laparotomy following diagnosis by laparoscope (disturbed ectopic pregnancy), while 92 cases (92%) were managed laparoscopically which resulted in 81 cases (81%) of successful laparoscopic procedure (31 appendectomies, 19 cholecystectomies, 12 ovarian cyst accident, and others) and 11 cases (11%) were converted to open surgery (4 gallbladder empyema, 2 appendicular mass, 2 intestinal obstruction, and others). Postoperative complications were two cases of wound infection managed conservatively (perforated appendix). The postoperative follow-up for six months was uneventful. CONCLUSIONS: Laparoscopic management of acute abdomen is a safe and effective method with the advantages of small scar, short hospital stay and early recovery.

Abdomen, Acute↗
PubMed2001

[A large ovarian teratoma mimicking acute abdomen--case report].

Authors present case report of an adolescent girl with the large ovarian teratoma. Teratoma of the ovary was surprising finding during laparotomy which was indicated on the basis of acute abdomen. Tumorectomy was performed. Microscopic examination revealed differentiated mature teratoma. There were no signs of recurrence. Authors present short review of the literature concerning this rare diagnosis and the reason of acute abdomen.

Abdomen, Acute↗
PubMed2002

[Acute abdomen in primary care].

The author--using his 30 years practical medical experience, from the point of view of a family doctor giving the first diagnose, analyses the problem of acute abdomen. Gives an overview of anamnesis (heteroanamnesis) and the data and their significance investigated during the physical examination of patient (inspection, palpation, percussion, auscultation), and that of the usefulness for the right diagnose. The author orients the reader's attention to the fact, that the beginning of the third millennium in the world of instrumental and laboratory diagnostics, in case of certain illnesses--so in the case of acute abdomen--physical examinations have not lost a bit from their significance.

Abdomen, Acute↗
PubMed1975

Acute abdomen due to torsion of a pedunculated mesenteric fibroma.

A case history of a boy with an acute abdomen due to torsion of a pedunculated mesenteric fibroma is presented. A review of the literature shows that only a relatively small number of mesenteric fibromata have been reported. In these cases the tumor was described as growing between the two leaves of the mesentery. The symptoms these tumors gave usually were due to the size of the tumor and compression of adjacent organs. The present case is unusual because of the pedunculated nature of the fibroma and its presentation as an acute abdomen.

Abdomen, Acute↗
PubMed2001

Burst abdomen. Local synthesis of nucleic acids, glycosaminoglycans, proteins and collagen in wounds.

BACKGROUND AND AIMS: Abdominal wound dehiscence and evisceration is a surgical emergency. The general phenomena leading to this complication are for the most part known. However, the local biochemical events of different layers of the abdominal wall in wound dehiscence have not been studied. The purpose of the present study was to analyze the synthesis and contents of DNA, RNA, proteins and collagen in fascial, subcutaneous and skin layers in burst abdomen. MATERIAL AND METHODS: The material consisted of 10 controls and 12 patients divided into two groups. Group A consisted of 7 patients with acute free or covered perforation of the gastrointestinal tract and group B consisted of 5 critically ill patients at admission. RESULTS: In group A, higher amounts of specific isotopes were accumulated into DNA, proteins and collagen in fascial and subcutaneous wound layers than in those of the controls. However, in critically ill patients the corresponding accumulation was lower than in controls. On the other hand, in both group A and B, the content of hydroxyproline (collagen) was below the control level in fascial and subcutaneous layers of the abdominal wound. CONCLUSIONS: The results indicate that the degradation of collage exceeds the synthesis of collagen in wounds of patients with burst abdomen. Probably this increased degradation of collagen in wounds partly explains the higher wound disruption rate in these patients.

Abdomen↗