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PubMedDate not supplied

Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus.

In recent years the increasing use of ultrasonography and computed tomography in the assessment of diseases causing acute abdomen and the diagnostic possibilities of magnetic resonance have decreased the role of conventional radiology techniques, especially of plain abdominal film in the diagnosis of acute abdomen. However, serial plain abdominal film is still the first diagnostic procedure used in the assessment of patients with acute abdominal pain, providing important diagnostic information if correctly performed and carefully observed. In this paper serial plain abdominal film findings related to the different types of ileus (spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus) are presented.

Abdomen, Acute↗
PubMed2005

Bile leakage presenting as acute abdomen due to a stone created around a migrated surgical clip.

BACKGROUND: Surgical clips may migrate into the common bile duct after surgery for cholecystolithiasis leading to usually early or middle-term complications. CASE REPORT: A 31-year-old woman, 6 years after laparoscopic cholecystectomy, developed acute abdomen and choloperitoneum after rupture of a secondary bile duct and bile leakage. This complication was due to a solitary common bile duct stone. The stone was formed around a surgical clip that had migrated from the cystic duct remnant to the common bile duct. The patient underwent investigative laparotomy and, subsequently, an ERCP with stone extraction and clearance of the common bile duct. She was perfectly well at the follow-up after 14 months. CONCLUSIONS: Rupture of a bile duct and biliary peritonitis may be a delayed complication of laparoscopic cholecystectomy due to surgical clip migration and formation of a stone. Definitive treatment of the condition may be achieved through ERCP. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdomen.

Abdomen, Acute↗
PubMedDate not supplied

[Uncommon etiology of acute abdomen in pediatric age: the torsion of spleen].

The torsion of spleen on its vascular shank represents an uncommon problem, responsible of acute and chronic pain. The mobile spleen is fixed only through hilus vessels the gastrosplenic ligament. The incidence is unknow, greater in the male with an M:F ratio 6.1 in the first ten years of life, even if an episode of intrauterine torsion has been reported. The diagnosis can be performed with ultrasonography, angiography, scintigraphy and CT scan. There are reported two cases: male of 2.5 years female of 14 years who presented with recurrent pain to the left side, vomit diarrhoea and fever. Objectively a palpable mass was present. Ultrasonography and angio-CT scan of abdomen revealed splenomegaly, ptosis of the spleen and malrotation with signs of obstruction of the vessels. The treatment in both cases was splenectomy. The spleen appeared rotated on its shank and increased of volume, deprived of anatomical structures of fixation. The histological report confirmed the haemorrhagic infarction. The excessive mobility of the spleen, from insufficiency or absence of the ligamentous attachments is case of abdominal pain or acute abdomen, that can complicate with the infarction of the spleen. Angio-CT scan, in the cases here reported, has shown to greater sensibility in comparison to the ultrasonography. The Authors believe that the video-laparoscopic splenopexy, when the diagnosis is made of "wandering spleen" with painful repeated episodes, can be finalized, to the preservation of organ.

Abdomen, Acute↗
PubMed2005

Acute abdomen secondary to ascaris lumbricoides infestation of the small bowel.

Ascariasis is a helminthic infection commonly found in tropical climates. It often propagates in communities of low socioeconomic status secondary to contamination of the soil and water supply with human feces. We present a case report of a 42-year-old Asian-Indian female presenting with a long-standing history of severe recurrent postprandial epigastric pain, requiring multiple hospital admissions. Ultrasound, computed tomography (CT), and nuclear biliary scan were negative. She underwent esophagogastroduodenoscopy that suggested ischemia. Magnetic resonance angiography (MRA) and mesenteric angiography were inconclusive. As conservative treatment had been unsuccessful, a small bowel series was performed. The radiographs demonstrated characteristic findings of Ascaris lumbricoides infestation. Although the prevalence, diagnosis, and subsequent treatment of an acute abdomen secondary to Ascaris lumbricoides infestation is commonly seen in developing countries, clinicians in developed countries may not consider this entity when faced with a patient with similar symptoms. We frequently care for immigrants from developing countries and our own citizens who visit the countries where ascariasis is endemic. Therefore, heightened awareness of Ascaris lumbricoides infection (ALI) presenting as an acute abdomen is necessary. The diagnosis requires an experienced radiologist and knowledge by the clinician of treatment options and of when a surgeon should be involved.

Abdomen, Acute↗
PubMedDate not supplied

[Perforated jejunal diverticulum: a rare cause of acute abdomen].

Jejunal diverticulum is an uncommon, acquired condition, and the majority of patients are usually asymptomatic. Jejunal diverticula become clinically relevant when complications, such as diverticulitis, intestinal bleeding, obstruction, or perforation occur. A rare case of acute abdomen due to a perforated jejunal diverticulum is presented. The diagnosis was initially suggested by CT and confirmed intraoperatively when a 74-year-old male patient underwent a segmental jejunal resection with primary anastomosis. A review of the literature indicates the rarity of this condition, and therefore the aetiology, pathogenesis, diagnosis, and management are briefly discussed. An early diagnosis, based on ultrasonography and CT, and consequently prompt resection of the jejunum affected are the keys to a successful outcome. Because a longer duration of symptoms before operation correlates with a worse prognosis, the possibility of a clinical diagnosis of perforated jejunal diverticulum should be entertained as part of any evaluation of acute abdomen, especially in the elderly.

Abdomen, Acute↗
PubMed1992

[Salmonellosis and shigellosis in the differential diagnosis of acute abdomen].

There are only very few reports in our literature on problems and pitfalls of the differential diagnosis and present incidence of acute abdominal salmonellosis and shigellosis. Based on evaluated results of a three-year investigation from their department the authors draw attention to the relatively frequent concurrent incidence of acute abdomen and infectious diarrhoeal disease, the difficulty of differential diagnosis and indication of surgery even when the results of cultivation examinations are known due to the common interlinked symptomatology and coincidence. The symptoms imitating acute abdomen in infectious diarrhoeal diseases predispose by concentration of infectious patients in surgical departments the development of nosocomial infections and epidemics.

Abdomen, Acute↗
PubMed2005

[Spontaneous omental bleeding presenting as acute abdomen during treatment for polycythemia vera].

A 54-year-old woman with polycythemia vera (PV) presented as an emergency patient with acute abdomen. Her platelet count was 119 x 10(4)/microl. Computed tomography scan revealed fluid accumulation in the omentum and peritoneal space. An emergency laparotomy was undertaken because of severe abdominal pain and omental bleeding was diagnosed. Peritoneal hemorrhage and hematoma weighing in total 1040 g was drained. Although a part of the omentum and stomach was excised, we could not find any orifice from which bleeding could have occurred despite a thorough pathological examination. Massive hemorrhage should be considered in cases with PV presenting as acute abdomen, especially when the platelet count is extremely high (over 100 x 10(4)/microl).

Abdomen, Acute↗
PubMed2005

Gonococcal infection as a cause of acute abdomen.

Gonococcal infection in the postantibiotic era continues to cause disseminated and severe disease in some patients. The differential diagnosis of pain in the lower abdomen in young women is difficult. Our case report described a 19-year-old patient who presented with acute abdomen as a result of Gonococcal infection, assessed as a local complication, pelveoperitonitis: pelvic inflammatory disease. The message of our case report is sexually transmitted infections should invariably be considered in young women and searched for accordingly.

Abdomen, Acute↗
PubMed2006

Dengue hemorrhagic fever patients with acute abdomen: clinical experience of 14 cases.

Among 328 patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure-related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a dengue-endemic setting.

Abdomen, Acute↗
PubMed1991

[The concept of the acute abdomen].

The term "acute abdomen" stands for a group of abdominal symptoms which rapidly get worse and therefore require immediate treatment--especially conditions associated with peritonitis, ileus or massive bleeding. No time should be wasted on lengthy diagnosis or organizational problems. In the majority of cases a simple clinical diagnosis gives sufficient indication for surgery. Various manifestations simulating acute abdomen in children are discussed in order to prevent unnecessary laparotomy.

Abdomen, Acute↗
PubMedDate not supplied

The abdomen, thigh, and arm as sites for subcutaneous sodium heparin injections.

The purpose of this study was to evaluate three subcutaneous injection sites for low-dose heparin therapy (5,000 units). One hundred and one subjects were randomly placed in one of three groups. Group A received injections in the abdomen, Group B, in the thigh, and Group C in the arm. Each subject received three injections at the one site. Activated partial thromboplastin time (APTT) was measured prior to initiation of heparin and again four hours after the first injection. Bruising was measured at 48, 60, and 72 hours postinjection. There were no statistically significant differences among groups for either changes in APTT or bruising at 60 and 72 hours postinjection. Thus the clinical practice of utilizing the abdomen as the only or preferred site for subcutaneous heparin injections was not supported.

Abdomen↗
PubMed1991

[Phlegmonous enteritis--a rare cause of acute abdomen].

A 73 year old woman presenting with an acute abdomen was diagnosed as having phlegmonous enteritis after microscopic examination revealed the characteristic finding of a diffuse suppurative inflammation limited to the submucosa in the resected ileal segment. Culture of Klebsiella pneumoniae, and the microscopic demonstration of gram positive cocci and gram negative rods confirmed the bacterial etiology of this disease. There was no evidence of mucosal injury in this patient, but the possible role of ischemia secondary to atherosclerotic vascular disease cannot be assessed. Because of the associated high morbidity and mortality, phlegmonous enteritis should be considered in the differential diagnosis of acute abdomen.

Abdomen, Acute↗
PubMedDate not supplied

[Acute abdomen in childhood caused by intestinal angiostrongylus infection: a case report].

A case of acute abdomen in a one-year-old infant with abdominal angiostrongyliasis is reported. The main clinical and pathologic features of this disease are discussed. The diagnosis is made only through a biopsy that shows maturing stages of the worm within the intestinal wall and/or mesentery. Neither eggs nor larvae have been found in human feces. Treatment has been by surgical resection of the inflammatory mass. The prevalence of this illness is underestimated because of the difficult diagnosis. The main purpose of the present article is to attract attention to this diagnostic possibility as a cause of abdominal pain and acute abdomen in childhood.

Abdomen, Acute↗
PubMed1990

[Differential diagnosis of acute abdomen and latrodectism].

Among the causes of pseudo-acute abdomen the Latrodectism, or poisoning by malmignatta spider Latrodectus mactans tredecimguttatus bite, is often forgotten in Italy, Unfortunately, it is common knowledge that its severe clinical picture sometimes induces the surgeon to make diagnostic mistakes, and to unnecessary laparotomy. The Authors briefly describe the toxic syndrome and supply the first principles for a correct differential diagnosis to acute abdomen.

Abdomen, Acute↗
PubMed1990

Contrast-enhanced magnetic resonance imaging of the abdomen and pelvis.

Contrast media in magnetic resonance imaging (MRI) of the abdomen and pelvis are applied for various purposes; different substances and forms of application must be distinguished. Oral contrast agents are primarily used to enhance the discrimination of the intestine from the other organs and from pathological lesions. Clinical studies of i.v. contrast agents focus on two substances: gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) and superparamagnetic iron oxide. Whereas dynamic Gd-DTPA-enhanced MRI improves the differential diagnosis of focal hepatic lesions, iron oxide is a promising agent for increasing the sensitivity of MRI in the detection of hepatic and splenic tumors. Dynamic Gd-DTPA-enhanced MRI of the kidney allows functional assessment of this organ; good demarcation of kidney tumors is only achieved during the early phase of a dynamic examination. In the assessment of adrenal lesions, dynamic Gd-DTPA-enhanced MRI permits better differentiation of adenoma from malignancy. Intravenous Gd-DTPA also appears to be useful in the staging of urinary bladder tumors to distinguish between superficial and infiltrating tumors. Although offering no major diagnostic advantage in the staging of cervical carcinomas, Gd-DTPA-enhanced MRI improves the discrimination of necrotic tumor portions of endometrial carcinoma and allows good differentiation of this lesion from fluid retained in the uterine cavity. Studies of new contrast agents for MRI of the abdomen, which have so far only been investigated in animal experiments, focus on liver imaging. These substance include hepatobiliary agents, Gd-DTPA-containing liposomes, and paramagnetic macromolecules.

Abdomen↗
PubMed1990

[Stereoscopic MR angiography of the abdomen].

We have developed a new method of stereoscopic MR angiography of the abdomen using gradient echo images. Consecutive coronal scanning of the abdomen was performed by fast scan during breath hold. These images were overlapped by means of MR angiography. Then two slightly different views that can give a true stereoscopic effect were constructed. The more precise spatial relationship of the abdominal vessels can be visualized with our new method.

Abdomen↗
PubMed1990

Ultrasound of the acute abdomen--Part V.

Patients with an acute abdomen have complaints of brief duration which must be properly diagnosed and treated to reduce mortality and morbidity. There are a few instances, mostly involving massive haemorrhage, where the patient's condition is so poor that minutes count and a delay in operation will result in fatality. Imaging techniques have no role in these circumstances. In the majority of cases, however, there is time to make use of the various diagnostic imaging methods available to help arrive at the correct diagnosis. The role of ultrasound in this setting has been reviewed. Our own experience supports the view that it is an important modality for the investigation of patients with acute abdomen. It should be available on a round-the-clock basis.

Abdomen, Acute↗
PubMedDate not supplied

Pattern of surgical acute abdomen in the University of Port Harcourt Teaching Hospital.

This paper presents a retrospective study on 279 cases of surgical acute abdomen seen and treated at the University of Port Harcourt Teaching Hospital over a period of about 2 1/2 years, September 1983-February 1986. The majority of the patients were in the second and third decades of life. Acute appendicitis and obstructed hernias were the commonest causes of surgical acute abdomen, while abdominal pain and vomiting were the commonest symptoms. Only two patients in the series had acute pancreatitis. The overall mortality was 13.3%.

Abdomen, Acute↗