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PubMed1990

[Acute abdomen in the elderly].

After a review of the literature on the subject, all IIIrd and IVth age patients admitted for acute abdomen to the Department of Surgical Pathology I of the University of Pavia between 1-1-1974 and 31-12-1988 were studied. The various pathologies encountered in acute abdomen are considered on the basis of the results obtained, stress being laid on the clinical and diagnostic problems observed in these patients in relation to those of adult age. It is concluded that the study method used in the elderly gave good results with a mortality rate lower than that encountered in other studies on the subject.

Abdomen, Acute↗
PubMed1990

[Continuous thoracic epidural analgesia in surgical interventions on the upper half of the abdomen--the noninvasive monitoring of the early hemodynamic changes].

Operative interventions in the upper half of the abdomen have been performed in 32 surgical patients under thoracic epidural analgesia (TEA) with bupivacain at T4-L2 level, with the use of catheter technique. Before operation the patients were hydrated with 12.5 per cent of the circulating blood volume, calculated by nomogram. By noninvasive approach were monitored: pulse rate (PR), mean arterial pressure (MAP), minute cardiac volume (MCV), peripheral vascular resistance (PVR) and cardiac index (CI) for the following times; T0--basal preoperative value, T1--on the 5. min; T2--on the 10. min; T3--on the 15. min.; T4--on the 20 min.; T5--on the 50. min after application of bupivacain analgesia. The results were compared by variation analysis to T0. PVR was reduced with statistical significance for T2, T3 and T4 (p less than 0.01). MCV, CI and MAP tended to be reduced, while PR showed no significant changes. The results may be summarized, as follows: 1. Noninvasive monitoring of PR, MAP, MCV, CI and PVR in TEA is necessary for early detection and control of their pathologic changes; 2. The hemodynamic changes in TEA with bupivacain at T4-L2 level after premedication with vagolytic and hydration with Ringer-lactate (in amount 12.5 per cent of the circulating blood volume) are not significant and do not require additional treatment; 3, TEA at T4--L2 level allows performance of operative interventions in the upper half of the abdomen with adequate analgesia and relaxation, being particularly indicated for patients at risk.

Abdomen↗
PubMed1989

[The so-called spontaneous hematoma of the anterior rectus abdominis reproducing syndromes of acute surgical abdomen].

Personal experience of spontaneous haematoma on the anterior straight muscles of the abdomen over 15 years is reported. True spontaneous haematoma on the anterior straight muscles of the abdomen are extremely rare, even exceptional and must be distinguished from those haematomas, improperly called spontaneous that are, in fact, clearly traumatic in origin. Personal observation suggests that true spontaneous haematoma is the expression of a pathological rupture of the muscle and/or the epigastric blood vessels that in its turn reflects a serious basic pathology.

Abdomen, Acute↗
PubMed1989

[Acute abdomen and thermal burns].

A review of the literature is made on the problem of the acute surgical abdomen under conditions of thermic shock. Such basic nosologic entities, as acute ulcers, acute cholecystitis, thrombosis and embolism of mesenterial vessels and hematogenous peritonitis, which may be directly related to thermic burns, are given detailed consideration. Thermic trauma raises complex and diverse problems; one of the pathways to reduce the lethal outcome in patients with burns is to face the acute abdomen problem with adequate approach to the pathogenesis, diagnosis and treatment of each nosologic entity.

Abdomen, Acute↗
PubMed1989

[An uncommon cause of acute abdomen--hemorrhage into an accessory hepatic lobe].

The author presents the case-history of a young female who was hospitalized because suspicion of acute abdomen. The condition did not call for an urgent operation, during the subsequent examination a hepatoma was suspected. On operation a congenital accessory liver lobe was found, the size of a fist, and was removed. The cause of manifestations of acute abdomen was haemorrhage into its parenchyma.

Abdomen, Acute↗
PubMed1989

The presentation and management of the acute abdomen in the patient with sickle-cell anemia.

Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1986

[Acute rectus sheath hematoma (differential diagnosis of acute abdomen)].

The rectus sheath hematoma is a generally rare disease, however the frequency of occurrence has increased with introduction of anticoagulant therapy. It almost always mimics the symptoms of acute abdomen. In 7 out of 14 cases, which we observed, an anticoagulant therapy was administered. During this therapy 5 rectus sheath hematomas occurred spontaneously. In the remaining 2 patients severe coughing attacks were reported additionally. The case histories of the other 7 patients included 3 patients with bronchitis, 2 patients with trauma and 2 patients without a relevant history ("spontaneous"). The correct diagnosis of rectus sheath hematoma could primarily be revealed by sonography in 8 of 14 patients, after which an appropriate therapy followed. In 6 patients a laparotomy was performed, because rectus sheath hematoma was not considered. The correct diagnosis was found intraoperatively as a surprising assessment. By inclusion of rectus sheath hematoma in the differential diagnosis of acute abdomen and the verification by sonography an emergency laparotomy because of a false diagnosis in the often severe ill patients can be avoided in favour of a minor and more appropriate procedure.

Abdomen, Acute↗
PubMed1988

Magnetic resonance imaging of the abdomen--1988.

This article reviews the current clinical use of magnetic resonance imaging (MRI) in the abdomen with regard to recent technological advances, organ analysis and the integration of MRI in diagnostic imaging. The authors conclude that while MRI is not at present establishing itself as a leading diagnostic imaging method in the abdomen, if MRI machines were to become more widely available, abdominal applications could become a reality.

Abdomen↗
PubMed1988

[Acute abdomen as form of presentation of hepatic adenoma].

We report the case of a woman aged 33 years old who was admitted with an acute abdomen. She referred oral contraceptives intake. Physical findings were abdominal tenderness, involuntary guarding and right upper quadrant rigidity. The following studies were performed: laboratory tests excluded hydatidosis and amebiasis. Ultrasonography showed a nodular image in the right hepatic lobe and a normal biliary tract. A low-density mass was observed with the computed tomographic scanning. A tomographic guided needle biopsy was informed as normal liver cells. Angiography showed tortuous hepatic arteries. Laparoscopy revealed a solid formation blood was obtained when it was punctured. Laparotomy was indicated. A tumor in the right hepatic lobe was found but a surgeon did not resect the lesion because a congelation biopsy failed to demonstrate tumoral cells. The diagnosis of hepatic adenoma was reached with the definitive biopsy. Our patient had a good evolution with the contraceptives withdrawal and a tomographic scanning one year after surgery showed the almost complete remission of the tumor. Pain as the initial symptom was observed in 12-52% of patients with an hepatic adenoma an audden onset in 33% of them. However this tumor is not frequently considered as a cause of acute abdomen.

Abdomen, Acute↗
PubMed1988

[Acute abdomen in unrecognized hyperparathyroidism].

The incidence of acute abdomen in patients with unrecognised hyperparathyroidism (HPT) was investigated in 61 patients with primary and 15 patients with secondary HPT, operated on at the Surgical University Department in Düsseldorf between 4/86 and 10/87. In seven patients (9%) an acute abdomen occurred preoperatively (bleeding ulcer n = 3, ulcer perforation n = 1, acute pancreatitis n = 3). Recurrent gastrointestinal disease was observed in 20 of the 76 Patients (28%). The fast and surprising clinical recovery of patients with pancreatitis and HPT after operation of the HPT support the assumption of a causal relation between hyperparathyroidism and pancreatitis. The importance of hypercalcaemia and HPT as causative factors in gastrointestinal ulcers, remains uncertain, however. Possible acute abdominal emergencies in the clinical course of primary hyperparathyroidism support the indication for early operation.

Abdomen, Acute↗
PubMed1986

[Acute abdomen in patients under anticoagulant treatment].

Hemorrhagic complications induced by anticoagulants occur in about 10-20% of patients treated. The bleeding source is found in the gastrointestinal tract in 30%. A careful history and physical examination, in combination with radiologic evaluation, serve to localize the bleeding site and avoid unnecessary surgery. Because anticoagulated patients may have the clinical picture of acute abdomen, it is important to differentiate extra-, intra- and retroperitoneal complications. During the past ten years we have treated 16 patients with acute abdomen under anticoagulation therapy: extra-, intra- and retroperitoneal complications were found in three, nine and four cases respectively. Rectus sheath hematomas, intramural bowel hematomas and retroperitoneal hematomas primarily underwent conservative, symptomatic treatment. Only intraperitoneal hemorrhage and psoas hematomas with neurologic manifestations required early surgical treatment. After successful treatment the indication for anticoagulation therapy should be reevaluated.

Abdomen, Acute↗
PubMed1985

Plain film diagnosis of the acute abdomen.

Abdominal plain films are essential for accurate assessment of the acute abdomen. In many cases, they may confirm the presence of a perforated viscus, colonic obstruction, or other abnormality requiring immediate surgical intervention. Alternatively, they may suggest relatively benign disease and help avoid unnecessary operations in these patients. In either case, emergency room physicians should benefit greatly from a systematic approach to the plain film diagnosis of the acute abdomen.

Abdomen, Acute↗
PubMed1985

A study of the techniques of cardiac massage with the abdomen open.

The present study compares the hemodynamic effectiveness of closed-chest cardiac massage (CCCM) with closed subdiaphragmatic massage (CSDM) and four open transdiaphragmatic cardiac massage techniques during cardiac arrest with an open abdomen. In 10 dogs CCCM resulted in the lowest cardiac index (CI), mean arterial pressure (MBP), and carotid blood flow (CBF) of all cardiac massage techniques tested. CSDM was not statistically superior to CCCM in the dog (p greater than 0.05) but did result in a 23% increase in CI and a 54% increase in CBF. Transdiaphragmatic retrocardiac massage through an incision in the diaphragm resulted in the highest CI, MBP, and CBF of all the four open transdiaphragmatic techniques and had significantly higher values than those for CCCM in the dog (p less than 0.05). In three cadaveric renal donors, all four open transdiaphragmatic techniques and CSDM were noted to be equal to or superior to CCCM. Three patients have been successfully resuscitated with diaphragmatic cardiac massage techniques for cardiac arrest while undergoing abdominal operations. These studies reveal that all subdiaphragmatic or transdiaphragmatic techniques for cardiac massage are hemodynamically equivalent to or superior to the standard CCCM without such complications as fractured ribs and should be considered the treatment of choice for cardiac arrest in the patient with an open abdomen.

Abdomen↗
PubMed1979

Dagnostic imaging of the upper part of the abdomen.

The new diagnostic procedures developed during the last several years present a confusing dilemma. The state of the art of ultrasound, computed tomography and nuclear scintigraphy is progressing so rapidly that what one says today is generally out of date tomorrow. However, certain guidelines should be followed in evaluating various organ systems. Generally, ultrasound is the procedure of choice in the upper part of the abdomen in most patients who are not extremely obese or filled with intestinal gas. A sonogram is less expensive than computed tomography and, at the present time, is considered noninvasive compared with compound tomography, which produces a small, but significant, radiation exposure. The accuracy of the two modalities is quite similar. Using the slight advantage that computed tomography may have in a given organ system does not generally override other factors, such as cost and radiation dose. However, mitigating factors, such as obesity, presence or absence of intestinal gas or barium, should be taken into account when selecting patients for either procedure. In many clinical situations, neither computed tomography nor ultrasound should be used until other modalities, such as conventional radiography or scintigraphy, have first been tried. Should the problem not be resolved by these more conventional techniques, an ultrasound or computer tomographic examination may be indicated to delineate further the pathologic condition of the abdomen.

Abdomen↗
PubMed1979

[Tumors as a cause of acute abdomen in children].

The authors share their experience in treating children aged 1 day to 14 years with acute processes in the abdomen induced by various tumors. During 10 years 51 patients have been observed. "Acute abdomen" was induced by tumors and cysts of ovaries (16 patients), lymphangiomas, cysts and tumors of the mesentery, greater and lesser omentum, retroperitoneal cavity (14 patients), intestinal tumors (7), small pelvis tumors (6), tumors of kidneys (4), liver (3), cyst of the pancreatic gland (1). The clinical picture of the disease, possible timely diagnosing and tactics are presented. All the patients were operated urgently. After operation 44 patients recovered and were discharged from the hospital, 7 patients died.

Abdomen, Acute↗
PubMedDate not supplied

[The "open abdomen" method of treatment of postoperative peritonitis].

The authors stress the therapeutical difficulties encountered in patients with severe postoperative peritonitis, necessitating multiple interventions for the solution of viscero-peritoneal problems, and of the abdominal wall. The authors' personal experience is presented with the method of the "opened abdomen", which is applied abroad under the improper name of "coeliostomy". The authors describe their procedure, and also describe a complementary method, of the socalled "semi-open abdomen", which is in fact a narrowing of the surgical wound with threads of inxodable wire. Four of six patients hospitalized in an extremely serious condition have been recovered.

Abdomen↗
PubMed1983

[Acute abdomen caused by phlegmonous appendicitis and leukemic infiltration of the cecum in a patient with acute lymphatic leukosis in relapse: clinico-therapeutic aspects].

We report a case of eleven years old child with an acute lymphoblastic leukemia who developed an acute abdomen while in haematological relapse. He had an acute appendicitis with leukemic infiltration of the coecum. The early surgical intervention and the coecum irradiation were successful: the following chemiotherapy achieved remission. A more aggressive surgical approach to the acute abdomen, combined with careful supportive measures, might improve the usually grim prognosis in patient whose leukemia offers a chance for remission.

Abdomen, Acute↗
PubMed1982

[Hyperthyroidism as a rare cause of "false acute abdomen"].

4 patients affected by hyperthyroidism presenting a feature of "false acute abdomen" as main clinical sign are presented. The low incidence of that association, according to the literature, and the difficulties of a correct diagnosis, which could lead to a useless laparotomy is pointed out. The conclusion is drawn that tests of thyroid functions should be done whenever the feature of acute abdomen presents without any past history of gastro-enteric lesions.

Abdomen, Acute↗