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A case of epidermoid cyst of the spleen in an 8-yr-old boy presented as acute abdomen secondary to rupture of the cyst. The lesion is classified and the relevant literature surveyed. Particular reference is made to the pathogenetic mechanism responsible for the picture of acute abdomen.
The aim was to study thoracic gas volume (TGV) in anesthetized and paralyzed subjects (n = 16) and to analyze any change in TGV in terms of thoraco-abdominal dimensions. TGV was measured by means of a body plethysmograph, using a super syringe for lung inflation during muscle paralysis. The thoraco-abdominal shape at the mamillary and umbilical levels was studied by means of magnetometry for the assessment of antero-posterior diameters (A-P), a strain gauge technique for measuring circumferences and respiratory inductive plethysmography for the recording of cross-sectional areas. TGV was reduced by an average of 28 per cent, from 2.38 1 awake to 1.72 1 during pentothal anesthesia and spontaneous breathing. No change in A-P diameters or cross-sectional areas were noticed. Muscle paralysis and mechanical ventilation caused no further change in TGV, nor were there any changes in A-P diameters, circumferences or cross-sectional areas of the chest or abdomen. The rib cage contribution to the tidal breath was significantly increased, from 41 per cent to 62 per cent to the tidal volume. The result of a lowered TGV during anesthesia concurrently with no measurable change in chest-abdomen dimensions remains a paradox not yet fully understood.
35--40% of psychosomatic disturbances among depressive patients present as abdominal troubles. These are difficult to interpret in the case of larvate depression which manifests itself mainly in the somatic sphere. For the last twenty years, we have noticed an increased incidence of larvate depressions. As a result, patients are often inadequately treated or submitted to surgery. This report is about a 37-year-old female patient who was referred to us with the diagnosis of an acute abdomen. After extensive investigations we were able to rule out as well a mechanical as a reflectory ileus. Nevertheless, the rapid deterioration of her general condition, increasing peritonism and radiological evidence of ileus made us suspect a perforated ulcer with accompanying paralytic ileus and perform an exploratory laparotomy 24 h later. We were very surprised not to discover any abnormal findings at operation. The consultant psychiatrist eventually diagnosed a depression. Up to this date, we have not been able to discover any information about similar patients presenting with such an acute history, even in specialised psychiatric literature. Should one refer such patients with acute abdomen to the psychiatrist before operating?
Clinical applications of phase-contrast MR angiography have been focused mainly on the head and neck, and its applications to the thorax and abdomen are still limited. This technique, however, has several unique uses that can be used to good effect. This articles examines the practical uses of phase-contrast MR angiography in the abdomen and thorax.
Two young soldiers presented with acute abdomens, then received surgical procedures under initial impression of acute cholecystitis and acute appendicitis respectively. Operative findings did not confirm the initial diagnosis, and the clinical condition did not improve after operation. Scrub typhus was suggested later by clinical manifestations of fever, chills, headache, lymphadenopathy, skin rash and presence of eschar formation; this diagnosis was finally confirmed by positive serologic results of high Weil-Felix OXK agglutination and/or Rickettsia tsutsugammushi immunoflorescence titers in paired sera. Both patients rapidly became afebrile after administration of tetracycline. This unusual presentation with acute abdomen in scrub typhus is emphasized, with caution that the possibility of scrub typhus should be taken considered, especially in patients coming from hyperendemic areas.
Bleeding complications associated with anticoagulant drugs can development abdominal pain simulating acute surgical conditions of abdomen. We report six cases of intraabdominal spontaneous haemorrhage presenting as an acute abdomen in patients on anticoagulant therapy: two rectus sheath hematomas, a abdominal wall hematoma, a spontaneous hemoperitoneum, a retroperitoneal hematoma and an intramural hematoma of the small bowel. The article conclude that computed tomography examination provided useful information in this complications because can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. Finally, authors expose the surgical indications of the different bleeding syndromes in this patients.
Plain x-rays of the abdomen remain an integral feature of the diagnostic work-up in cases of acute abdomen. Chest x-rays, often recommended in the USA, are standard routine at only one third of Swedish radiology units. The article outlines the advantages of including chest x-ray in the abdominal examination: it facilitates the detection of pneumoperitoneum, it yields (pre-operative) cardiopulmonary information, and it may show abdominal pain to be of extra-abdominal aetiology. Regarding the latter point, a study of 555 cases showed the chest x-ray to yield valuable information in 14 cases.
MR angiography is established in the abdomen for the study of venous disease and has been applied with more limited success to the aorta and its major branches. Future improvements in gradient and surface coils and contrast agents as well as the refinement of pulse sequence design will help define the ultimate role of MR angiography in vascular disease. This article reviews current imaging methods and their clinical application in the abdomen.
The authors reports an unrecognised secondary effect, but perhaps not as rare as has been thought, of enalapril: the acute abdomen. Three similar cases have previously been reported. The underlying mechanism is probably the inhibition of degradation of tissue kinins to inactive peptides as in subcutaneous and/or submucous angioneurotic oedema. Todate, this secondary effect has not been reported with other angiotensin converting enzyme inhibitors. The relationship between the acute abdomen and angioneurotic oedema with primary hyperaldosteronism is discussed.
Among patients with life-threatening sepsis that has no clear site of origin, the abdomen continues to be a probable and tractable possibility. The cavity has the microbiologic and anatomic potential for sudden or indolent sepsis and the cause may be either obvious or obscure. The abdomen or the various structures may be primary sources that are secondary and independent of disease that brought the patient to peril. They also could be secondary and dependent upon an abdominal operation complicated by sepsis. The partnership of intensivist and surgical consultant, addressing possibilities and challenges, must identify the most probable cause and the most timely response for positive intervention in the critically ill patient threatened by sepsis.
The diagnostic and therapeutic value of laparoscopy in emergency was studied in 314 patients presenting with non-traumatic acute abdomen. Laparoscopy gave a correct and complete diagnosis of the underlying disease in 92% (290/314) of cases. An erroneous preoperative diagnosis was corrected by laparoscopy in 18% (58/314) of cases. This implied a change of the therapeutic strategy in 9% (27/314). Seventy five per cent (234/314) of patients were exclusively treated by laparoscopy, 22% (68/314) by laparotomy and 3% (11/314) by laparoscopically assisted surgery. Mortality was 2.5% (8/314) and morbidity 9% (29/314). In conclusion, laparoscopy is a valuable diagnostic tool for the surgeon in the context of acute abdomen and is an interesting therapeutic alternative in selected cases. However, it requires extensive experience in laparoscopic techniques.
As a cause of small intestine occlusion, volvulus is often a consequence of a band or adhesions. Except in infants, it is rarely the primary cause of symptomatology. Between January 1976 and December 1992, 13 patients (7 women and 6 men, mean age of 56.8 years) were admitted in our department for an acute abdomen due to a spontaneous primary volvulus of the small bowel. Clinical examination and laboratory tests did not help in preoperative diagnosis. All patients underwent an explorative laparotomy. Six patients had had prior abdominal surgery but none of them presented adhesion or band. In 8 patients (62%), detorsion was sufficient. Resection of a segment of small bowel was necessary in 4 patients. Gangrenous of the entire bowel was observed in one patient who rapidly died. Two patients presented minor complications. One patient with Down syndrome died of bronchoaspiration. One patient has been reoperated on one year later for recurrence of the volvulus, and underwent a Noble procedure. We conclude that volvulus of the small bowel is a rare cause of acute abdomen that must be remembered. Early surgery is mandatory to reduce the risk of gangrene, which is known to double the mortality. Laparoscopy will be helpful in early diagnosis and therapy.
Laparoscopic techniques in general surgery have become a widely accepted method, especially for treatment of symptomatic gallstone disease. Many reports have investigated the indications, contraindications, equipment, techniques and outcome of laparoscopic procedures. However, as yet, relatively few studies have discussed the problems concerning patient's monitoring and care during the postoperative course. In the present paper, the authors review the pertinent literature analyzing the management of the postoperative period after laparoscopic surgery of the upper abdomen. Obviously, most data have regarded cholecystectomy, that is the most frequent procedure. Surgical laparoscopists have utilized knowledge deriving from gynecological experience, but these procedures are generally short and performed on young, otherwise healthy female patients. On the contrary, laparoscopic digestive surgery shows both gastrointestinal and peculiar general problems. These procedures are frequently performed on older patients who may have pre-existing diseases and require longer periods of peritoneal insufflation. During surgery of the upper abdomen, the pneumoperitoneum and the patient's operative position produce haemodynamic and respiratory changes coupled with acid-base disturbances. Intraabdominal hypertension causes a venous stasis along the inferior vena caval territory that can lead to a decrease in cardiac preload and in cardiac output. Usually, a compensatory increase in peripheral vascular resistance ensures normal or mildly high values of arterial tension. Furthermore, a hypercapnia and a mild mixed acidosis can develop as a result of the concomitance of different pathogenetic factors.(ABSTRACT TRUNCATED AT 250 WORDS)
While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.
Twenty patients were investigated with MR imaging of the abdomen before and after the administration of oral magnetic particles in the form of a per os solution for opacification of the gastrointestinal lumen. The parameters which were evaluated were a) distribution of the contrast medium in the gastrointestinal tract, b) delineation with the contrast medium of the region of interest c) image quality of general contract effect of the contrast medium d) diagnostic accuracy compared with CT and plain MRI of the same region. At a concentration of 0.5 mg/oral magnetic particles produced a constant negative signal from the gastro- intestinal tract in all spin echo sequences (T1 weighted, T2 weighted, proton density). Its diagnostic accuracy was similar to CT but better than plain MR examination of the same region in 70% of the cases. The diagnostic accuracy was inferior in the lower abdomen because of underdistension of the bowel. Perhaps the solution to the problem would be the combined per os and per rectum administration of the contrast medium.
An unusual case of acute abdomen as a distinct manifestation of severe preeclampsia is described. At laparotomy all other causes of the abdominal emergency were excluded. Among the many manifestations of preeclampsia one must now include the diagnosis of acute surgical abdomen.
Three laparoscopic procedures were performed on each of 6 adult Jersey cows in the first trimester of gestation to describe normal laparoscopic anatomy of the bovine abdomen. Also, a technique for laparoscopy of the cranioventral portion of the abdomen was described. Right paralumbar fossa, left paralumbar fossa, and cranioventral midline laparoscopy were performed 72 hours apart of each cow. Physical examination findings, CBC, serum biochemical analysis, and peritoneal fluid analysis before and 72 hours after the first surgery were used to assess the effects of the procedures on the cows. Exploratory celiotomy was performed 2 weeks after the last laparoscopy. The cows were then reexamined 6 weeks after the last procedure. The t-test for paired data was used for statistical analysis; the level of significance was P < 0.05. Laparoscopy was performed without complication in all cows. Adverse effects of laparoscopy, individually or serially, were not observed. Significant differences were not found between CBC, serum biochemical, and peritoneal fluid variables taken before and 72 hours after surgery.
An acute abdomen requires prompt diagnosis and therapy in all age groups. In the elderly population, rapid recognition is particularly important, because the patient may have delayed seeking medical care and may have uncommon illnesses complicating the ultimate course. The causes of an acute abdomen in this population are similar to those found in younger patients with some differences in frequency. In each case, a sense of urgency to make the proper diagnosis and then institute appropriate therapy is critical.