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At least 109 records · Page 6Linked to original sources
PubMed1997

Sonographic appearance of hemorrhagic ovarian cyst with acute abdomen by transvaginal scan.

Hemorrhagic ovarian cyst (HOC) which is one of the functional cysts, is often involved in acute abdomen leading to laparatomy intervention. The reason for this mainly lies in the fact that it is easily misdiagnosed as an organic mass because of the presence of lower abdominal pain and the variable appearance of ultrasonographic images at presentation. We analyzed 15 cases of HOC associated with acute abdomen, of which in 2 cases the disease was confirmed by laparotomy. The remaining 13 cases were followed-up clinically and by daily transvaginal sonography (TVS) from the first detection of the cyst until complete resolution. The TVS images showed a variety of changes; however, when the images or their magnified views were observed precisely, important diagnostic characteristics were found which were classified into 3 categories: type 1 images showed mixed hypoechoic and hyperechoic areas, the demarcation line between which appeared as a thin or thick septum-like echo of smooth formation; type 2 images showed hypoechoic background and vertical, horizontal, or lamellar thin or thick thread-like echoes with an overall reticular-like or sponge-like pattern; and type 3 images showed an overall hyperechoic and solid pattern. Type 1 and 2 images occurred more frequent (93.3%), and only 1 case had a type 3 image. In all image types, septum-like or thread-like echoes were seen, TVS type 1 and 2 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. Severe lower abdominal pain was present for 1 to 3 hours in 12 cases (80%), 4 to 6 hours in 2 cases (13.3%), and 11 hours in 1 case (6.7%). Other characteristics of HOC may be its most frequent occurrence in the young age group (10 to 20 years old, 80.0%) and in the luteal phase (84.6%). With operative cases, histopathological diagnosis was HOC. The clinical and particularly TVS findings described in the present study are of significant value in differential diagnosis of HOC with acute abdomen from other disorders presenting with acute abdomen.

Abdomen, Acute↗
PubMed2002

Acute abdomen due to late retroperitoneal extravasation from a femoral venous catheter in a newborn.

CONTEXT: The use of parenteral nutrition via a central venous catheter is a common practice in the neonatal intensive care setting. Extravasation of the infusate leading to an acute abdomen is a complication that has only rarely been documented. This report describes the case of a premature infant with a femoral catheter placed in the inferior vena cava, who developed an acute abdomen as a result of late retroperitoneal extravasation of parenteral nutrition. CASE REPORT: A pre-term infant receiving total parenteral nutrition via a femoral venous catheter developed an acute abdomen five days after the catheter placement. Extravascular catheter migration to the retroperitoneal space and extravasation of the infusate was diagnosed by contrast injection. Withdrawal of the catheter was followed by prompt cessation of the signs and full recovery from the acute abdomen, without the need for surgery. A review of the literature is presented, emphasizing the clinical and therapeutic aspects of this unusual complication from femoral venous catheterization and parenteral nutrition.

Abdomen, Acute↗
PubMed2003

Unusual causes of acute abdomen in a Nigerian hospital.

UNLABELLED: Acute abdomen is the most common abdominal emergency associated with high morbidity and mortality in General surgical practice. Over a 7-year period, a study of unusual causes of acute abdomen was undertaken, with the aim of identifying these causes and outcome of operative management. Eleven cases were identified accounting for 4% of cases of acute abdomen seen during the period of the study. Four cases of liver diseases (33.3%) comprising 2 patients (16.7%) with ruptured primary liver cell carcinoma, 1 (one) case each of haemoperitoneum due to ruptured liver haemangioma and haemorrhagic disorders from liver cirrhosis. One patient had acute leukaemia with massive haemoperitoneum and acute abdomen. Five (45.5%) had gastrointestinal perforations; 1 patient (9%) each had multiple jejunal perforations, perforation of stomal ulcer at gastrojejunostomy site, perforation of gastric cancer; perforated carcinoid tumour of sigmoid colon and idiopathic perforation of the caecum. There was also a case of caecal volvulus. Mortality was 7 patients (63.6%). All patients with liver pathology and acute leukaemia died. The cases of malignant tumour perforation were well and alive 4-6 years after the operation. CONCLUSION: Operation could have been avoided in 45.5% of these cases if the appropriate investigations, had been available and carried out.

Abdomen, Acute↗
PubMed2002

Sonography of the acute abdomen in the pediatric patient.

OBJECTIVE: To review the causes and sonographic appearance of pathologic processes that result in abdominal pain in the pediatric patient and to understand the use and limitations of abdominal sonography in the acute pediatric abdomen. METHODS: A pictorial review of cases is presented. RESULTS: Sonography in conjunction with color and pulsed Doppler imaging is a valuable tool in the evaluation of the acute abdomen in the pediatric patient. This article reviews the use of sonography in the evaluation of the acute abdomen in the pediatric patient. CONCLUSIONS: The causes of the acute abdomen in children vary depending on the ages of the children. Sonography is a noninvasive modality and is useful for assessing these patients.

Abdomen, Acute↗
PubMedDate not supplied

[Laparoscopy in an abdominal emergency: the diagnosis and therapy in 3 clinical cases of acute abdomen].

Authors report three cases of acute abdomen due a probable appendicitis and submit to laparoscopic procedure. In the first case acute abdomen was due to a bowel obstruction secondary to an ectopic pregnancy; in the second case acute appendicitis was associated with a rare congenital malformation (atresia of uterus); in third case acute abdomen was due to a rare case of torsion of accessory spleen in an adult. In all the cases laparoscopy demonstrated the elective procedure in urgency, permitting the diagnosis and the surgical treatment of acute abdomen with the post-operatory advantage of the technique.

Abdomen, Acute↗
PubMed1999

[New diagnostic imaging technology often offers no advantage in the differential diagnosis of acute abdomen].

Imaging techniques may lead to better insight in the diagnosis of the acute abdomen, and in specific cases to a more rapid diagnosis, especially in the upper abdomen. However, frequently the only result of the accessory diagnostic methods is delay of the necessary treatment. The yield of CT scanning in acute abdomen is too small to justify routine use. Ultrasonography is useful in selected cases, but not for routine application. Laparoscopic examination in acute abdomen in certain conditions facilitates making the correct diagnosis, but it constitutes an aggressive method for patients found free of abnormalities. Skillful history-taking and adequate performance of physical examination still constitute the basis of correct diagnosing. Technical aids may be of value. Good systematical studies of the clinical results and the cost effectiveness of physical examination and of the technological aids are still largely lacking.

Abdomen, Acute↗
PubMed2000

[Differential diagnosis and therapy of acute abdomen in sickle cell crisis. A rare case in visceral surgery].

Surgical therapy of the acute abdomen often allows only limited time for differential diagnosis to confirm the indication for surgery. Under consideration of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Differential diagnostic considerations and eventual therapy are presented in the following case of a 25-year-old Afro-american who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical setting of an acute abdomen the patient presented with acute respiratory failure and laboratory signs of severe hemolysis in combination with newly detected splenomegaly. The indication for splenectomy was made following CT-proven complete splenic infarction due to repeated acute squestration. Histologic examination of the spleen together with hemoglobin electrophoresis confirmed the clinical assumption of unusually late primary manifestation of a sickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-beta-thalassemia. A ten-day course of intensive care therapy was necessary to treat ongoing multiorgan failure due to persistent sickle cell crisis. Current diagnostic and therapeutic procedures in connection with sickle cell crisis as a rare cause of an acute abdomen with the necessity for surgical intervention are presented.

Abdomen, Acute↗
PubMed2001

Percutaneous endoscopic gastrostomy in patients with an open abdomen.

Percutaneous endoscopic gastrostomy is a commonly performed procedure for enteral access. In the past decade surgeons have used the open abdomen technique with increased frequency for the treatment of intra-abdominal compartment syndrome. Because these patients often have associated malnutrition long-term enteral access is complicated by the massive ventral hernia. We reviewed the records of two patients with an open abdomen who needed long-term enteral access. Both patients had a large midabdominal soft tissue defect, which posed a concern about the technique for gastrostomy creation. Both patients underwent percutaneous endoscopic gastrostomy. In each case the entrance site was located on a portion of intact abdominal wall lateral to the open abdomen tissue defect. No intraoperative or postoperative complications were noted. We conclude that percutaneous endoscopic gastrostomy can be safely performed in patients with an open abdomen. Adherence to standard principles of performing percutaneous endoscopic gastrostomy allows for enteral access in these patients.

Abdomen↗
PubMedDate not supplied

Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in children with an atypical clinical presentation.

BACKGROUND/AIMS: Diagnosing acute appendicitis in children with equivocal signs and symptoms is usually difficult. The usual approach to the patient is hospital observation and frequent reexamination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. The aim of this study is to assess and compare the value of the Tc-99m HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cell abdomen scan and abdominal sonography in the diagnosis of acute appendicitis in children with an atypical clinical presentation. METHODOLOGY: Forty children with acute abdomen and possible acute appendicitis but atypical findings were included in this study. After an intravenous injection of Tc-99m HMPAO white blood cells, serial anterior abdomen scans at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images. RESULTS: Thirty-three children received operation for surgical and pathological diagnoses. The other 17 children did not receive operation but follow-up of at least a one-month period. The overall sensitivity, specificity, and accuracy of Tc-99m HMPAO white blood cell scan to diagnose acute appendicitis in children with atypical findings is 96.7%, 80.0%, and 90.0%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography is 86.6%, 90.0%, and 88.0%, respectively. CONCLUSIONS: The Tc-99m HMPAO white blood cell abdomen scan provides a more sensitive and accurate method for the diagnosis of appendicitis in children with atypical clinical presentation when compared with abdominal sonography.

Abdomen↗
PubMed1992

Acute surgical abdomen in systemic lupus erythematosus--an analysis of 10 cases.

Gastrointestinal manifestations in a lupus patient may be due to different aetiologies such as vasculitis or a surgical condition. Problems of diagnosis are frequently encountered because the clinical presentations may mimic each other. We analysed ten lupus patients with acute surgical abdomen to identify the clinical, laboratory and radiological features that may aid in early diagnosis and management. Three patients with surgical abdomen had concomitant active lupus. Intra-abdominal sepsis and bleeding peptic ulcer disease constituted two major causes of laparotomies. Overt signs of peritonitis might not be present due to steroid masking effect. There were no specific clinical features, laboratory or radiological tests that could distinguish gastrointestinal vasculitis from acute surgical abdomen. Blood cultures, C-reactive protein and CT abdomen were useful adjuncts in the management of abdominal sepsis. No correlation was found between the timing of surgery, mortality, steroid dosage and wound complication.

Abdomen, Acute↗
PubMed1992

[Rules and procedures in the diagnosis and medical (non-surgical) treatment of acute abdomen].

The acute abdomen is due to a medical disorder or surgical problems. Diagnosis is often difficult; acute diseases of the lung, chest, kidney, for example, may closely mimic primary diseases of the abdomen and can masquerade as surgical abdomen. The history assumes overwhelming importance, a careful physical examination is absolutely essential. It is incumbent upon the physician first to decide what is the most likely diagnosis to be correct; and then to undertake treatment indicated for that diagnosis. The laboratory studies, x-ray studies, echography, abdominal paracentesis and other diagnostic approaches may be indicated, when the diagnosis may still be obscure. In the course of the investigation of a patient with acute abdomen, the immediate goals are the correction of dehydration, electrolyte depletion and other problems. It is extremely important that no analgesics or sedatives ever be given until a decision is made as to a proper working diagnosis.

Abdomen, Acute↗
PubMedDate not supplied

[Diagnostic laparoscopy in nontraumatic acute abdomen].

Laparoscopy was performed in 49 patients admitted to the Emergency Service of Hospital das Clínicas of the Medical School of the University of São Paulo with a possible diagnosis of acute non traumatic abdomen. The procedure was indicated because routine clinical and laboratory investigations had proved inconclusive. Accuracy (96%), sensitivity (97.5%), specificity (89%) and positive (97.5%) and negative (89%) predictive values of laparoscopy were assessed in 41 patients with a clinical suspicion of inflammatory acute abdomen, in 5 with a clinical diagnosis of vascular abdomen, in 1 with a perforative acute abdomen, and in 2 patients to assess the viability of the small bowel after and intestinal resection due to mesenteric ischemia. Laparoscopy proved to be a reliable and simple procedure which facilitated the choice of the best therapeutic alternative in each case. A significant number of unnecessary laparotomies was avoided. No complications imputable to laparoscopy were observed in this series.

Abdomen, Acute↗
PubMed1990

An experience with diagnostic paracentesis in 100 cases of acute abdomen.

Prognosis of acute surgical conditions of abdomen of both traumatic and non-traumatic origin depends on accurate diagnosis and early surgical intervention. However, the diagnosis in acute abdomen is quite difficult. The problem becomes more complex when 24 hours services of radiology and laboratories are not available. Abdominal tap gives a valuable clue to diagnosis. A 10 ml syringe fitted with a 20 gauge intravenous needle was used for the purpose. Both the flanks and the four quadrants of the abdomen were selected for site of the tap according to the suspected pathology. Results were indicated as positive when abnormal fluid (clear, turbid, purulent, bloody, serosanguinous, bile stained and urine, etc) were aspirated. Accurate diagnosis were made in 84.3% in blunt abdominal trauma and 76.47% in non-traumatic acute abdomen. High incidence of accurate results were obtained in gastroduodenal perforations (92%), ruptured ectopic gestation (100%) and burst amoebic liver abscess (100%). The procedure is very simple which could be done at bed side without much disturbance to the severely ill patients. It is safe and free from any complications even if the bowel is also punctured during the tap.

Abdomen, Acute↗
PubMed1986

The open management of the septic abdomen.

The mortality rate of severe intra-abdominal infections is still very high. The open management of the abdomen is a method of treatment which has gained popularity over the past few years. Its advantages include a better drainage of the peritoneal cavity, a greater protection of the parietes, an improved perfusion of the abdominal viscera and a decrease in postoperative pulmonary complications. It is indicated in patients with severe intra-abdominal sepsis, especially when multiple re-explorations of the abdomen are likely. A variety of techniques, including the use of Marlex mesh have been devised to contend with possible complications: spontaneous fistulas, exogenous bacterial contamination, evisceration and massive fluid losses. The open method of management has not made the treatment of septic abdomen much easier; it requires intensive care support and repeated assessment of the peritoneal cavity. The closure of the abdomen is a problem which must be addressed when the sepsis has subsided. The value of this technique is still difficult to assess in the absence of controlled randomized trials.

Abdomen↗
PubMed1995

[Is medical/surgical false acute abdomen a clinical reality?].

The false acute abdomen is a real Clinic picture. In pur experience it represents the 0.63% of acute surgical abdomen. Sometimes diagnosis could escage because patient's erethism. To obviate this event surgeons must reach a detailed history, perform a complete pshysical examination and repeat clinical evaluation many times above all when then the clinical picture is dubious. Laboratory and instrumental tests could be useful to reach accurate diagnosis. However, in our opinion, when clinical and physical examination are unclear, sometimes in spite of disappointment of other physicians, do explorative laparotomy is better is than non-treatment of an acute surgical abdomen. False acute abdomen.

Abdomen, Acute↗
PubMed1996

Laparoscopic anatomy of the abdomen in dorsally recumbent horses.

OBJECTIVES: To provide an accurate and detailed description of the laparoscopic anatomy of the abdomen of horses positioned in dorsal recumbency and to compare those observations with laparoscopic anatomy of standing horses. The effects of laparoscopy and positional changes on arterial blood pressure and blood gas values also were investigated. DESIGN: Descriptive anatomic study. SAMPLE POPULATION: Laparoscopy was performed on 6 horses (2 mares, 2 geldings, and 2 stallions) to record the normal laparoscopic anatomy of the abdomen in dorsal recumbency. PROCEDURE: Feed was withheld from all horses for 36 hours. Horses, under general anesthesia, were examined in horizontal and inclined positions (head-up and head-down). Intermittent positive-pressure ventilation was used, arterial blood pressure was continuously monitored, and samples for arterial blood gas measurements were taken at intervals. RESULTS: The main structures of diagnostic relevance observed in the caudal region of the abdomen were the urinary bladder, mesorchium and ductus deferens (left and right), left and right vaginal rings, insertion of the pre-pubic tendon, random segments of jejunum and descending colon, pelvic flexure of the ascending colon, body of the cecum, and cecocolic fold. The main structures observed in the cranial region of the abdomen were ventral surface of the diaphragm, falciform ligament and round ligaments of the liver, ventral portion of the left lateral, left medial, quadrate, and right lateral lobes of the liver, spleen, right and left ventral colons, sternal flexure of the ascending colon, apex of the cecum, and stomach. CONCLUSIONS: Alterations in cardiovascular and respiratory function in response to pneumoperitoneum and various positional changes indicated the need for continuous and thorough anesthetic monitoring and support. Comparison of anatomic observations made in dorsally recumbent, inclined horses with those reported for standing horses should enable practitioners to make patient positioning decisions that best suit access to specific visceral structures. Development of special instrumentation for manipulation of the viscera in horses, particularly the intestinal tract, would increase the diagnostic and therapeutic capabilities of laparoscopy during dorsal recumbency.

Abdomen↗
PubMed1997

Clostridium difficile colitis presenting as an acute abdomen: case report and review of the literature.

Pseudomembranous colitis associated with Clostridium difficile rarely manifests as an acute abdomen and even more rarely as an acute abdomen without abnormal radiologic studies. The following is a case report of a 52-year-old white man who had an acute abdomen without abnormal radiologic studies, and was given a final diagnosis of C difficile colitis. Surgery was averted only by the ability to do an expeditious flexible sigmoidoscopy with the visualization of pseudomembranes. Diagnosis was later confirmed by a positive toxin assay and culture of C difficile. Treatment for C difficile colitis is usually medical, with oral vancomycin the preferred agent. Surgery may be needed when there is an acute abdomen with other systemic signs (fever or leukocytosis) or abnormal radiologic studies.

Abdomen, Acute↗
PubMed2001

[Intraperitoneal chemo-hyperthermia with "overflow" open abdomen].

The authors report an original procedure of open-abdomen intraperitoneal chemo-hyperthermia. The skin edges are watertightly stapled with a soft "abdominal cavity expander", supported by a Thompson self-retaining retractor positioned over the abdomen. So, the level of the liquid can be widely raised above the level of the skin edges. The anterior wall peritoneum, the wall edges are constantly exposed to the liquid. Large amplitude movements become possible: introduction into the abdomen of two forearms, even two arms, does not induce loss of any liquid. The small bowel, the stomach can be partially exteriorized. It becomes very easy to expose all the peritoneal spaces, to maintain an homogeneous hyperthermia within the abdomen, while using only one inflow drain, and one outflow drain.

Abdominal Neoplasms↗