Abdominal Pain Of Unknown Cause Research Articles

Ekipa hitne pomoći kao slučajni svedok rituala egzorcizma kod trudnice islamske veroispovesti

Introduction/Aim No known religion in the world has remained immune to the issue of magic, obsession, and exorcism. We present the first recorded case in our country, a religious exorcism ritual performed on a Muslim woman in her third month of pregnancy. The Emergency Medical Team (EMT) was dispatched to deal with sudden-onset abdominal pain which had occurred during the ritual of exorcism, to which the EMT was an unexpected witness. Case report The EMT responded to a call requesting medical assistance for an 18-year-old pregnant woman of Roma nationality and Muslim religion, who had experienced a short-term loss of consciousness accompanied by body tremors. Upon arriving at the scene, the EMT walked in on a religious ritual of exorcism, which was performed by a Muslim priest. After the ritual was completed, the patient was examined by the EMT doctor. The patient gave anamnestic data about sudden onset upper abdominal pain with an urge to vomit, which occurred about 15 minutes before the EMT was called. She associated her current condition with black magic and an evil force (a demon) that had entered her during a short walk. She stated that she had experienced this type of pain before but did not at that time ask for medical help, because the exorcism ritual had worked and resolved the situation. She denied having previous illnesses and medical treatments and stated that everything was fine during regular examinations by her gynaecologist. Upon examination, she was found to be afebrile, eupneic, euglycemic, and normotensive, with a normal heart rate, and naturally darker skin. Upon auscultation, her heart and lung sounds were found to be normal. When palpated, her abdomen was found to be soft and slightly painful in the stomach region. Her peristalsis was audible. The position of her uterus was normal inside the pelvis, the size of a larger orange or grapefruit. Other findings were normal. The patient was transported to a gynaecology and obstetrics hospital with the diagnosis of abdominal pain of unknown cause She was also referred to be examined by a psychiatrist. Conclusion In anticipation of new scientific views on this increasingly common topic, doctors find themselves in a position where they must find a balance between the patients' religious beliefs and realistic clinical diagnoses while caring for such patients, respecting moral, ethical, and legal norms.

664 Superior Mesenteric Vein and Portal Vein Thrombosis in a Patient With COVID-19: A Rare Case

Abstract A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.

Subtotal Stomach Preserving Pancreaticoduodenectomy for a 14-Year-Old Boy with Benign Duodenal Stenosis

Background: Subtotal stomach preserving pancreaticoduodenectomy (SSpPD) is one of the highly invasive surgery and rarely performed on pediatric patients. We show a pediatric patient who underwent SSpPD because of benign duodenal stenosis and Groove pancreatitis associated with duodenal ulcer. Case: A 14-year-old boy had been suffered from repeated abdominal pain of unknown cause for 5 years. Because of abdominal pain and vomiting, he was referred to our hospital, and diagnosed with duodenal stenosis and Groove pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a biliary-duodenal fistula and the main pancreatic duct stenosis in the pancreas head. Although endoscopic pancreatic stenting was performed into the narrowed pancreatic duct, the replacement of stent became difficult due to the exacerbation of duodenal stenosis, and the patient was introduced to our department for surgery. Treatment course: SSpPD was performed. Operation time was 6 hours 49 minutes, and the amount of blood loss was 10 ml. He could take a solid diet postoperatively, and was discharged without any complication 18 days after the surgery. Discussion: There are several reports of pancreaticoduodenectomy in children for malignant tumors, but reports of benign diseases such as this case are extremely rare. Considering the requirement of long-term prognosis and quality of life, the operative indication of SSpPD for pediatric patient with benign diseases should be carefully decided.

Sigmoid colon perforation caused by migrated plastic biliary stents: a case report

Endoscopic migration of plastic biliary stents is performed by endoscopic retrograde cholangiopancreatography (ERCP) for biliary and pancreatic diseases. This plays an increasingly important role. Intestinal perforation caused by stent migration is one of the complications. Although sigmoid colon perforation caused by stent migration is rare, it can be life-threatening. This case shows us that we should increase awareness of sudden abdominal pain after ERCP. We provide a review of the clinical manifestations, imaging data of this case, and the literature related to the perforation caused by stent migration. A male patient had a history of choledocholithiasis, cholecystolithiasis, and biliary pancreatitis treated with ERCP and a pancreatic stent. After the operation, the patient developed cholangitis and was treated with ERCP and a plastic biliary stent. This patient was admitted to the emergency department with sudden lower abdominal pain. A CT scan showed sigmoid colon perforation by a foreign body and infra-diaphragmatic free air. An emergency surgery confirmed that the stent had caused the perforation. The patient was then treated with sigmoid colectomy and sigmoidostomy. Biliary stent migration after ERCP is rare, but intestinal perforation caused by migration should be considered in cases of abdominal pain of unknown cause.

Diagnosis and treatment of chronic abdominal pain 5 years after Roux-en-Y gastric bypass

BackgroundKnowledge of optimal diagnostic workup, etiology, and response to treatment of chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) is limited. ObjectiveTo define the etiology of chronic abdominal pain presenting at the 5-year follow-up after RYGB and to evaluate response to treatment. SettingOslo University Hospital (tertiary referral center for obesity surgery). MethodsOf 234 patients operated during a randomly selected 12-month period, 165 (71%) returned for 5-year follow-up, and 160 responded to study questionnaires. Of these, 54 (34%) reported chronic abdominal pain and were invited to participate in a structured diagnostic and treatment algorithm. These patients were contacted for the evaluation of their response to treatment. ResultsFifty-one of 54 patients (94%) reporting chronic abdominal pain at the 5-year follow-up were included in the study. Of the 45 patients with onset of symptoms post-RYGB, 28 (62%) underwent one or more radiologic evaluations, 10 (22%) underwent endoscopy, and 13 (29%) underwent laparoscopy. Diagnosis and treatment were established for 34 patients (76%), whereas 11 (24%) had abdominal pain of unknown cause. The most common etiology was internal herniation (n = 6), dumping (n = 6), food intolerance (n = 6), gallstones (n = 5), and irritable bowel syndrome (n = 4). After a median follow-up of 13.0 months (standard deviation, 11.5), 37 (82%) patients reported remission or improvement of symptoms, 6 had unchanged symptoms, and 2 patients were lost to follow-up. ConclusionsThe etiology of long-term chronic abdominal pain post-RYGB is diverse. A multidisciplinary team can help most patients with dedicated follow-up, but a subset of patients has symptoms of unknown etiology.

PPO.59 ‘Clip it or snip it before you ablate it’ beware the pregnancy following endometrial ablation. A Case Report of antenatal uterine rupture with placenta percreta

IntroductionEndometrial ablation is a common gynaecological treatment for heavy menstrual bleeding.1 The NICE guideline recommends that women undergoing ablation must be advised to avoid subsequent pregnancy2 because of the risks...

To Refer or Not to Refer: A Qualitative Study of Reasons for Referral From Role 1

Objectives: There are currently over 9000 British soldiers serving in Afghanistan. The Defence Medical Services provide primary health care to soldiers at forward locations using Regimental Medical Officers (RMOs) and...

Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: prospective randomised study

Objectives: To evaluate the impact of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause on length of hospital stay and accuracy of diagnosis.Design: Randomised, prospective...

Medical oxymorons can be pretty ugly.

In 1 986, Warren S. Blumenfeld, a professor at Georgia State University, published an obscure book [2] that attracted widespread attention among those with an acute interest in the obtuse. It was entitled: Jumbo Shrimp and Other Almost Perfect Oxymorons. A few examples from his book reveal the oxymoron’s real potential for serious satire: criminal justice, political scientist, graduate student, rock music, light opera, live television, military intelligence, civil wan, legal brief, statistical significance, casual sex. Since reading Professor Blumenfeld’s book, I have noticed examples of the oxymoron lurking conspicuously in nadiologic publications. These have resulted, sadly, in unintended humor and have cleanly confused the reading audience. Here are some examples: “Absence of breath sounds was present” (or “Presence of breath sounds was absent”). “Absence...present” and “Presence...absent” are models of the type of oxymoron to avoid. In short, they serve only to lengthen the sentence. Suggestion: “Breath sounds were absent.” “The patient had a diagnosis of undiagnosed abdominal pain How can a diagnosis be undiagnosed? This construction is another excellent example of a terrible oxymoron. Suggestion: “The patient had abdominal pain of unknown cause.” “Causes of epigastnic pain include peptic ulcer, hiatal hernia, cholecystitis, and idiopathic.” Because idiopathic means “of unknown cause,” listing idiopathic as a cause is almost identical (perhaps even exactly similar) to saying that the patient has a diagnosis of undiagnosed pain. Suggestion: “Causes of epigastric pain include peptic ulcer, hiatal hernia, and cholecystitis. In some patients, the cause is never determined.” “1311-Hippuran showed no visualization of the kidneys.” This construction (“showed no visualization”) is obviously a subtle oxymoron (the tracer showed something that was not shown). Suggestion: “Renal uptake of 131l-Hippuran was absent.” ‘This represents a nonmnflammatory arthritis.” Arthritis comes from the Greek arthron = a joint, and -itis (suffix) = inflammation. A noninflammatory inflammation is cleanly confusing. Suggestion: ‘This is a noninflammatory arthnopathy.” A typical variant of the oxymoron is the following: ‘The results of pulmonary function tests in our patient were nonmal. The only abnormality was decreased diffusing capacity.” Having just explicitly implied that the test results were normal, the author states the exact opposite. Suggestion: “The only abnormal result of pulmonary function tests in our patient was “These findings were also present in several normal patients.” Care should be exercised in juxtaposing “normal” and “patients.” Patients normally have abnormalities that constitute ill health, even though the abnormalities may appear to the blinded observer to lie on a normal distribution curve. In general, it is always better to use the term “healthy subjects.” “Discussion was centered around the relative merits of MRI and CT myelognaphy.” Scattered occurrences of the term “centered around” are ubiquitous in the radiologic litenatune, despite the fact that this term does not square with the properties of the circle as described by the principles of practical Euclidean geometry. The center (from Greek: kentron = sharp point) is the point about which a circle’s cincumfenence is drawn. To write on say “centered around” is to confuse the center with the circumference. This is another variant of the oxymoron, and a pretty ugly one at that. Suggestion: “centered on.” The oxymoron, particularly the unintended oxymoron, detracts from scientific writing. Because the oxymoron involves intimate juxtaposition of two widely disparate concepts, it may definitely confuse casual readers who are scrutinizing what you have written. Deliberately avoid the oxymoron, particularly the unintended oxymoron, unless you have a confident suspicion that the reader knows exactly what you think you mean.

Appendicitis

One thousand cases of appendicitis seen from 1963 to 1973 were reviewed. The overall negative appendectomy rate was 20%, but in women between ages 20 and 40 it exceeded 40%. Two thirds of the negative appendectomies were due to nonsurgical lesions. Mesenteric adenitis, gastroenteritis, and abdominal pain of unknown cause accounted for one third of the errors in females and two thirds in males. These diseases were best distinguished from appendicitis on the basis of temperature and white blood cell count. The remainder of the errors in females were due to pelvic inflammatory disease or other gynecologic diagnosis and were best distinguished from appendicitis on the basis of history and physical findings. The rate of perforation was 21% overall. The incidence of wound infection was 8.5%. Use of systemic antibiotics did not affect the wound infection rate.