Acute Abdominal Crisis Research Articles

Delayed Rupture of the Spleen A Case Report

The diagnosis of delayed rupture of the spleen is demonstrated and discussed by presenting a case in which the patient had significant thoracoabdominal trauma with an initially normal liver/spleen scintigram and benign hospital course. Twenty-three days after the trauma, the patient developed an acute abdominal crisis that brought him to the emergency room where an emergency ultrasound revealed hemoperitoneum and a subcapsular hematoma. At laparotomy, a splenic rupture was found. A splenectomy was not performed. Postoperative liver/spleen scintigram showed a persistent defect which was not present on the initial liver/spleen scintigram.

Effects of toxic doses of phenylbutazone in ponies: Charles G. MacAllister, DVM. Am J Vet. Res 44:12, 2277–2279(1983)

Toxic doses of phenylbutazone (10 mg/kg of body weight) were administered to 10 ponies once daily for 14 days. Clinical signs of toxicosis similar to those seen in other species included CNS depression, anorexia, oral ulcers, and soft feces. Six ponies died in 7 to 20 days; 1 pony was euthanatized during an acute abdominal crisis; and 3 ponies survived the study. At necropsy, the major lesions were oral and gastrointestinal ulcerations and renal changes.

Abdominal Crisis in the Horse: A Comparison of Pre‐Surgical Evaluation With Surgical Findings and Results

The results of preoperative examination, surgical intervention and the outcome of 50 cases of acute abdominal crisis in the horse are presented. Pre‐surgical parameters discussed in this correlative study include duration of the condition prior to sergery, pulse rate, packed cell volume (PCV), abdominal distention, intestinal motility and tympany, rectal findings, reflux of fluid after passage of a nasogastric tube, and abdominal paracentesis. A retrospective study was performed to evaluate the usefulness of each clinical parameter in deciding that a case was surgical, arriving at a specific pre‐surgical diagnosis, and in giving a prognosis. Rectal examination was the single most useful diagnostic tool. Reflux of gastric fluid through the nasogastric tube usually indicated obstruction of the small intestine.

Renal artery thrombosis.

Renal artery thrombosis may follow blunt trauma or may he spontaneous. It causes hypertension that may be fulminant or very insidious in onset. Spontaneous renal artery thrombosis may present as hypertension or as an acute abdominal crisis.

Suppression of Amylase Activity by Hypertriglyceridemia

Patients with clinical acute pancreatitis or abdominal crises possibly indicating surgery, accompanied by lactescent plasma and normal serum amylase values, pose a therapeutic dilemma of medical supportive therapy vs prompt surgical intervention. Plasma triglyceride levels in the 500 to 6,000 mg/100 ml range (with grossly turbid plasma) interfere in vitro with determination of amylase activity. In three patients with clinical pancreatitis (normal undiluted serum amylase levels) and lactescent plasma with type V hyperlipoproteinemia, serum amylase level was shown to be elevated after correction for dilution. Serial dilutions of serum with saline solution allow correction to actual amylase in hyperlipemic serum, apparently by reducing in vitro interference caused by elevated triglyceride levels.

Cystic Astrocytoma of the Spinal Cord Presenting as an Acute Abdominal Crisis

A case of a spinal intramedullary cystic astrocytoma presenting with acute lower abdominal pain has been documented. The rarity of these initial symptoms in a spinal tumor has been noted and the difficulties in diagnosis of spinal cord tumors in childhood have been emphasized.

Pancreatitis in pregnancy

Pancreatitis in pregnancy is not a rare disease and must be considered in the differential diagnosis of any patient with hyperemesis gravidarum as well as those pregnant patients with signs of an acute surgical abdominal crisis. The serum amylase and diastase tests are rapid and reliable and provide an excellent diagnostic and prognostic test for the clinician. It must be remembered that the amylase in serum is excreted rapidly and so a urinary diastase test must always be ordered concurrently. It cannot be overemphasized that the patient with pancreatitis (including severe cases) may present initially without pain or tenderness. If the diagnosis is made early, medical management is almost always successful and the prognosis for mother and fetus is good. The excellent results obtained in this series are a result of early diagnosis and rapid treatment.

Spontaneous rupture of the kidney with massive hemorrhage: A complication of anticoagulation

A case of spontaneous or nontraumatic rupture of the kidney resulting in nearly fatal massive hemorrhage in a patient on long-term anticoagulant therapy has been reported. This case illustrates that rupture can occur in an essentially normal kidney. Rupture of the kidney is a diagnosis that should be considered in any acute abdominal crisis manifested by sudden flank pain and shock. Diagnosis is best made by intravenous pyelography or, as in this case, by transfemoral arteriography. After the patient is treated for shock, nephrectomy should be performed as soon as possible.

The Acute Abdomen and Emergent Lesions of the Gastrointestinal Tract

The editors, with 71 contributors, have covered in a helpful and thorough manner the various problems of the acute abdominal crisis, including urological and gynecological emergencies. In the opening chapter, Ravdin gives general guidelines for handling the patient with an acute abdomen; and Bockus, after a physiologic analysis of abdominal pain, reviews the diagnostic differentiation between true abdominal and masquerading extra-abdominal lesions. After these excellent basic approaches, the reader is carried through the pitfalls of mistaken diagnosis, improper preparation for surgery, the special problems incident to infancy and old age, and the recognition and treatment of hemorrhagic and septic shock. Hodes and Stein summarize the helpful place that radiology holds in handling the acute abdominal crisis. The portion of this text dealing with abdominal trauma in itself makes the volume worthwhile. Covered adequately are problems of the biliary tract requiring urgent surgery, acute obstructions of the small and large intestine,

ACUTE ABDOMINAL CRISIS, CIRCULATORY COLLAPSE AND SUDDEN DEATH IN HAEMOCHROMATOSIS

The clinical features and autopsy findings are described in nine cases of haemochromatosis dying suddenly with an unexplained acute abdominal crisis and peripheral circulatory collapse. From an analysis of these and six other cases in the literature a distinct syndrome emerges. Possible underlying mechanisms are discussed and suggestions made as to investigations in future cases.

VISCERAL INJURIES IN BATTERED CHILDREN.

The “battered-child” or the “unsuspected trauma syndrome” is well known since the publication of the initial articles of Caffey (3) and Silverman (9). The term refers to an infant or child who has sustained physical abuse, usually repeatedly, from a parent or guardian. A complete review of this subject is found in the excellent papers of Gwinn et al. (5), Kempe et al. (7), and Woolley and Evans (10). This study is concerned with 10 infants or small children suffering initially unexplained visceral trauma (Table I). All patients presented as acute abdominal crises. The history given by the parents was usually vague and obscure or sometimes purposely misleading. No history could be obtained from the children. Seven of the children were male and 3 female. Their ages ranged from five to thirty months. Visceral Rupture Or Laceration Rupture of the small bowel, the most common visceral injury, was found in 7 of the 10 children. Two sustained laceration of the liver, and 1 a perforation of the stomach. Laceration of the lung occurred in 1 child, and subpleural hemorrhage in another. Multiple viscera were traumatized in 5. With rupture of the intestinal tract, the radiographic findings were pneumoperitoneum, hemoperitoneum, and/or ileus (Figs. 1 and 2). In 1 patient with a perforated duodenum there was a considerable delay in seeking medical care and multiple peritoneal abscesses were found (Fig. 3). In the 2 children with a ruptured liver, hemoperitoneum was a striking finding (Fig. 4). Other Systemic Injuries Various combinations of skeletal, craniocerebral, and soft-tissue injuries were found in these children (Table II). 1. 1. Skeletal Fractures. Five patients had evidence of injury to the skeleton exclusive of the skull. In 2, there were a large number of fractures. The radiographic characteristics of skeletal injuries have been described in detail by Fisher (4), Jones and Davis (6) and Silverman. Metaphyseal fractures are common because the metaphysis is least resistant to trauma in this age group (Fig. 5). Periosteal elevation follows with abundant subperiosteal new bone formation. Often noted are fractures in various stages of healing, a sign of repeated trauma. Multiple fractures in the growing bone with subsequent repair cause marked deformities with blunted ends and twisted shafts (Fisr. 5) Numerous fractures in infants and children may be simulated by (a) vitamin C and D deficiency, (b) leukemia, (c) metastatic neuroblastoma, (d) syphilis, (e) osteogenesis imperfecta (f) hypophosphatemia, (g) osteomyelitis, and (h) cortical hyperostosis. 2. 2. Craniocerebral Injuries. Old or recent craniocerebral damage was found in 3 of the 10 children. A fractured skull was present in 1 child on a prior admission. At the time of entry, 1 had bilateral subdural hematomas and another exhibited radiographic evidence of increased intracranial pressure.

Urticaria of the gastric mucosa with massive hemorrhage following oral penicillin anaphylaxis.

Case Reports1 August 1959URTICARIA OF THE GASTRIC MUCOSA WITH MASSIVE HEMORRHAGE FOLLOWING ORAL PENICILLIN ANAPHYLAXISS. P. BRALOW, M.D., F.A.C.P., L. S. GIRSH, M.D.S. P. BRALOW, M.D., F.A.C.P.Search for more papers by this author, L. S. GIRSH, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-51-2-384 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt is not unusual for anaphylaxis to be accompanied by nausea, vomiting and abdominal pain. These attacks may be so severe as to simulate an acute abdominal crisis, and unwarranted surgery may be performed. This syndrome has also been called acute abdominal angioneurotic edema, because the reaction is thought to be due to acute edema of the gastrointestinal mucosa resembling a large hive. Such areas have been described in the bowel wall of patients who were mistakenly subjected to surgery. Gastrointestinal bleeding may sometimes accompany these acute abdominal crises. As a rule, the hemorrhage is accompanied by either urticaria or...Bibliography1. Tuft L: Clinical allergy, 2nd Ed., 1949, Lea and Febiger, Philadelphia, p. 459. Google Scholar2. Lyons C: Penicillin therapy of surgical infections in U. S. Army, J. A. M. A. 123: 1007, 1943. CrossrefGoogle Scholar3. KolodnyDenhoff MHE: Reactions in penicillin therapy, J. A. M. A. 130: 1058, 1946. CrossrefMedlineGoogle Scholar4. Kleinfeld L: Sequelae following oral and topical use of penicillin, New York State J. Med. 46: 915, 1946. MedlineGoogle Scholar5. MaceyHays HBTG: Allergic reactions to penicillin therapy, U. S. Nav. M. Bull. 45: 1143, 1945. MedlineGoogle Scholar6. Walley JF: Severe reactions after penicillin, Brit. M. J. 1: 150, 1948. CrossrefMedlineGoogle Scholar7. Maganzini HC: Anaphylactoid reaction to penicillins V and G administered orally, New England J. Med. 256: 52, 1957. CrossrefMedlineGoogle Scholar8. Madalin HE: Anaphylactoid reaction following use of penicillin lozenges, J. Michigan M. Soc. 53: 61, 1954. Google Scholar9. EisenstadterHussar DAE: Severe anaphylactic reaction from oral penicillin, Am. Pract. and Digest Treat. 5: 783, 1954. MedlineGoogle Scholar10. PetersHendersonPrickman GALLLE: Anaphylactic penicillin reactions, Proc. Staff Meet., Mayo Clin. 30: 634, 1955. MedlineGoogle Scholar11. de MelloMendes JFE: Rencão do tipo anafilatico após uma prova intradérmica com penicilina, Rev. Asoc. méd. brasil 2: 145, 1956. MedlineGoogle Scholar12. KernWimberley RANA: Penicillin reactions: their nature, growing importance, recognition, management and prevention, Am. J. M. Sc. 226: 357, 1953. CrossrefMedlineGoogle Scholar13. Chevallier R: L'oedème fugace de la région antropylorique au cours des gastropathies allergiques. Etude gastroscopique, Bronchoscop., oesophagoscop. et gastroscop. 2: 129, 1935. Google Scholar14. PollardStewart HMGJ: Experimental reproduction of gastric allergy in human beings with controlled observation on the mucosa, J. Allergy 13: 467, 1942. CrossrefGoogle Scholar15. Smith VM: Fatal reactions to penicillin: evaluation of a test for sensitivity, New England J. Med. 257: 447, 1957. CrossrefMedlineGoogle Scholar16. AfendulisGulzow TM: Die allergisch-hyperergische Gastritis. Tier experimentelle Untersuchungen, Ztschr. f. d. ges. exper. Med. 104: 167, 1938. CrossrefGoogle Scholar17. Schindler R: Gastroscopy: the endoscopic study of gastric pathology, 2nd Ed., 1950, University of Chicago Press, Chicago, pp. 254-256. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Received for publication May 23, 1958.From the Department of Medicine, Temple University Medical Center, Philadelphia.Requests for reprints should be addressed to S. P. Bralow, M.D., Temple University Medical Center, 3400 North Broad Street, Philadelphia 40, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRecurrent oedema of the small intestineDrug-Induced Gastrointestinal DisordersDrug-induced gastrointestinal diseasePENICILLIN ALLERGY: A REVIEW OF THE IMMUNOLOGICAL AND CLINICAL ASPECTSDRUG REACTIONS INVOLVING THE ALIMENTARY TRACTReferences 1 August 1959Volume 51, Issue 2Page: 384-390KeywordsAnaphylaxisEdemaGastroenterology and hepatologyHemorrhageMucous membranesNauseaPenicillinSurgeryUrticariaVomiting ePublished: 1 December 2008 Issue Published: 1 August 1959 PDF downloadLoading ...

Idiopathic Hyperlipemia

Idiopathic hyperlipemia represents the homozygous abnormal state. The basic metabolic defect in this condition is a retarded removal of ingested fat from the blood stream after normal absorption. The homozygous abnormal state is further complicated by hepatosplenomegaly; abdominal, coronary, and central nervous system crises, and, frequently, secondary xanthoma. Many patients believed to be psychotic proved to be subject to idiopathic hyperlipemia after thorough diagnostic screening. Furthermore, many patients seen in the emergency room because of an acute abdominal crisis, and subjected to a number of surgical procedures, often are helped as a result of a simple observation of which they exhibit during these acute episodes. These manifestations are believed to be due to an increase in neutral fats in particulate form, which impart a milky turbidity to the serum, known as lactescence. This milky appearance becomes evident if the lipid level reaches about 4,000 mg. %. There is also

Abdominal pain following use of chlorpromazine.

Hepatitis due to chlorpromazine (Thorazine) hydrochloride is often a diagnostic problem because it may mimic biliary obstruction from both the clinical and the laboratory standpoints. Pain, such as is commonly seen in biliary colic, is extremely unusual, although some patients complain of soreness in the upper part of the abdomen at the onset of the hepatitis. In a recent series of 23 cases of hepatitis due to chlorpromazine encountered at the Mayo Clinic, only one patient had pain that might conceivably be construed to represent biliary colic. We have reviewed the English literature with particular reference to pain and found it to be in agreement with our experience. It has been emphasized that the onset of hepatitis due to chlorpromazine may be sudden and associated with high fever and chills. Pain of the intensity and character usually associated with an acute abdominal crisis has not been reported to our knowledge.

Some Observations of the Behavior of Amylase in Relation to Acute Renal Insufficiency

THE increased concentration of plasma amylase during chronic renal insufficiency has long been recognized and is considered to be a result of renal excretory failure. Plasma amylase is reported to rise in parallel with urea concentration1 but not to heights encountered in acute pancreatitis.2 Similar rises in amylase might be expected to accompany urea retention in acute renal insufficiency, but this phenomenon has received little attention.The clinical interest in plasma amylase elevation during acute renal insufficiency is heightened by the occurrence in this condition of acute abdominal crises that may resemble acute pancreatitis. The decision to perform or defer . . .

Biochemistry and metabolism of an acute intermittent porphyria

SummaryA case of intermittent acute porphyria occuring immediately after pregnancy is described in a female of 25, up to then in good health. The clinical symptomatology was characterised by acute abdominal crisis with vomiting and constipation, hypertension periods with uremia, a severe extensive and progressive polyneuritis appearing on a very peculiar mental background made of hysteria and melancolia.The biochemical study of urine has shown the constant presence of large amounts of porphobilinogen and uroporphyrin III (up to 3,5 mgr. per day), of uroporphyrin I (up to 1,7 mgr. per day), of coproporphyrin (150 to 200 γ per day).The patient’s mother, although otherwise healthy shows a comparable urinary syndrom, but with a lesser excretion of uroporphyrin. The patient’s sons present an unconstant excretion of porphobilinogen. These facts confirm the hereditary character of the disease. Finally the authors discuss the physiopathology of porphyrinuria, and its relationship with the metabolic and endocrinol...

The diagnosis of volvulus of the cecum.

Volvulus is a twisting of the bowel which produces luminal occlusion. When it occurs in the cecum, the clinical findings are those of intestinal obstruction of sudden onset, the cause of which is obscure. The radiologic observations, however, may be strikingly diagnostic. In spite of the fact that cecal volvulus constitutes a radiologic entity, there is a remarkable paucity of comment on this type of acute abdominal crisis in the radiologic literature. Indeed, during the past fifteen years, not a single American radiologic journal has published an original article on volvulus of the cecum. The present report is based on 7 proved cases and emphasizes the radiologic criteria for diagnosis. The term “volvulus of the cecum” is somewhat of a misnomer, since in every case more or less of the ascending colon and terminal ileum participates in the twist. The first description of cecal volvulus was made by Rokitansky in 1841 (29). Since that time, many cases have been reported, and by 1942, Wolfer, Beaton and Anson were able to collect over 300 examples from the literature (33). During the past ten years, at least 60 additional cases have been described (6, 8, 10–12, 16, 17, 20, 21, 25, 28, 34). Most of these earlier cases were discovered on the autopsy table, and it was not until recent years that survival became the rule rather than the exception (6). In a review of 100 reported cases, Donhauser and Atwell, in 1949, stressed the grave prognostic implications of gangrene and pointed out that most of the survivors have been operated upon within twenty-four hours after the onset of symptoms (8). Early recognition, then, is imperative. It is possible only where awareness of the entity coincides with knowledge of its clinical and roentgenographic manifestations. Etiology The factors implicated in the precipitation of volvulus of the cecum are legion. Previous operations (7, 23), bands (25), tumors (25), hernias (5), violent coughing (33), pregnancy (2, 18, 24, 26), mesenteric cysts (22), typhoid fever (13), excessive physical exertion (26, 33), over-eating (26, 31), abdominal trauma (33), diet (13), constipation (25)—all these and many more possible causes have been mentioned. In our own cases, it was impossible to discern any common precipitating factor. It is probably more important to understand the basic anatomic abnormality without which volvulus could not occur, namely, excessive mobility of the cecum and ascending colon. The embryonic intestine, which at four weeks of life is a simple tube, shortly thereafter undergoes ventral flexion, forming a horizontal U-shaped loop (Fig. 1). At this time, the cecum first appears as a bulge in the caudal half of the loop; by six weeks, rotation of the loop about the superior mesenteric artery brings the cecum from an inferior to a superior position to the left of the mid-line.

L’Infarctus Du Rein: Diagnostic A Envisager Devant Un Syndrome Abdominal Aigu

SummaryThree cases of renal infarcts in which clinical signs suggested an acute abdominal crisis are reportedIn two of these cases clinical diagnosis was possible; post-mortem examination was obtained in one case.75 cases of renal infarct have been collected from the files of the medical department of St.-Pierre Hospital. Clinical diagnosis was possible in 8,7 % of these cases. Clinical signs are described. These are clear enough when te renal infarct is large and when cardiac signs suggest the possibility of arterial embolisation.

Abdominal pain in pneumonia

1. Thoracic pain occurs in eighty per cent of patients with pneumonia, while abdominal pain occurs in eight per cent of patients with this disease. 2. The occurrence of thoracic pain in pneumonia is a helpful symptom because it directs attention to the diseased organs, thereby aiding in their diagnosis; but the appearance of abdominal pain distracts attention from the disease giving rise to it, and so becomes a source of confusion. 3. Abdominal pain has little if any physiologic relationship to the pneumonia which produces it. It is a physiologic paradox. 4. Abdominal pain and other associated symptoms may be so pronounced as to completely mask the respiratory infection, and may simulate acute abdominal disorders, as acute appendicitis, acute cholecystitis, intestinal obstruction, etc. 5. The ability of referred abdominal pain and the associated symptoms to simulate acute appendicitis is annoyingly real at times; and laparotomies have been performed as a result of this mimicry. 6. The probable explanation for the production of referred abdominal pain lies in the toxemia which occurs in the disease. 7. The toxemia consists of two factors, a specific factor elaborated by the pneumococcus, and a non-specific factor resulting from the general fever process. 8. We regard the toxemia acting on the gastrointestinal tract as a responsible for the production of the symptoms of abdominal pain, meteorism, flatulence, nausea, vomiting, distention, constipation, etc. 9. The differential diagnosis between the acute abdominal crises and pneumonia is arrived at by a painstaking consideration of all the available clinical material.

Investigation of Free Gas in the Peritoneal Cavity

The radiological technique for the detection of free gas in the peritoneal cavity is dependent on the situation of such gas and the condition of the patient at the time of the examination. The majority of patients examined are ill—acutely ill, either in the immediate post-operative period or have been admitted as an acute abdominal crisis. For this reason they are mostly ward cases in bed and must be disturbed as little as possible. A ward unit is used, either portable or mobile, and the positioning of the unit should be done before disturbing the patient. Most cases are already in the Fowler's position, propped up in bed, and invariably have a degree of respiratory embarrassment. To avoid disturbing the patient, the cassette is placed behind and an antero-posterior view taken, the tube centred a little above the xyphisternum. The low centring enables us to include the lower zones of the lung and the upper abdomen on one film. The kilovoltage used is slightly more than the usual chest technique, about 75 kV, and the distance is 4 ft. In view of the small outputs of the X-ray units, ultra-rapid screens and films should be used. If the case is ambulant an examination can be made in the X-ray department by the usual techniques, always bearing in mind that free gas in the peritoneal cavity will rise to the most dependent part and is best shown beneath the diaphragm in the upright position and in the flanks in the lateral decubitus.