Acute Abdominal Distress Research Articles

Bowel ischemia as onset of COVID‐19 in otherwise asymptomatic patients with persistently negative swab

BackgroundAsymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) can develop hypercoagulable conditions and acute vascular events. The objective of this study is to determine whether SARS‐CoV‐2 was present in resected specimens from patients with acute bowel ischemia, but asymptomatic for Coronavirus Disease 2019 (COVID‐19) and with persistently real‐time polymerase chain reaction negative pharyngeal swab.MethodsThree consecutive patients presented severe abdominal symptoms due to extensive ischemia and necrosis of the bowel, with co‐existent thrombosis of abdominal blood vessels. None had the usual manifestations of COVID‐19, and repeated pharyngeal swabs tested negative. They underwent emergency surgery with intestinal resection. Immunohistochemical testing for SARS‐CoV‐2 on resected tissue was performed.ResultsAll tested samples were strongly positive for SARS‐CoV‐2.ConclusionsThis is the first case report in which patients with severe intestinal symptoms presented a marked SARS‐CoV‐2 positivity in the resected tissues, without any usual clinical manifestations of COVID‐19. These results suggest that the patients might be infected with SARS‐CoV‐2 presenting acute abdominal distress but without respiratory or constitutional symptoms.

Obliterative cholangiopathy in acquired cystic biliary atresia type III after cyst perforation: a case report

BackgroundIn biliary atresia, the disease process of obliterative cholangiopathy may begin in the perinatal period; however, no chronological evidence exists on how the cholangiopathy progresses to biliary obliteration.This is the first acquired case with the final diagnosis of type III cystic biliary atresia with an extrahepatic biliary cyst which showed the progression of obliterative cholangiopathy in chronological order after birth.Case presentationAn 81-day-old girl presented with acute abdominal distress due to bilious peritonitis caused by biliary cyst perforation, for which she underwent emergency biliary drainage. Postoperative images showed a dilated common bile duct and hepatic ducts bilaterally, with flow of the contrast medium to the duodenum through the dilated common bile duct. Biochemistry of the bile collected during and after the operation revealed elevated levels of pancreatic enzymes in the bile from the gallbladder. The patient was diagnosed as having a congenital choledochal cyst and underwent laparotomy at 120 days of age which revealed that she had pancreaticobiliary maljunction. The biliary cyst was resected at the narrow portion just above the junction with the main pancreatic duct. During dissection up to the hepatic hilum, we found that the hilar hepatic ducts were bilaterally replaced by fibrous tissue and were obstructed, leading to a diagnosis of type III a1, μ biliary atresia. The fibrous tissue was excised, and hepatic portoenterostomy was performed according to the Kasai procedure. The patient’s postoperative course was uneventful and the jaundice resolved within 1 month. She has had normal liver function tests with no episode of cholangitis for 3 years after discharge.ConclusionsWe demonstrated the process of acquired type III biliary atresia in a patient with cystic biliary atresia and biliary cyst perforation. To the best of our knowledge, this is the first case of acquired cystic biliary atresia showing chronological progression of the course of obliterative cholangiopathy, providing a better understanding of the development of type III biliary atresia as an acquired disease.

AtypicalStreptococcus suisin Man, Argentina, 2013

Atypical<i>Streptococcus suis</i>in Man, Argentina, 2013

Gastric Dilitation-Volvulus in a Red Panda (&lt;i&gt;Ailurus fulgens&lt;/i&gt;)

ABSTRACTA 10-year-old male red panda presented acutely with symptoms of shock due to acute abdominal distress and respiratory compromise. Abdominal ultrasound confirmed a severely distended stomach for which passage of an orogastric tube for relief was unsuccessful. Intra-operatively, the stomach was found to be distended and torsed around its long axis supporting the diagnosis of Gastric dilitation-volvulus (GDV). The animal arrested and died intra-operatively and was submitted for necropsy with lesions supportive of the diagnosis of GDV. No risk factors for GDV were found to correlate between the panda and those described in domestic dogs. This case suggests that red pandas can be susceptible to this condition in captive settings.

Acute peritonitis secondary to traumatic breeding in the bitch

AbstractObjective:To discuss 2 cases of acute peritonitis caused by traumatic breeding in the bitch.Series summary:Two bitches presented with acute abdominal pain, clinical signs, and laboratory abnormalities compatible with peritonitis. Both bitches were in estrus and had been observed copulating with male dogs prior to the onset of clinical signs. Diagnostic testing revealed bacterial peritonitis in both dogs, and intracellular and extracellular spermatozoa in ascites from 1 of the dogs. Surgical exploration revealed rupture of the uterine body and generalized peritonitis in both animals. Both bitches recovered following surgical and medical treatment.New or unique information provided:This is the first reported series of cases of peritonitis secondary to traumatic breeding. These cases introduce a unique presentation for peritonitis and acute abdominal distress. Peritonitis because of traumatic seeding of the abdominal cavity with bacteria from the urogenital tract, with or without seminoperitoneum, should be considered for bitches presenting with appropriate history, signalment, and clinical signs.

Radiographic techniques and interpretation of the acute abdomen

Radiography is a familiar and available imaging modality for the evaluation of patients with acute abdominal distress. Potential causes for acute abdominal distress include the hepatobiliary system, spleen, urogenital tract, and gastrointestinal tract. Radiographic signs associated with specific conditions are described, including gastric-dilation volvulus, urinary bladder rupture, ureteral rupture, urethral rupture, pancreatitis, and small intestinal obstruction. Additionally, contrast procedures that can be beneficial in evaluating the patient with acute abdomen, including positive contrast cystography, urethrography, excretory urography, and peritoneography, are described.

The acute abdomen: A surgeon's approach to diagnosis and treatment

Clinical approach to a patient with acute abdominal distress involves decision making: whether to take a patient to surgery, or manage the patient medically. A thorough and systematic approach requires the use of diagnostic imaging modalities, including radiology and ultrasonography, performing diagnostic peritoneal lavage or abdominal paracentesis techniques, and bloodwork evaluation, including complete blood count and serum biochemistry profiles. In some cases, the results of diagnostic tests may lead to surgical versus medical management, alone. In other cases, such as GDV syndrome, penetrating abdominal wounds, pyometra, or uncontrolled abdominal hemorrhage, rapid surgical management is necessary for patient survival. This article describes a systematic approach to a small animal patient with acute abdomen.

Contrast Radiography in Small Bowel Obstruction: A Prospective, Randomized Trial

Small bowel obstruction is a common cause of acute abdominal distress, accounting for up to 20% of emergency admissions to surgical services. Although the majority of obstructions will resolve with conservative therapy alone, there are currently no reliable tests for identifying the patients who will require operation. Barium contrast studies have the potential to rapidly identify patients with complete small bowel obstruction, but many surgeons are hesitant to use them for fear of inducing complications. We report the results of a randomized, prospective trial comparing immediate oral barium contrast studies with plain abdominal X-rays in patients presenting with signs and symptoms of small bowel obstruction. End points included time to resolution of the symptoms or operation, total number of hospital days, and morbidity. Sixty-four patients completed the study; of these, 23 received contrast studies and 41 had plain radiographs only. Six of the contrast group (26%) and 11 of the plain radiograph group (27%) ultimately went to operation. Barium contrast studies had a sensitivity of 100% for diagnosing complete obstruction, whereas the sensitivity of serial plain radiographs was only 82%. Among those going to operation, the time from admission to operation was 8.2 hours in the contrast group and 12.4 hours in the plain radiograph group, but this result did not reach statistical significance (p = 0.25). Total hospital days were similar between the two groups (8 vs. 12 days, p = 0.40). There were no complications resulting from the oral administration of barium. Small bowel contrast studies using barium are safe and may shorten the time to operation in patients presenting with signs and symptoms of small bowel obstruction.

Anoplocephala perfoliata in Horses in Sweden: Prevalence, Infection Levels and Intestinal Lesions

Distal ileum, caecum and proximal colon of 470 horses were examined for helminths during 1 year at an abattoir in central Sweden. The infection levels of the horse tapeworm Anoplocephala perfoliata, their stage of development, site of attachment and gross pathological lesions caused by the worm were recorded. Faecal samples from 395 of the horses were examined specifically for tapeworm segments and eggs in order to correlate these findings with the numbers in the alimentary canal. In total 65% of the horses were infected with A. perfoliata and the mean intensity of infection was 79 worms per infected horse with a maximum of 912. The level of infection was significantly higher in (1) 3rd and 4th than in 1st and 2nd quarter of the year; (2) older horses than in yearlings; (3) females than in males and geldings; (4) thoroughbred and cold-blooded horses than in Swedish standard breeds and ponies. The level of infection was unaffected by the usage of anthelminthics against nematodes. Of the horses examined 51% had 1-100 worms whereas 14% were infected with more than 100 worms. Of the tapeworm positive horses 72% had mixed infections with both adult and juvenile worms, 20% solely juveniles, and 8% solely adults. The severity of intestinal lesions exacerbated by increasing numbers of A. perfoliata. About 11% of the intestines examined had severe lesions, but there was no history of acute abdominal distress in any of the horses included in this study. Although the number of detectable eggs was significantly higher for horses heavily infected with A. perfoliata, the egg recovery among infected horses was only 35%. An additional field survey comprising 218 horses on 88 premises in central and southern parts of Sweden showed that the prevalence of A. perfoliata egg positive horses was the same as found on faecal examination during the abattoir survey.

Naloxone‐induced abdominal distress in the horse

Endogenous opioid peptides have been implicated in the regulation of pain perception, behaviour, gastrointestinal activity and other physiological responses. However, the functional role of these peptides in the horse has yet to be elucidated. The opioid antagonist, naloxone, is often administered to infer endogenous opioid effects. In the present study, naloxone (0.75 mg/kg bodyweight) was administered to eight Thoroughbred racehorses and a number of behavioural and autonomic responses were measured. Naloxone produced rapid onset diarrhoea, restlessness, abdominal checking, tachycardia, tachypnoea, paradoxical yawning and diaphoresis. These responses described an acute abdominal distress syndrome similar to spasmodic colic. Results from this study suggest that, in the horse, endogenous opioids: 1) influence behaviour, 2) modify intestinal activity and sensation, and 3) if perturbed, may be involved in pathophysiology of colic.

Neutropenic Enterocolitis: A New Complication of Head and Neck Cancer Chemotherapy

Neutropenic enterocolitis is a recognized complication of immunosuppression or chemotherapy for leukemia. It presents as severe abdominal pain and tenderness, fever, and diarrhea associated with granulocytopenia. Gastrointestinal symptoms associated with chemotherapy for head and neck neoplasms include nausea and emesis, but not acute abdominal distress. We present, to our knowledge, the first case of neutropenic enterocolitis in a patient receiving cisplatin and fluorouracil chemotherapy for metastatic head and neck cancer.

Symptomatic accessory lobe of the liver associated with hyperthyroidism

A case of symptomatic accessory lobe of the liver occurred in a 15-year-old Japanese girl with hyperthyroidism. The patient presented with acute abdominal distress; at operation, a twisted necrotic mass of the accessory lobe of the liver was found. A review of the literature failed to show a previously reported instance in a child.

Abdominal emergencies

This brief review of abdominal emergencies is by no means encyclopedic. Indeed, it simply reflects the multiplicity of problems that can occur and suggests the need for a high index of suspicion and an optimistic attitude toward their solution. In addition, the surgeon must keep in mind the fact that cancer patients may also suffer acute abdominal distress from extra-abdominal causes such as pneumonia, myocardial infarction, diabetes mellitus, and hematologic abnormalities such as porphyria or sickle cell anemia. Inflammatory bowel disease, pelvic inflammatory disease, acute hepatitis or other similar problems more commonly seen in general hospital populations may also develop. Consultations for an acute condition of the abdomen in patients receiving marrow-suppressing chemotherapy are challenging problems and repeated examination every few hours is required to detect subtle changes. Hypovolemia, sepsis, confusion and unexplained metabolic acidosis may be the only criteria for surgical exploration. An unnecessary operation in a leukopenic and thrombocytopenic patient is indeed risky, but failure to drain an occult abscess or resect a perforated segment of bowel is always lethal. An additional consideration is the likelihood of response to further treatment of the underlying disease. Unless further effective therapy is unavailable, pessimism is unwarranted.

Fatal disseminated stronglyloidiasis presenting as acute abdominal distress in an urban child

1. Harrison GA, and McNee JW: An investigation ofsclerema neonatorum; with special reference to the chemistry of the subcutaneous tissue, Arch Dis Child 1:63, 1926. 2. Reed RJ, Clark W, and Mihm M: Disorders of the panniculus adiposis, Hum Pathol. 4:219, 1973. 3. Shaffer B: Liquifying nodular panniculitis: Report of a case, Arch Dermatol 38:535, 1938. 4. Lynn TE, Dockerty MB, and Waugh JM: A clinopathologic study of the epiploic appendages, Surg Gynecol Obstet 103:423, 1956.

Role of the Excretory Urogram in the Diagnosis of Renal and Ureteral Disease

Radiography is a familiar and available imaging modality for the evaluation of patients with acute abdominal distress. Potential causes for acute abdominal distress include the hepatobiliary system, spleen, urogenital tract, and gastrointestinal tract. Radiographic signs associated with specific conditions are described, including gastric-dilation volvulus, urinary bladder rupture, ureteral rupture, urethral rupture, pancreatitis, and small intestinal obstruction. Additionally, contrast procedures that can be beneficial in evaluating the patient with acute abdomen, including positive contrast cystography, urethrography, excretory urography, and peritoneography, are described.

ACUTE OSTEOMYELITIS OF THE SUPERIOR MAXILLA IN A YOUNG INFANT

Acute osteomyelitis of the superior maxilla in infants is sufficiently uncommon to merit reporting, and, with the exception of the picture accompanying a case report by Bass, it has no pictorial record known to me. This disease is so typical in its signs, as illustrated in the accompanying photographs, that it should not fail to be recognized. <h3>REPORT OF A CASE</h3> John W., aged 5 months, the first child of healthy parents, was suddenly seized with apparent acute abdominal distress on Dec. 31, 1929. He had had no history of previous illnesses or of injuries. The temperature was 100.2 F. Physical examination failed to reveal the disorder. The infant was restless all night, and on January 1 the temperature was 101 F. There had been no stool for the previous twenty-four hours, and clear water only was returned from enemas. No mass could be felt in the abdomen. Urinalysis gave