Acute Abdominal Syndrome Research Articles

Acute Abdominal Pain in Children: Causes and Development Factors

Currently differential diagnosis of acute abdominal pain syndrome in children at prehospital care units is vital and urgent problem which requires solution. Unfortunately, embarrassing mistakes are still followed by late or inadequate treatment and complications as a result. The problem solution requires both medical stuff alert and diagnosis algorithm revision and improvement. Improvement of technical equipment and availability of instrumental diagnostic methods at the out-hospital settings is a pressing need. The article provides a classification, detailed pathogenesis, and clinical presentation of acute abdominal pain in children under different nosologies (therapeutic and surgical). We considered the problem of adequate differential diagnosis of acute abdominal pain in children when the diagnostics is performed by primary care physicians and specialists of emergency medical services at the prehospital stage.

Gastrointestinal emergencies in critically ill cancer patients

PurposeTo describe gastrointestinal emergencies in cancer patients. MethodsAll cancer patients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997–2011) were included. ResultsA total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51). ConclusionsGastrointestinal emergencies in cancer patients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.

Postrenal acute kidney injury and abdominal compartment syndrome associated with bladder pressure: type III rectus sheath hematoma.

Postrenal acute kidney injury and abdominal compartment syndrome associated with bladder pressure: type III rectus sheath hematoma.

Acute abdominal compartment syndrome: current diagnostic and therapeutic options.

If untreated, the abdominal compartment syndrome (ACS) has a mortality of nearly 100 %. Thus, its early recognition is of major importance for daily rounds on surgical intensive care units. Intraabdominal hypertension (IAH) is a poorly recognized entity, which occurs if intraabdominal pressure arises >12 mmHg. Measurement of the intravesical pressure is the gold standard to diagnose IAH, which can be detected in about one fourth of surgical intensive care patients. The aim of this manuscript is to outline the current diagnostic and therapeutic options for IAH and ACS. While diagnosis of IAH and ACS strongly depends on clinical experience, new diagnostic markers could play an important role in the future. Therapy of IAH/ACS consists of five treatment "columns": intraluminal evacuation, intraabdominal evacuation, improvement of abdominal wall compliance, fluid management, and improved organ perfusion. If conservative therapy fails, emergency laparotomy is the most effective therapeutic approach to achieve abdominal decompression. Thereafter, patients with an open abdomen require intensive care and are permanently threatened by the quadrangle of fluid loss, muscle proteolysis, heat loss, and an impaired immune function. As a consequence, complication rate dramatically increases after 8 days of open abdomen therapy. Despite many efforts, the mortality of patients with ACS remains unacceptably high. Permanent clinical education and surgical trials will be necessary to improve the outcome of our critically ill surgical patients.

The Feasibility of the Damage Control Surgery for Life Threatening Conditions

Background: Damage control surgery is a lifesaving technique used to control bleeding or contamination and to close temporary operative wounds in life threatening conditions. After the correction of physiologic abnormalities, patients will receive definitive management. The aim of this study is to evaluate the feasibility of the DCS for life threatening conditions. Methods: This study was conducted on 13 patients who underwent DCS between March 2003 and May 2007. 10 patients were traumatic injury patients, and 3 were mesenteric infarction patients. We retrospectively evaluated the feasibility of DCS, and analyzed the risk factors after DCS. Results: Overall mortality rates were 38.5% (five deaths among thirteen patients). The mortality rates of the patients with lethal triad; acidosis, hypothermia and coagulopathy are 83.3% (five deaths among six patients), 60.0% (three deaths among five patients), 50.0% (five deaths among ten patients), respectively. None survival patients were more frequent acute respiratory distress syndrome (60.0%), multi-organ dysfunction (100.0%) and abdominal compartment syndrome (60.0%). Conclusions: DCS for the patients with life threatening conditions showed feasible results in our study. The mortality of patients with acidosis, coagulopathy and hypothermia were higher than the patients without.

LA RUPTURE UTERINE SPONTANEE SUR UTERUS NON CICATRICIEL EN COURS DE GROSSESSE : A PROPOS DE DEUX OBSERVATIONS ET REVUE DE LA LITTERATURE

The occurrence of spontaneous uterine rupture on unscarred gravid uterus is an exceptional event during pregnancy. We report the clinical findings of two patients who experienced spontaneous uterine rupture during pregnancy. The rupture was found in both cases by acute abdominal pain syndrome associated with an array of intraperitoneal hemorrhage. No maternal death was lamented. The fetal outcome was dramatic in both cases. Support is an effective resuscitation followed by surgical hemostasis. Based on our observations and various published articles, we recall aspects etiopathogenic, clinical and therapeutic of spontaneous uterine rupture on unscarred gravid uterus during pregnancy. Keywords: hemoperitoneum - pregnancy – uterine rupture – unscarred uterus

Catastrophic hemorrhage of adrenal pheochromocytoma following thrombolysis for acute myocardial infarction: case report and literature review

We describe here the case of a 62-year-old man with acute abdominal syndrome and severe hemorrhagic shock following successful thrombolysis for acute cardiac infarction. Emergency surgical exploration revealed extensive intraperitoneal and retroperitoneal hemorrhage resulting from the rupture of a large adrenal tumor. The diagnosis of pheochromocytoma was confirmed by histological findings. The patient died a few hours after surgery from multiorgan failure despite resuscitation attempts. This report discusses the diagnosis difficulties, treatment approach, and relevant literature.

Acute intestinal obstruction

A 12-year-old boy is admitted for emergency surgery for acute abdominal syndrome. The intervention showed strangulation of the terminal ileum by the vermiform appendix. The pathology analysis showed bilharzial appendicitis by Schistosoma haematobium. The patient was treated with praziquantel. The literature is not plentiful on this subject. Because protozoiasis is endemic in this area, it should be looked for in all cases of appendicitis, as it requires medical treatment in addition to the appendectomy.

Conservative management of eosinophilic enteritis presenting with acute abdominal syndrome

Eosinophilic enteritis, an increasing recognized condition, is rare and often presents with non-specific symptoms. We report a case of a 46-year old female who presented with acute onset abdominal pain and nausea associated with ascites, small bowel thickening and peripheral eosinophilia. Diagnosis was confirmed by biopsies taken at esophagogastroduodenoscopy demonstrating diffuse infiltration by inflammatory cells, mainly eosinophils. Appropriate therapy was instituted. The patient recovered well and was symptom-free at 1-month follow up. In this report, we discuss the clinical presentation and the diagnostic criteria of the eosinophilic enteritis, and examine the pathophysiological theories and therapeutic strategies. The relevant literature on eosinophilic enteritis is summarized.

The importance of timing of decompression in severe acute pancreatitis combined with abdominal compartment syndrome

Surgical decompression is widely considered as an important treatment in patients with severe acute pancreatitis (SAP) and abdominal compartment syndrome (ACS). Until now, the indication and optimal time of decompression remain unknown, and no experimental data exist, although extremely high mortality has been repeatedly reported in these patients. The aim of this study was to evaluate the effects of three different time points for decompression in a 24-hour lasting porcine model. Following baseline registrations, 32 animals were divided into four groups (8 animals each group) as follows: one SAP-alone group and three SAP + ACS groups, which received decompression at 6, 9, and 12 hours. We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mm Hg and retrograde intra-ductal infusion of sodium taurocholate to induce SAP. Global hemodynamic profiles, urine output, systemic oxygenation, and serum biochemical parameters of the animals were studied. At the end of the experiment, histologic examination of the intestine and lung was performed. The survival time of the 12-hour group was significantly shortened (p = 0.037 vs. 9 hours and p = 0.008 vs. 6 hours). In SAP + ACS animals, decompression at 6 hours restored systemic hemodynamics, oxygen-derived parameters, organ function, and inflammatory intensity to a level comparable with that of the SAP-alone group. In contrast, animals in the 9 hours and 12 hours developed more severe hemodynamic and organ dysfunction. The histopathologic analyses also revealed higher grade injury of the intestine and lung in animals receiving delayed decompression. Well-timed decompression in a porcine model of SAP incorporating 25-mm Hg intra-abdominal hypertension/ACS was associated with significantly reduced mortality, improved systemic hemodynamics and organ function, as well as alleviated histologic injury and inflammatory intensity. According to our results and previous reports, both too early and too late decompression should be avoided owing to significant morbidity for the former and unfavorable outcomes for the latter.

Neonatal gastric perforation with tension pneumo-peritoneum

A case of neonatal gastric perforation presenting as acute abdominal compartment syndrome manifesting as refractory metabolic acidosis and difficulty in ventilation during transfer is described. Plain abdominal X-ray and decubitus view were helpful in defining a perforation of a hollow viscous. On arrival, she needed immediate needle decompression followed by an exploratory laparotomy and repair of the gastric perforation and a temporary tube gastrostomy. The baby did well postoperatively and was discharged home in 6 days. Neonatal gastric perforation is a serious and potentially life threatening condition. Long distance to tertiary center and a prolonged transfer time mandates that the tension pneumo-peritoneum is relieved by needle compression by the transfer team at the base hospital.

Changes in serum dehydroepiandrosterone, androstenedione, testosterone, and 17β-oestradiol levels associated with disease and surgery in the horse

The aim of this work was to measure serum concentrations of dehydroepiandrosterone, androstenedione, testosterone and 17β-oestradiol in horses with various diseases and after surgery. We hypothesize that diseases and castration could potentially affect concentrations of steroid reproductive hormones. Blood samples were obtained from six groups of horses comprising a total of 119 horses (75 males and 44 females, 5–15 years old) with laminitis, acute abdominal syndrome, acute diseases, chronic diseases, after castration and healthy control. Hormone concentrations in serum were determined for each group using competitive enzyme immunoassay. Significant increases compared to control were found for dehydroepiandrosterone in horses with castration (P< 0.01), acute abdominal syndrome and acute diseases (P< 0.05). Besides, significant increases were observed for androstenedione in horses with laminitis, castration and acute diseases (P< 0.01), and in acute abdominal syndrome and chronic diseases (P< 0.05). Significant increases were also found for testosterone in horses with castration (P< 0.01) and with laminitis, acute abdominal syndrome and chronic diseases (P< 0.05). The lowest values of testosterone were found in the control group. Compared to control, 17b-oestradiol serum concentrations showed significant decreases (P< 0.01) in horses with laminitis, acute abdominal syndrome, acute and chronic diseases. Significant differences (P< 0.05) for the four studied hormones were found between males and females in each group. Our results showed that there were significant differences in steroid reproductive hormone concentrations in diseased horses and in those after surgery, compared to controls.

Evaluation of signalment, clinical, and laboratory variables as prognostic indicators in dogs with acute abdominal syndrome

The aim of the study was to identify predictors of mortality and to propose a new severity scoring system in dogs with acute abdominal syndrome. A retrospective study was carried out on 58 dogs presented with acute abdominal syndrome with American Society of Anesthesiologists grades III-IV and treated surgically by exploratory laparotomy. Medical records were reviewed and information regarding dog signalment, history, clinical, and laboratory data; surgical findings; and outcome was collected. Multiple easily measurable variables were found to be mortality predictors in dogs with acute abdominal syndrome, but the most relevant were the presence of neoplastic process, organ rupture, abdominal distention, and solid organ involvement. Based on the acute abdomen scoring system, animals that received 14 points had a 50% chance of survival, with a sensitivity of 90.48%, specificity of 97.3%, and positive and negative predictive values of 95% and 94.7%, respectively, at this cut-point. According to the receiver operator curve (ROC) analysis, this scoring system classified 94.83% of the cases correctly with the area under the ROC curve (AUC) = 0.965 (P = 0.0001). The presented severity scoring system could reliably assess the severity and probability of death in dogs with acute abdomen and could be used in small animal clinical practice.

The Large Gastric Trichobezoar Associated with Ulcers and Antral Polyposis: Case Report

Trichobezoar of gastrointestinal tract is an uncommon clinical condition and can present diagnostic and therapeutic challenge in practice. Clinical manifestations vary from no symptoms to serious complications. Delay in diagnosis may lead to an acute abdominal syndrome with lethal consequences, because of perforation, bleeding and obstruction of gastrointestinal tract. The most useful diagnostic procedure is gastroscopy. Large trichobezoars are difficult to remove endoscopically, so majority of cases require surgery. We report a unique case of large gastric trichobezoar in young female with nonspecific symptomatology but with palpable huge epigastric mass and rare complications: multiply gastric ulcers and antral polyposis. After operative removal of the bezoars ulcers healed completely, but antral polyposis persists.

Gastric dilatation and circulatory collapse due to eating disorder

Anorexia-bulimia is a frequent psychiatric affection in adolescent female populations [1]. Such eating disorders may have a higher morbi-mortality than usually described in literature. Among frequently encountered complications of this disease, major gastric dilatation can dramatically evolve to death. We present the case of a young woman which presented a rare cause of acute abdominal compartment syndrome.

Atypical appearance of pneumatosis intestinalis at multidetector CT

Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. Abdominal CT scan showed a double gas collection within the wall of a jejunal segment, with a characteristic target air distribution. The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.

Acute abdominal compartment syndrome complicating a colonoscopic perforation: a case report

IntroductionA perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems.Case presentationWe report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later.ConclusionAcute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.

Volvulus du foie d’évolution fatale 16 mois après la cure d’une omphalocèle géante

We report the case of an infant who underwent surgery on the first day of life for a giant omphalocele. At the age of 16 months, he presented an acute abdominal syndrome and died a few hours later. Autopsy revealed a twisted left liver lobe (LL) including a suprahepatic vein. To our knowledge, this is the first case of giant omphalocele complicated by twisted liver lobe and fatal outcome.

Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.

Cortisol, adrenocorticotropic hormone, serotonin, adrenaline and noradrenaline serum concentrations in relation to disease and stress in the horse

No detailed comparative data are available on the hormonal parameters of horses suffering from a number of diseases. The aim of our study was to measure concentrations of cortisol, adrenocorticotropic hormone (ACTH), serotonin, adrenaline and noradrenaline in horses with various diseases and following surgery, to assess the response of the HPA axis and adrenal medulla.Blood samples were obtained from six groups of horses comprising a total of 119 animals as follows: laminitis, acute abdominal syndrome (AAS), castration surgery, acute diseases, chronic diseases and healthy controls. Serum hormonal concentrations were determined for each group for comparison.Statistically significant differences between all groups and controls were found for cortisol, ACTH (except for castration), serotonin and adrenaline concentrations but only in horses with laminitis and AAS for noradrenaline. No statistically significant differences were found between males and females. The largest changes in the pituitary–adrenal axis activity occurred mainly in acute diseases, laminitis and in the AAS group.