Acute Abdominal Syndromes Research Articles

Rupture of the left rectus abdominis muscle due to COVID-19 related cough

Throughout the coronavirus disease 2019 pandemic, patients using oral anticoagulants for mechanical valve replacement and/or another clinical-pathological condition might have faced various clinical scenarios. Rectus sheath hematoma is one of the acute abdominal pain syndromes. This study presented a patient with developed anticoagulation-induced rectus sheath hematoma after mitral valve replacement.

Perforated colorectal cancers: clinical outcomes of 18 patients who underwent emergency surgery.

IntroductionAlthough colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment.AimIn this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated.Material and methodsThe data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery.ResultsEight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31–104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% (n = 14), and the operative mortality rate was 44% (n = 8). Additional organ injuries occurred during resection in 2 patients.ConclusionsColorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.

Isolated omental panniculitis: two case reports and review of literature

Isolated omental panniculitis (IOP), a rare form of acute abdominal syndrome, is defined as intraabdominal panniculitis that involves only omentum without extraabdominal fat necrosis, inflammatory bowel disease and pancreatitis. In the search made using PubMed English database, only 4 cases are determined with IOP. IOP is conceptually confused with idiopathic omental infarction (IOI). However, omental infarctions that are rare causes of acute abdominal syndromes were published by Bush for the first time in 1986 and less than 400 cases were reported. In this article we aimed to publish 2 IOP patients who applied with acute abdominal manifestation and were treated with laparoscopic omental resection to discuss the other 4 IOP cases comparing with IOP together with literature.

Somatosensory Hypersensitivity in the Referred Pain Area in Patients With Chronic Biliary Pain and a Sphincter of Oddi Dysfunction: New Aspects of an Almost Forgotten Pathogenetic Mechanism

Somatosensory hyperalgesia in the referred pain area (RPA) in patients with acute or chronic abdominal pain syndromes may result from the convergence of nerve fibers from visceral and somatic tissues at the spinal and supraspinal levels. Chronic biliary pain in patients with the postcholecystectomy syndrome (i.e., biliary hypersensitivity) may be explained by persistent hyperexcitability of neurons in the central nervous system (CNS). The aim of this study was to evaluate the cutaneous neural sensory perception in the RPA in patients with chronic postcholecystectomy biliary pain and a sphincter of Oddi (SO) dysfunction (SOD). Forty-two patients with persistent biliary pain and suspected SOD, 27 age-matched healthy volunteers, and 18 age-matched asymptomatic cholecystectomized controls were prospectively investigated by quantitative sensory testing (Neurometer CPT). The biliary symptoms and the severity of pain were classified on a visual analog pain severity scale system via a previously validated and standardized questionnaire. The patients helped the doctors locate the RPA in the right upper quadrant. The sensory detection threshold was determined noninvasively (Neurometer CPT) with transcutaneous electrical stimulation at 5, 250, and 2,000 Hz, and different current intensities (range from 0.01 to 9.99 mA) applied in a single (patient) blinded method. These three frequencies selectively excite small unmyelinated (C fibers), small myelinated (A-delta), and large myelinated (A-beta) fibers, which transmit dull pain, sharp pain, and touch, respectively. The contralateral region of the abdomen left upper quadrant served as the control area. The sensory current perception threshold ratio (SCPTR) of the data measured in the contralateral area and the RPA was calculated. The SCPTRs in the definite SOD patients with biliary pain, healthy volunteers, the asymptomatic cholecystectomized controls, and the symptomatic cholecystectomized patients but without SOD were 2.32 +/- 1.4 versus 1.06 +/- 0.24 versus 0.97 +/- 0.16 versus 0.83 +/- 0.35 at 2,000 Hz; 2.19 +/- 1.0 versus 1.01 +/- 0.26 versus 1.02 +/- 0.25 versus 0.88 +/- 0.35 at 250 Hz; and 2.19 +/- 1.1 versus 1.12 +/- 0.26 versus 0.99 +/- 0.37 versus 0.84 +/- 0.32 at 5 Hz, respectively. Significant hypersensitivity was detected in the RPA at different stimulation frequencies in the SOD patients with biliary pain versus the cholecystectomized controls: at 5 Hz: P = 0.00001; at 250 Hz: P = 0.00001; and at 2,000 Hz: P = 0.0001, respectively. Continuous visceral pain (biliary pain) caused by local inflammatory/sensitizing processes or a CNS malfunction could lead to significant hypersensitivity of the peripheral nociceptive nerve fibers in SOD patients. Postcholecystectomy pain may be explained by persistent hyperexcitability of the nociceptive neurons in the CNS with or without objective motility disorders of the SO.

Gastrointestinal Involvement in Pediatric Polyarteritis Nodosa

Gastrointestinal Involvement in Pediatric Polyarteritis Nodosa

Chylopéritoine compliqué d’occlusion intestinale

Acute chylous ascites is an affection rarely encountered among acute painful abdominal syndromes. An acute chylous ascites was observed in a 76 Year-old man without prior history. Its etiology was an acute pancreatitis. Intestinal occlusion on the 15th day post-surgery required adhesiolysis. Intestinal occlusion is exceptional after chylous acsites despite the potential adherence of the chyle. Regarding the pathogenesis, analysis of the literature and our case report suggest either a bridle, adherences, or a peri-intestinal sheath due to the organisation of the chyle at the origin of the occlusion following chyloperitonitis. Although an etiology of chylous ascites can be an intestinal occlusion, it can, although rarely, also be a more or less late complication.

Gastrointestinal involvement in polyarteritis nodosa (1986–2000):: Presentation and outcomes in 24 patients

PurposeGastrointestinal involvement in polyarteritis nodosa carries a poor prognosis. A 1982 review from our institution reported acute abdominal syndromes in 31% of patients with polyarteritis nodosa, and that all 5 patients with acute surgical abdomens died. We reviewed our more recent experience to determine if outcomes have changed since. Subjects and methodsWe reviewed the records of all patients with polyarteritis nodosa in our vasculitis database between 1986 and 2000. Inclusion criteria were a diagnosis of polyarteritis nodosa, symptoms or signs of gastrointestinal involvement, and either a mesenteric angiogram consistent with polyarteritis nodosa or histopathologic proof of a medium-vessel vasculitis. We calculated a prognostic (5 factor) score for all patients. ResultsWe identified 24 patients with polyarteritis nodosa who had gastrointestinal involvement during their illness. Thirteen (54%) of the patients developed acute surgical abdomens, 3 of whom died (P = 0.02 by comparison with the historical cohort). Mean (± SD) prognostic scores were higher among patients in the acute abdomen group compared with those who did not have acute abdominal syndromes (1.7 ± 0.9 vs. 0.6 ± 0.7, P = 0.002), corresponding with the observed mortality in these groups. ConclusionGastrointestinal involvement occurs commonly in polyarteritis nodosa and carries a poor prognosis. Compared with a historical cohort at our institution, mortality from this complication may have decreased, perhaps because of earlier diagnosis.

Intra-abdominal Metastases from Primary Carcinoma of the Lung

.The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence : he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation.Intra-abdominal métastasés of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.

Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years.

Pathologic changes of the pancreas have been observed as early as the recognition of the disease termed initially "cystic fibrosis of the pancreas". Atrophy of the gland and its fatty infiltration were considered as usual features. The aim of this study was to follow-up the evolution of cystic fibrosis pancreas and to define its successive stages in correlation with the clinical, biochemical, and imaging findings. Fifty-five patients were followed up during 9 years. The patients' genetic backgrounds were systematically performed. Blood lipase levels were analyzed systematically at each consultation of the patients and in the event of bouts of abdominal pains. Imaging using mainly echograms and tomodensitometric scans were regularly performed: echograms every 6 months, and tomodensitometric scans every 1 to 2 years. Magnetic resonance imaging was performed in four patients. Five groups of patients were identified on the basis of tomodensitometric scan findings: normal pancreas (n = 4), incomplete lipomatosis of the pancreas (n = 9), complete lipomatosis of the pancreas (n = 23), cystic pancreas (n = 5), macrocystic pancreas (n = 1), atrophic pancreas (n = 13). Pancreas exocrine function was not correlated with findings. Forty episodes of pancreatitis were observed in seven patients. They had bouts of abdominal pain and elevation of lipase levels. Five of these patients were composite heterozygotes (D508/other). Incomplete lipomatosis represents an intermediate stage leading toward complete lipomatosis or toward atrophy after pancreatitis. Studies of pancreatic function should be performed routinely in cystic fibrosis, especially in pancreatic sufficiency or in patients with normal pancreas images. Acute pancreatitis should be diagnosed and properly identified to be differentiated from other acute abdominal syndromes occurring in cystic fibrosis.

Laparoscopie à visée diagnostique dans les urgences abdominales

In acute abdominal syndromes when a surgical exploration is required by the presence of peritoneal symptoms, laparoscopy allows to recognize the lesions and to perform simultaneously the appropriate treatment in most cases. When the surgical indication is doubtful, mainly in case of acute appendicitis, sonography or scanography may confirm the diagnosis. In case of persisting doubt, diagnostic laparoscopy is justified and laparoscopic appendicectomy seems to be the best method when another pathology is not detected by laparoscopy. In abdominal wounds, laparoscopy is useful to confirm their intraperitoneal penetration, mainly in gunshot wounds, and to recognize a diaphragmatic wound which is often isolated and unknown. Laparoscopy often fails to detect all abdominal injuries. In blunt abdominal traumas, laparoscopy is not recommended at the first step. In conclusion, laparoscopy with diagnostic intent only is rarely indicated in abdominal emergencies and its use is not worth being extended. Diagnostic value of laparoscopy is closely linked to its therapeutic interest. Laparoscopy with both diagnostic and therapeutic intent has to be developed in most abdominal emergencies.

The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes.

Diagnostic laparoscopy plays a significant role in the evaluation of acute and chronic abdominal pain in the era of therapeutic laparoscopic surgery. We referred to our personal series of laparoscopy for both acute and chronic abdominal pain. This is a retrospective review of data accumulated prospectively between 1979 and the present. In our series, 387 consecutive patients underwent laparoscopy because of abdominal pain. In a group of 121 patients with acute abdominal pain, a definitive diagnosis was made in 119 cases (98%). Two patients needed laparotomy to confirm the diagnosis; both had a disease process that did not require laparotomy to treat. A definitive therapeutic laparoscopic procedure was performed in 53 cases 944%). In 45 patients (38%), a diagnosis was made that did not require therapeutic laparoscopy or laparotomy to treat. In the remaining 21 patients (17.5%), exploratory laparotomy was needed to treat the condition. In a chronic abdominal pain group of 265 patients, the etiology was established laparoscopically in 201 cases (76%). A definitive therapeutic laparoscopic procedure was performed in 128 patients (48%). There was a normal laparoscopic examination in 64 patients (24%). There was one false negative laparoscopy that required laparotomy to treat 1 month later. Laparoscopy is an accurate modality for the diagnosis of both acute and chronic abdominal pain syndromes. These data support the use of laparoscopy as the primary invasive intervention in patients with acute and chronic abdominal pain.

Activation of the renin system in acute pancreatitis

Activity of the renin-angiotensin system was assessed in patients with acute pancreatitis. Measurements of active plasma renin and inactive plasma renin were made in normal subjects, patients with acute pancreatitis, and patients with acute abdominal pain syndromes exclusive of pancreatitis. Active plasma renin values were significantly increased in acute pancreatitis, nearly 500 percent higher than in the other two groups. Inactive plasma renin values were similar in the three groups. In a subgroup of patients with acute pancreatitis, measurements were made on presentation and after recovery. The elevated active plasma renin values on admission fell significantly with recovery, in parallel with changes in serum amylase values. Inactive plasma renin values changed variably; there was a significant inverse regression relationship between the changes in active and inactive plasma renin values with recovery. The results indicate that the renin-angiotensin system is activated in acute pancreatitis to a significantly greater extent than in other syndromes with acute abdominal pain. The increased active plasma renin in acute pancreatitis is most likely due to renal release secondary to the reduced circulating volume and hypotensive effect of this disease. However, changes in the relationship between active and inactive plasma renin in some patients suggest that activation of inactive renin by proteolytic enzymes released in acute pancreatitis might play an additional role.

Intussusception of the Vermiform Appendix

SummaryIntussusception of the vermiform appendix (IVA) in a 14‐year‐old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a “spiral shell” filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.

The butterfly sign: an indicator of fluid within both the greater peritoneal cavity and the lesser omental bursa.

Fluid accumulations present in the lesser omental bursa and the greater peritoneal cavity simultaneously outline a pattern resembling a butterfly. This "butterfly sign" can contribute to a more accurate diagnosis in evaluation of acute pancreatic processes and, more generally, acute abdominal syndromes.

Abdominal radiography in the emergency department: A prospective analysis

We present a prospective analysis of 100 consecutive abdominal radiographs of 96 emergency patients who were referred to radiology with a variety of abdominal complaints. In patients with diffuse, nonspecific abdominal pain, nausea, vomiting, or gastrointestinal bleeding, 98% of the radiographs were negative or had positive findings which were unrelated to the current clinical problem. Ninety-three percent of the positive radiographs that were related to the acute problem occurred in patients with renal colic; hematuria; ingestion of foreign bodies; previously known surgical conditions, such as incarcerated hernias; intra-abdominal metastatic carcinoma; fecal impaction; or true acute abdominal syndromes.

Intestinal anisakiasis: First case report from North America

The first case of intestinal anisakiasis In North America is described. This parasitic disease is recognized as a public health hazard in Japan and Europe. Man becomes infected with a larval form of the nematode Anisakis by consuming raw or undercooked fish containing the parasite. Typically, patients present with acute abdominal syndromes. Clinical and roentgenographic features may cause confusion with regional enteritis. Histologically, a striking eosinophilic granulomatous reaction occurs. Anisakiasis is most effectively prevented by discouraging the consumption of raw fish.

Diagnosis of Acute Pancreatitis by Peritoneoscopy

The authors report a case of acute pancreatitis, where diagnosis was made by peritoneoscopy and was confirmed by peritoneoscopic biopsy. They suggest the usefulness of peritoneoscopic investigation in cases of acute abdominal syndromes.

Formas graves da síndrome de Weil

São apresentados 6 casos graves da síndrome de Weil. Especial atenção é dada aos 2 primeiros pacientes, desde que em ambos houve confusão inicialmente com quadros abdominais agudos de caráter cirúrgico ao lado de quadro de choque no início da sintomatologia. Um deles apresentou posteriormente na evolução hemorragia digestiva fulminante e incoercível responsável pela evolução fatal. Nos 4 restantes o quadro clínico foi dominado pela icterícia geralmente severa, insuficiência renal aguda, manifestações neuropsíquicas, necessitando todos êles terapêutica pela diálise peritoneal, ao lado de outros recursos terapêuticos que poderão ser usados nestas formas graves. Atenção também é despertada no sentido de enquadramento sistemático das leptospiroses no diagnóstico diferencial das icterícias, desde que são freqüentes entre nós.

Amebic perforation of the colon.

Conclusions Complications of amebiasis should be taken into consideration in all acute abdominal disorders which occur during or after severe attacks of diarrhea, dysentery or dysenterylike syndromes. In view of the grave consequences, all diagnostic resources should be exhausted before performing a laparotomy. In patients with acute abdominal syndromes, there is less risk in proctosigmoidoscopic examination than in exploratory laparotomy, despite the seriousness of the condition. Besides providing extremely valuable macroscopic data, proctosigmoidoscopy makes it possible to take samples for examination. This may provide a quick diagnosis and thereby avoid the loss of time required for stool tests, which are a most essential factor. Specific treatment with emetine should be begun as soon as the diagnosis is made. In cases of doubt, emetine should be administered as a therapeutic test which serves the same purpose as preparation for possible surgery. Since so few guarantees are provided by surgical treatment, the fewer operative and exploratory procedures employed, the better. Surgical results are improved, as in the case of abscess of the liver, if previous antiamebic treatment has been administered.