Acute Onset Of Abdominal Pain Research Articles

Congenital Malrotation of the Midgut Presenting as Acute Duodenal Obstruction in a Teenager — A Case Report

Background: Intestinal malrotation, a congenital anomaly, typically presents in neonates with midgut volvulus. However, recent studies suggest it may occur in adolescents and adults at a higher rate than previously thought. This case report investigates the presentation and management of malrotation with volvulus in an adolescent. Case Presentation: A 14-year-old boy presented with acute onset abdominal pain, vomiting, and a history of intermittent abdominal pain for several years. Initial diagnosis was gastritis, but imaging revealed malrotation with volvulus. He underwent a successful Ladd's procedure. Conclusion: This case emphasizes that malrotation can present with chronic or acute symptoms in adolescents. A high index of suspicion for malrotation is crucial, particularly in adolescents with recurrent abdominal pain. Early diagnosis and Ladd's procedure can prevent life-threatening complications.

Spontaneous Bladder Wall Rupture Due to Emphysematous Cystitis in a Diabetic Patient: A Case Report

Spontaneous rupture of the urinary bladder (SRUB) secondary to emphysematous. Cystitis (EC) in diabetic patients is extremely rare. Emphysematous cystitis is a relatively rare disease entity characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging. Its disease mechanism is not well understood. Case report: A 61-year-old diabetic woman presented to the emergency department with diffuse abdominal pain and hematuria of tree hours duration. Physical examination revealed generalized abdominal tenderness. Multi-slice abdominal and pelvic CT scans showed parietal pneumatosis of bladder and communicating continuity solutions with a pre-vesical collection (extravasation of PDC into the collection). After proper resuscitation, the patient was transferred to the operating room for exploratory laparotomy. A thickness bladder rupture was noted, which was repaired. Conclusions: SRUB in patients with poorly controlled diabetes and EC is highlighted in this case study. Urinary bladder rupture secondary to EC should be considered when a diabetic patient with a history of urinary symptoms presents with an acute onset of abdominal pain. Uneventful recovery from SRUB is dependent on early diagnosis and treatment.

Clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients

PurposeThis study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our objective was to better define the clinical presentation of adnexal torsion and to distinguish characteristics of those with torsion and those with an alternate diagnosis.MethodsRetrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019.Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 26.0.ResultsThe median age of the patients was 14.5 ± 3.6 years at the operation. 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. A total of 82.1% (174/212) of the participants underwent adnexal conservative surgery. 179 (84.5%, 179/212) patients underwent laparoscopic surgery with an average tumor size of 7.7 ± 3.4 cm, while 33 patients ( 15.6%, 33/212) underwent laparotomy. Rupture of mass and ectopic pregnancy accounted for 7.5% (16/212) and 0.9%(2/212), respectively. Torsion was responsible for 36.8% (78/212) of all patients. Among the patients with torsion, the symptom of nausea and vomiting was more common among girls without torsion (P < 0.0001). 88.5% of the girls with torsion had acute onset of abdominal pain, while 92.3% had persistent pain that could not be relieved or occurred repeatedly, which significantly higher than that in the patients without torsion (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). 88.5% of girls with torsion had an ovarian cyst/mass ≥ 5 cm, compared with 75.0% in girls without torsion (P = 0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm (OR 4.134, 95% CI: 1.349–12.669,P = 0.013), acute onset pain (OR 24.150,95%CI: 8.398–69.444,P = 0.000), persistent or recurrent pain (OR 15.911,95%CI: 6.164–41.075,P = 0.000) were significantly associated with increased risk of torsion.ConclusionsTorsion which is a relatively rare event in the pediatric population was not an uncommon condition and responsible for more than one third of all pediatric and adolescent patients presented with adnexal masses and abdominal pain. Pain assessment in children and adolescents is important to distinguish characteristics of those with torsion and those with an alternate diagnosis.Thus, pediatric and adolescent patients particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain have a benign cause and not missing the devastating condition that needs emergent attention. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL) may improve ovarian salvage.

Adolescent Female with Acute-onset Abdominal Pain

Background: Sigmoid volvulus is a more common cause of abdominal pain in geriatric patients. It is an uncommon cause for a pediatric patient, especially when dealing with an adolescent patient. Here we discuss an uncommon presentation of sigmoid volvulus.&#x0D; Case Description: A 14-year-old female presents with sudden-onset abdominal pain found to have sigmoid volvulus on CT imaging. She eventually underwent sigmoidoscopy for reduction and was monitored for 24 hours post-procedure.&#x0D; Conclusion: This case demonstrates the importance of having a high index of suspicion when a patient presents with volvulus, especially with adolescence. Although rare, it should always be on the differential due to its high rate of mortality if diagnosed late.

A Rare Case of Bilobed Gallbladder with Two Cystic Ducts

Bilobed or duplicate gallbladders are the rare anomalies of the biliary system occurring between the 5th and 6th weeks of embryonic life, of which Type 2 ductular variant is the commonest. Patients may be asymptomatic or symptomatic, with majority of the cases being detected intraoperatively or during re-operation. Once suspected a detailed preoperative evaluation is a must to avoid both intraoperative and postoperative complications. We report a case of a 34-year-old female who presented with acute onset of abdominal pain and was detected with symptomatic bilobed gallbladder (H Type) with cholelithiasis, with a resolution of symptoms after a successful laparoscopic cholecystectomy. The case emphasizes the importance of detailed preoperative evaluation in the form of ultrasound and magnetic resonance cholangiopancreatography to be considered during the management of biliary pathologies to avoid any intra- and post-operative complications.

Clinical features of patients with previous spontaneous rupture of ovarian endometrioma operated electively: a case-control study

BackgroundThe aim of the study is to investigate the proportion and clinical features of previous spontaneously ruptured ovarian endometrioma among women who underwent elective surgery for endometrioma.MethodsThis retrospective study was based on a cohort of elective surgeries for endometrioma performed by the same gynecologic team at Peking Union Medical College Hospital from January 2017 to October 2022. Patients diagnosed with previous spontaneously ruptured endometrioma during elective surgery were enrolled in the ruptured group. In the same cohort, patients with unruptured endometrioma treated during the same period were selected as the unruptured group by 1:2 matching according to age. Demographic and clinical information were collected and compared between two groups.ResultsA total of 422 patients in the cohort were diagnosed with endometrioma. There were 38 patients (9.0%) in ruptured group and 76 patients in unruptured group. All enrolled participants were treated by laparoscopic surgery. In ruptured group, 86.8% patients had a history of acute abdominal pain, which was only 13.2% in unruptured group (P < 0.001). Compared to unruptured group, patients diagnosed with ruptured endometrioma had a lower BMI (P = 0.021), larger maximum diameter of endometrioma (P = 0.040), higher proportion of cul-de-sac partial obliteration rather than complete obliteration (P = 0.003).ConclusionsSpontaneous rupture of endometrioma is not rare. The proportion of spontaneous rupture of endometrioma in our study was higher than that reported in the literatures. In women with endometrioma, the onset of acute abdominal pain should be considered a rupture of cyst, especially in patients with big cysts.

Point-of-Care Ultrasound of a Pediatric Gastric Trichobezoar: A Case Report.

This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical examination. Point-of-care ultrasound (POCUS) demonstrated a large gastric mass with ultrasonographic features consistent with a trichobezoar. After POCUS was performed, trichophagia was confirmed on history, and the patient went to the operating room for removal of a large trichobezoar. We conclude POCUS may be helpful for evaluation of epigastric masses and diagnosis of gastric trichobezoars. We review the ultrasound technique, sonographic findings, and literature regarding ultrasound diagnosis of trichobezoars.

SAT136 Severe Lactic Acidosis Due To Metformin Use.

Abstract Disclosure: A. Khan: None. Lactic acidosis is an important cause of metabolic acidosis. Broadly, etiology can be divided into type A (impaired tissue oxygenation), type B (systemic hypoperfusion), and D-lactic acidosis. One such etiology which deserves mentioning is metformin associated lactic acidosis (MALA). The incidence of MALA is more notable in the setting of kidney dysfunction, hepatic failure, and alcohol use. Severe acidosis due to Metformin is an emergency and warrants timely management to avoid further hemodynamic compromise. 73-year-old female with a history of hypertension and type II diabetes mellitus (on metformin) presented to the hospital with acute onset of abdominal pain, nausea, and vomiting. She reported having intermittent vomiting and diarrhea for three days prior to admission, and describes the abdominal pain as 10/10, sharp with radiation to the lower back, and worsening 6 hours prior to arrival. She denies fever, melena, hematochezia, change in appetite. She was brought to the hospital via EMS and was given fentanyl for her pain. Vitals on arrival were stable. On exam, she appeared in distress due to pain, with diffuse tenderness in her abdomen, with normal cardiac and lung exam. Labs showed leukocytosis 15 K/mm3, hemoglobin 11.1 gm/dl, hyperkalemia 5.7 mEq/L, bicarb &amp;lt;5 mEq/L, creatinine 13.4 mg/dl, BUN 107 mg/dl, venous lactate 15.1 mmol/l, lipase 435 U/L, ammonia 229 umol/L, with normal AST, ALT and ALP, and troponin. Urinalysis was negative. Initial ABG showed an unreadable pH, which was then repeated, and pH was noted to be 6.72, pCO2 of 29.4 mm/hg, CTA angiography was negative for dissection, mesenteric or bowel ischemia. Soon she was noted to be hypotensive and went into shock requiring pressors, bicarbonate drip, and broad-spectrum antibiotics. She eventually was intubated for airway protection. Subsequently, she was admitted to the ICU for possibly combined hypovolemic and septic shock with multi-organ dysfunction, severe lactic acidosis, acute kidney failure, and respiratory failure. Nephrology was consulted and dialysis was initiated. It was postulated that the presentation was likely due to metformin associated lactic acidosis (MALA). She required dialysis daily for 4 days and ultimately her kidney function improved. On discharge, she was not dialysis dependent. The case above illustrates the severity of lactic acidosis that can occur due to Metformin use. It is important to bear in mind that such presentation, may not necessarily occur on initiation of Metformin, but rather at any point of use. More importantly, its of utmost importance to consider effective therapeutic options like dialysis once severe academia is noted to allow correction of metformin induced acid-base disorder. Mortality estimates of MALA have been around 25-50%, highlighting the significance of prompt treatment of this condition. Presentation: Saturday, June 17, 2023

Spontaneous hemoperitoneum in a term pregnancy mimicking uterine rupture: A case report

Background: Spontaneous hemoperitoneum during pregnancy is a rare occurrence and an obstetric emergency that presents with acute abdominal pain and shock. &#x0D; Case presentation: A 25-year-old primigravida at 38 weeks of gestation presented to the emergency unit in shock. She had a history of severe generalized abdominal and back pain of sudden onset, dizziness, and syncope with no history of trauma. Ultrasonography revealed free peritoneal fluid with a live intrauterine fetus. Blood transfusion, emergency laparotomy, and cesarean delivery were performed. A live female infant was delivered and admitted to the newborn unit. Postoperatively, the patient was started on antibiotics and analgesics and was stable at discharge.&#x0D; Conclusion: Spontaneous hemoperitoneum in pregnancy is a rare cause of maternal collapse, which may mimic uterine rupture and abruptio placentae. A high index of suspicion is required in women with acute onset of abdominal pain and abnormal maternal hemodynamics during pregnancy.

Small bowel intussusception after Roux-en-Y gastric bypass: A case report

Introduction: Small bowel intussusception after Rouxen-Y gastric bypass is a rare condition, with a reported incidence of 0.07–0.6%, and a multifactorial etiology. The severity of the condition ranges from small bowel edema to ischemia and perforation with peritonitis, and the clinical presentation and blood tests are non-specific. The computed tomography (CT) scan is the best diagnostic tool in an emergency department context. Case Report: The authors present the case of a 41-year-old male patient, with history of Roux-en-Y gastric bypass two years before, who presented in the emergency department with acute onset abdominal pain and nausea. Abdominal exploration showed a tender mass in the left upper quadrant. Blood tests showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) and abdominal CT scan was compatible with a small bowel intussusception, without other findings. A diagnostic laparoscopy confirmed the diagnosis, and the intussusception was resolved without need of bowel resection. The patient showed no complications in the immediate post-operative period, with clinical and analytical improvement, and was discharged on the sixth post-operative day, without relevant complaints in the follow-up appointments. Conclusion: Due to the non-specific clinical presentation of small bowel intussusception, it is required a high level of suspicion in patients who underwent gastric bypass and present with abdominal pain. In terms of surgical approach, resolution of the intussusception may be enough in many cases, when there is no vascular compromise of the bowel, while the evidence of ischemia requires bowel resection.

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Rare Rupture of Small 4.3cm Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm (AAA) is a common medical condition with the feared, and often fatal, complication of rupture. The risk of rupture has been well documented to correlate with aneurysm size. It is exceedingly rare for an AAA less than 5cm to rupture. This case report demonstrates an asymptomatic 4.3cm AAA that ruptured while admitted to the hospital with COVID-19 pneumonia. The patient was successfully managed with an endovascular aortoiliac stent graft. Although rare, in patients with small AAA, rupture must remain in the differential diagnosis in the setting of acute onset abdominal or back pain. Furthermore, when quickly recognized, these patients can be safely managed with an endovascular approach.

A Case Study: Henoch-Schonlein Purpura in a Geriatric Patient with Gastrointestinal Involvement

IgA-mediated immune vasculitis known as Henoch-Schonlein purpura affects the small blood vessels in the joints, kidneys, GI tract, skin, and, less frequently, the brain and lungs. The present case report describes a 62-year-old female patient with Henoch-Schonlein purpura (HSP). HSP is a type of vasculitis that affects small vessels and is characterized by purpura, arthritis, abdominal pain, and kidney involvement. In this case, the patient presented with a rash with red lesions on the upper and lower limbs, crusted lesions on both lower limbs, and acute onset abdominal pain with hematochezia. Endoscopy revealed diffuse ulcerations in the stomach, duodenum, and right colon(fig.1). Biopsies revealed a leukocytoclastic vasculitis in the skin (fig2) and gastrointestinal tract. The patient had a history of hypertension and smoking, and laboratory investigations revealed leucocytosis, anaemia, and electrolyte imbalances. The diagnosis of HSP was made based on the clinical presentation, laboratory findings, and biopsy results. The patient was treated with a combination of steroids, antibiotics, and supportive care, which led to significant improvement of symptoms and laboratory findings. Steroid therapy was given according to guidelines for the treatment of HSP, and tapering the steroid therapy helped to improve gastrointestinal symptoms. The case report highlights the importance of careful monitoring and appropriate treatment of HSP in geriatric patients, as well as the potential benefits of immunosuppressant therapy.

A rare cause of hemoperitoneum – Gynecological emergency

Uterine fibroids are common benign smooth muscle tumors, at times may present with acute life-threatening complications. Spontaneous hemorrhage from a uterine fibroid is extremely rare but do occur. Herein, we report a case of a 36-year-old woman with acute onset of abdominal pain and diagnosed with hemoperitoneum for which emergency laparotomy was performed.

Perforated Caecum in a Left-sided Amyand's Hernia: A Case Report.

appendix; case reports; hernia.

Gallbladder torsion in a child diagnosed by ultrasonography and treated by laparoscopic cholecystectomy

ABSTRACT Gallbladder torsion is a very rare cause of acute abdominal pain. It usually occurs in elderly women, when the gallbladder twists around its mesentery. Contributory factors for this to occur are postulated to be an associated anatomical abnormality of the vascular pedicle to the gallbladder or the presence of an abnormally long mesentery from the gallbladder to the liver bed allowing it to float freely. Clinical symptoms are nonspecific, usually similar to biliary colic with acute onset of abdominal pain, nausea and vomiting. The absence of gallbladder stone with signs of acute cholecystitis on imaging findings can suggest a torsion of the gallbladder. This disease is a life - threatening emergency that requires urgent cholecystectomy. However, cases of gallbladder torsion in children undergoing laparoscopic cholecystectomy are rarely reported nationally or internationally due to the uncommonness of the disease. We report a 3 - year - old child admitted to the hospital with symptoms of acute abdominal pain and vomiting. Ultrasonography demonstrate a distended gallbladder, with a multilayered wall, which contained no stones. Laparotomy was performed and the gallbladder was found to be twisted around its pedicle. Cholecystectomy was performed. After surgery, the child was stable and was discharged from the hospital after 5 days of treatment.

Small bowel gastrointestinal stromal tumor presenting as a life-threatening emergency

Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Here in, we present a case of primary small bowel GIST treated at our department. A 58-year-old male patient presented to our emergency department with a diffuse abdominal pain of acute onset. Patient presented with symptoms and signs of acute intestinal obstruction. Imaging studies revealed a mass at mid ileum, with multiple air fluid levels. Intra-operatively, a mass of 12×9 cm was found at mid ileum on antimesenteric border with 3600 volvulus of adjacent ileum. En bloc resection was performed. Histopathology report was suggestive of gastrointestinal stromal tumor.

Secondary Budd-Chiari syndrome occurred after adjuvant radiotherapy for perihilar cholangiocarcinoma: a case report

BackgroundBudd–Chiari syndrome (BCS) is a rare vascular disorder of the liver, and acute and secondary BCS is even rarer.Case presentationA 62-year-old man with perihilar cholangiocarcinoma of Bismuth type IIIa underwent right hemi-hepatectomy with caudate lobectomy and pancreatoduodenectomy. Adjuvant chemoradiotherapy was performed due to a positive hepatic ductal margin. Subsequently, the disease passed without recurrence. The patient visited for acute onset abdominal pain at the 32nd postoperative month. Multidetector-row computed tomography (MDCT) showed stenosis of the left hepatic vein (LHV) root, which was the irradiated field, and thrombotic occlusion of the LHV. The patient was diagnosed with acute BCS caused by adjuvant radiotherapy. Although anticoagulation therapy was performed, the patient complained of sudden upper abdominal pain again. MDCT showed an enlarged LHV thrombus and hepatomegaly. The patient was diagnosed with exacerbated acute BCS, and stenting for the stenotic LHV root was performed with a bare stent. Although stenting for the LHV root was very effective, restenosis occurred twice due to thrombus in the existing stent, so re-stenting was performed twice. The subsequent clinical course was acceptable without recurrence or restenosis of the LHV root as of 6 months after the last stenting using a stent graft.ConclusionAlthough no case of BCS caused by radiotherapy has yet been reported, the present case showed that late side effect of radiotherapy can cause hepatic vein stenosis and secondary BCS.

Circulating monocytes in acute pancreatitis.

Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal pain. It is frequently associated with organ failure, pancreatic necrosis, and death. Mounting evidence describes monocytes - phagocytic, antigen presenting, and regulatory cells of the innate immune system - as key contributors and regulators of the inflammatory response and subsequent organ failure in acute pancreatitis. This review highlights the recent advances of dynamic change of numbers, phenotypes, and functions of circulating monocytes as well as their underling regulatory mechanisms with a special focus on the role of lipid modulation during acute pancreatitis.

ODP135 A New Life-Saving Treatment not yet Included in Guidelines for Recurrent Severe Hypertriglyceridemia-Induced Pancreatitis

Abstract Severe hypertriglyceridemia is a rare cause of acute pancreatitis especially in non-alcoholic, non- gallstones, non-obese, non-diabetic patients and has a few options for its management. Hypertriglyceridemia-induced pancreatitis causes 1 to 14 percent of all cases of acute pancreatitis. The risk of developing acute pancreatitis is approximately 5 percent with serum triglycerides &amp;gt;1000 mg/dL and 10 to 20 percent with triglycerides &amp;gt;2000 mg/dL. This is the case of a 63-year-old female who came to the Emergency Department with acute onset of abdominal pain, located at the mid-epigastric region, radiating to back, 10/10 in a scale of severity, no alleviating or aggravating factor, accompanied by nausea, 5 episodes of bilious emesis. Past medical history includes recurrent acute pancreatitis induced by hypertriglyceridemia (3 episodes last year), arterial hypertension, and dyslipidemia treated with Fenofibrate and Atorvastatin. Denies toxic habits. Physical examination showed abdominal tenderness with positive bowel sounds. Laboratories report cholesterol: 44mg/dl, triglycerides: 5,831mg/dl, LDL: -735 mg/dl, and HDL: 13 mg/dl. The patient condition warranted admission to the intensive care unit with the diagnosis of severe hypertriglyceridemia induced pancreatitis. Initially managed with insulin drip, bowel rest, and conservative management, which did not result in any improvement in her symptoms. A successful method of treatment relies on plasmapheresis for the lowering of triglyceride levels. This was first reported in 1978 by Betteridge and can result in a rapid decrease in triglyceride levels over a short period of time compared to the other treatment options. In this case, vascular surgery was consulted for apheresis catheter placement, with triglyceride improvement from 5,831mg/dl to 973 mg/dl after initial and single apheresis intervention, as the patient's symptoms resolved. Triglyceride levels decreased to 113 mg/dl after a week of therapy with plasmapheresis. The patient continues evaluation at the outpatient clinic and currently has been without recurrence of pancreatitis for the last year. Finally, the use of insulin infusion in conjunction with plasmapheresis has been demonstrated to be a viable option for rapid improvement in symptoms associated with acute pancreatitis associated with elevated triglycerides. Plasmapheresis rapidly removes triglycerides from the circulation removing the inciting factor, decreasing inflammation, and damage to the pancreas. The patient's triglyceride level decreased to 973 mg/dl the next day from 5,831mg/dl initially and the patient's symptoms resolved. Plasmapheresis is not an established guideline for the management of hypertriglyceridemia -induced pancreatitis. Plasmapheresis lowers the lipid levels drastically within hours compared to conservative therapy that usually takes several days to achieve the same reduction in triglycerides levels. Presentation: No date and time listed