Acute Abdomen Pain Research Articles

Adult duodenojejunal intussusception due to heterotopic pancreas - a rare entity

Approximately 95% of intussusception occurs in children, However it is a rare entity in adults accounting for 0.003% to 0.02 % of all the hospital admissions. Various causes of intussusception are well known, However intussusception caused by heterotropic pancreas is extremely rare and the rarity increases manifolds if it is in the duodenum of an adult and the cause being heterotropic pancreas. We report this rare case of intussusception due to pancreatic heterotropia in 43 year old male who presented with acute pain abdomen. DOI: http://dx.doi.org/10.3329/bjms.v13i3.12781 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.340-342

English

Role of conventional Radiology as a diagnostic application is not a lost love.A child presented with acute pain abdomen to our emergency department and was treatedsymptomatically, with on and off relief of the symptoms for next 2 days.Later the child was referred to Radiology department for erect abdomen radiograph. The radiograph showed multiple calcific densities filling the entire colon uniformly. No abnormal air fluid levels were seen. Child was given soap water enema after which loose stools was passed which contained multiple small stones, not blood tinged. Child improved symptomatically over the next 3-4 days and discharged cheerfully. The diagnosis of PICA was made (Medical disorder characterized by an abnormal appetite for substances largely non- nutritive) which was correlated with the history retrospectively.

A Case Report: Twisted Ovarian Cyst in Pregnancy

Ovarian torsion encountered during pregnancy carries significant risk to a pregnant woman and intrauterine foetus. In this case we report a 24 -year-old secondgravida with 14 weeks of pregnancy presenting with torsion of the left ovarian cyst. She presented to the Gynae. emergency with acute pain abdomen. She was diagnosed to have torsion of ovarian cyst with pregnancy and later emergency laparotomy followed by cystecomy was carried out. Her histopathology report showed a benign mucinous cystadenoma. Her pregnancy was followed up. She delivered a healthy female baby at term. Although the safety of antepartum surgical intervention has been accepted, abdominal surgery will always carry some risks to a pregnant woman and unborn foetus and so, before management , risks involved must be taken into consideration.

Bladder perforation during pregnancy due to misplaced surgical clips

Abstract Misplaced or wandering clips in endoscopic surgery have led to a variety of complications and diagnostic challenges. We describe a woman at 37 weeks of gestation, who presented to our hospital with symptoms of acute abdomen pain. Sonographic examination showed voluminous abdomino-pelvic fluid and laparotomy revealed a bladder perforation with endoclips attached to the urinary bladder fundus. The clips had been placed for hemostasis during the laparoscopic removal of an intrapelvic intrauterine device 2years earlier. We emphasize the importance of meticulous dissection, proper tissue handling and the removal of any misplaced/wandering clips during endoscopic surgery.

A case of post renal transplant with episodes of acute abdomen pain

A case of post renal transplant with episodes of acute abdomen pain

Endovaginal Sonoelastography (EVSE) in the Different Diagnosis of Acute Lower Abdomen Pain in Gynecology

Endovaginal Sonoelastography (EVSE) in the Different Diagnosis of Acute Lower Abdomen Pain in Gynecology

Mesenteric vascular remodeling in different mouse strains

Inflammatory Bowel Disease (IBD) is a category of inflammatory conditions of the colon and small intestine associated with oxidative stress (OS). Hyperhomocysteinemia (HHcy) is known as the cause of mesenteric vascular remodeling, inducing hypertension and acute abdomen pain. Patients with IBD often have HHcy compare to healthy people. We followed alterations of homocysteine (Hcy) level and mesenteric artery remodeling comparing four different strains of mice: C5BJ/L6 wild type (WT) as a control; cystathione beta synthase heterozygote knockout (CBS+/−) with increased level of Hcy; C3H, which is known as the most resistant to (OS) and double‐transgenic CBS/C3H mice. We suggested that Hcy level will be decreased in CBS/C3H compared to CBS, there will be amelioration of hemodynamics in mesenteric artery of CBS/C3H in comparison with CBS mice and attenuation of mesenteric vascular remodeling in CBS/C3H versus CBS. We used blood flow and mesenteric artery reactivity measurements, immunohistochemistry, electron microscopy of mitochondria, measurement of Dpr‐1 level (mediates mitochondrial fission during OS), measurement of Hcy level in plasma, Masson trichrome, PCR and Western blot (eNOS/iNOS, DDAH‐2, SAHH, CBS, CSE, 3MST, MTHFR, DNMT). Our preliminary data suggests that mesenteric vascular remodeling and HHcy are attenuated and hemodynamic of mesenteric artery is ameliorated in CBS/C3H versus CBS mice.

Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature

Acute abdomen due to female genital apparatus disease is very rare. Most are due to intralesional effusion of benign tumors. The authors present a 40-year-old woman with acute abdomen pain due to haemorrhagic ovarian metastasis of colorectal cancer, focusing on the role of imaging to get the management of the patient.

Xanthogranulomatous appendicitis: Uncommon histological variant of a common entity

Xanthogranulomatous inflammation (XGI) is a rare form of chronic inflammation characterized histologically by presence of high number of foamy histiocytes admixed with lymphocytes and plasma cells, first reported in the genitourinary tract.1 It can involve any organ, but the most common sites are kidney and gallbladder.2,3 Although acute appendicitis is a very common surgical condition, xanthogranulomatous appendicitis is a rare phenomenon. Only few cases have been reported so far in the literature in which XGI involved the appendix and the patient presented as a case of acute appendicitis. Xanthogranulomatous appendicitis may mimic a locally advanced cancer but has a benign course, and can be cured by surgical resection.4 Due to the rarity of this condition, we report a case of xanthogranulomatous appendicitis in 21-year-old lady, who presented with acute pain abdomen and operated as a case of an acute appendicitis.

Acute Delirium due to Parenteral Tramadol

Tramadol is a widely used medication by physicians and is held to be a safe analgesic. It has been claimed to be helpful in the elderly and hepatic and renally compromised subjects. We would like to report a case of delirium in a middle-aged female with acute pain abdomen on tramadol while being treated in the surgical unit. The patient developed alteration in the level of consciousness and cognitive deficits following injectable dose of tramadol. She was diagnosed as a case of tramadol-induced delirium. The patient improved spontaneously after stoppage of tramadol injection. The probable mechanism for development of tramadol-induced delirium is discussed along with clinical implications.

Acute Axial Torsion of Gravid Uterus by 360 degrees – A rare case report and an unpredictable complication of pregnancy

Introduction: To report a case of acute uterine torsion of gravid uterus by 360 degree at 26 weeks gestation. Method: A 32 yr old multigravida presented with acute pain abdomen at 26 weeks of gestation. On ultrasound revealed a dead foetus with concealed placental abruption. On laparotomy, it was diagnosed to be a case of 360 degree acute axial torsion of uterus. Due to excessive necrosis hysterectomy was done. Result: Laparotomy revealed a 360 degree axial torsion of gravid uterus, with a dead foetus and placental abruption, and gangrenous necrosis of uterus. Hysterectomy was done in view of gangrenous uterus and multiparity of the patient. Conclusion: It is a very unpredictable and rare differential diagnosis of pain abdomen in pregnancy, rarely diagnosed antenatally, and is associated with an adverse foetal outcome. If diagnosed early, it may improve the maternal outcome and spare a hysterectomy.

A rare case of gangrenous appendicitis by eggs of Taenia species

Cysticercosis and Taeniasis continue to be a major public health burden in the developing countries like India. Humans are the only definitive hosts infected by ingestion of eggs of Taenia species. Appendicular Taeniasis is rare with few isolated case reports during the past 30years. Here, we report the case of a 38-year-old female patient from Nepal who presented with acute pain abdomen, was operated and diagnosed as suffering from gangrenous appendicitis caused by eggs of Taenia species.

Ischemic Colitis in an Elderly Patient

Acute abdomen pain refers to a sudden severe abdomen pain that is less than 24 hours in duration and can be caused by ischemic colitis. Ischemic colitis is an ischemic injury to the colon. Most patients affected are elderly with non-specific symptoms and are easily overlooked. We present a case of an elderly female patient with ischemic colitis, who was initially misdiagnosed. An 83-year-old woman had a history of uremia with dialysis, peripheral arterial occlusive disease, atrial fibrillation without medical control, and rectal cancer (post operation of partial proctectomy with right nephrectomy). She visited our emergency room because of acute abdominal pain including bloodied stool passage lasting for one day. Physical examination of the abdomen showed diffuse tenderness. Laboratory tests showed leukocytosis, hyperamylasemia, and poor renal function. Abdominal computed tomography showed mural thickening with peri-focal stranding in the exhausted descending and sigmoid colon. Ischemic colitis was suspected, but the surgeon hesitated to initiate surgery due to non-specific symptoms. Finally, colonoscopy demonstrated segmental edematous, fragile mucosa with scattered erosions and ulcerations from the rectum to the splenic flexure of the colon. Ischemic colitis of the descending colon, sigmoid colon and upper rectum was proved after surgery. The patient’s condition improved after prompt surgery.

Fatal liver abscess caused by <i>Clostridium perfringens</i> complicated with transarterial chemoembolization

A 77-year-old man who received transarterial chemoembolization for large hepatocellular carcinomas complained of acute pain in the upper abdomen and suddenly developed severe jaundice, anemia, and massive hematuria. Abdominal computed tomography demonstrated gas gangrene at the tumor site. Clostridium perfringens was identified from blood samples and drainage cultures from the liver abscess. Despite intensive treatment, the patient died 55 hours after chemoembolization due to multiple organ failure. When treating patients with large tumors, such as in our case, this rare but fatal complication that causes sepsis and hemolysis with lightning-like rapidity should be considered.

Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum

We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.

Radiology of vernix caseosa peritonitis: Case report and discussion

Vernix caseosa peritonitis is a rare complication of pregnancy that can occur following Caesarean section. If fetal vernix enters the peritoneal cavity, it may incite an acute inflammatory response leading to peritonitis. This diagnosis should be considered when patients present with an acute abdomen pain following Caesarean section. Radiological imaging may identify lesions in the abdominal wall wound or peritoneal cavity, and the diagnosis can be made by image-guided biopsy.

Gossypiboma, a rare cause of acute abdomen: A case report and review of literature

Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Inadvertent retention of a foreign body in the abdomen often requires another surgery. This increases morbidity and mortality of the patient, cost of treatment, and medicolegal problems. We are reporting case of a 45-year-old woman who was referred from periphery with acute pain in abdomen. She had a surgical history of abdominal hysterectomy 3 years back, performed at another hospital. On clinical examination and investigation, twisted ovarian cyst was suspected. That is a cystic mass further confirmed by abdominal computerized tomography (CT). During laparotomy, the cyst wall was opened incidentally which lead to the drainage of a large amount of dense pus. In between pus, there was found retained surgical gauze that confirmed the diagnosis of gossypiboma.

Fitz-Hugh–Curtis syndrome

Fitz-Hugh–Curtis syndrome is characterized by perihepatic inflammation appearing with pelvic inflammatory disease (PID), mostly in women of childbearing age. Acute pain and tenderness in the right upper abdomen is the most common symptom that makes women visit the emergency rooms. It can also emerge with fever, nausea, vomiting, and, in fewer cases, pain in the left upper abdomen. It seems that the pathogens that are mostly responsible for this situation is Chlamydia trachomatis and Neisseria gonorrhoeae. Because of its characteristics, differential diagnosis for this syndrome is a constant, as it mimics many known diseases, such as cholelithiasis, cholecystitis, and pulmonary embolism. The development of CT scanning provided diagnosticians with a very useful tool in the process of recognizing and analyzing the syndrome. Nevertheless, the only secure diagnostic method is the laparoscopic evaluation of the abdomen and the spotting of the unique “violin-string” adhesions between the liver and the abdominal wall or the diaphragm. Though it is a difficult diagnosis, the syndrome and, therefore, the PID that caused its outburst are usually easily treated with courses of antibiotics, as monotherapy or combined, with satisfactory results.

Adherent appendix vermiformis within an incisional hernia after kidney transplantation mimicking acute appendicitis: report of a case

We report a very rare case concerning a 69-year-old woman with acute onset pain in the right lower abdomen. Kidney transplantation for chronic renal insufficiency had been performed 4 years previously. Clinical examination and diagnostic imaging revealed an appendix-associated incisional hernia at the lateral edge of the inguinal scar. We performed a laparoscopic appendectomy and hernia repair with external knots. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day in a good general condition. Appendix-associated hernias are very rare but can cause severe complications in case of delayed diagnosis, particularly in patients undergoing immunosuppressive treatment.

Mesenteric vascular remodeling in hyperhomocysteinemia

Remodeling by its very nature implies synthesis and degradation of extracellular matrix components (such as elastin, collagen, and connexins). Most of the vascular matrix metalloproteinase (MMP) are latent because of the presence of constitutive nitric oxide (NO). However, during oxidative stress peroxinitrite (ONOO-) activates the latent MMPs and instigates vascular remodeling. Interestingly, in mesenteric artery, homocysteine (Hcy) decreases the NO bio-availability, and folic acid (FA, an Hcy-lowering agent) mitigates the Hcy-mediated mesentery artery dysfunction. Dimethylarginine dimethylaminohydrolase-2 (DDAH-2) and endothelial nitric oxide synthase (eNOS) increases NO production. The hypothesis was that the Hcy decreased NO bio-availability, in part, activating MMP, decreasing elastin, DDAH-2, eNOS and increased vasomotor response by increasing connexin. To test this hypothesis,the authors used 12-week-old C57BJ/L6 wild type (WT) and hyperhomocysteinemic (HHcy)-cystathione beta synthase heterozygote knockout (CBS+/-) mice. Blood pressure measurements were made by radio-telemetry. WT and MMP-9 knockout mice were administered with Hcy (0.67 mg/ml in drinking water). Superior mesenteric artery and mesenteric arcade were analyzed with light and confocal microscopy. The protein expressions were measured by western blot analysis. The mRNA levels for MMP-9 were measured by RT-PCR. The data showed decreased DDAH-2 and eNOS expressions in mesentery in CBS-/+ mice compared with WT mice. Immuno-fluorescence and western blot results suggest increased MMP-9 and connexin-40 expression in mesenteric arcades of CBS-/+ mice compared with WT mice. The wall thickness of third-order mesenteric artery was increased in CBS-/+ mice compared to WT mice. Hcy treatment increased blood pressure in WT mice. Interestingly, in MMP-9 KO, Hcy did not increase blood pressure. These results may suggest that HHcy causes mesenteric artery remodeling and narrowing by activating MMP-9 and decreasing DDAH-2 and eNOS expressions, compromising the blood flow, instigating hypertension, and acute abdomen pain.