Case Of Acute Abdomen Research Articles

Acute Appendicitis as a Rare Cause of Acute Surgical Abdomen in Neonates: A Case Series

Background: Neonatal appendicitis is a rare diagnosis. There is increased morbidity with associated complications like perforation, mass formation etc. Cases: We present here 6 cases of acute surgical abdomen, with pre-operative diagnosis of right iliac fossa lump formation in 3 and perforation peritonitis, intussusception, liver abscess each in 1 patient. On exploration, they were found to have complicated appendicitis. 5 of them could be salvaged, with 1 mortality. Conclusion: It is imperative to have high index of suspicion to prevent delayed treatment. Early surgical intervention is recommended to avoid potential morbidity and mortality.

Spontaneous Renal Artery, Superior Mesenteric Artery and Distal Splenic Artery Thrombosis: An Unusual Case of Acute Abdomen

Spontaneous Renal Artery, Superior Mesenteric Artery and Distal Splenic Artery Thrombosis: An Unusual Case of Acute Abdomen

Thickness of subcutaneous fat in the right iliac fossa as a predictor of surgical site infection in open appendicectomy- a single centre prospective study

Background: Acute appendicitis is the acute inflammation of appendix accounting to 7-10% of acute abdomen cases. The complications vary from surgical site infection to enterocutaneous fistula and stump appendicitis. The surgical site infections after appendicectomy are postoperative nosocomial infections affecting the incision site, deeper tissues and organs at the operative site within 30 days of surgery. The study was aimed at predicting subcutaneous fat thickness causing surgical site infection in open appendicectomy wounds. Methods: This prospective study was conducted in Trichy SRM Medical College Hospital and Research Centre, Tamil Nadu from January to June 2021 in 82 patients. Patients who underwent open appendicectomy for uncomplicated acute appendicitis were included. Patients underwent preoperative Ultrasound abdomen to measure the subcutaneous fat thickness in right iliac fossa and was correlated with post operative surgical site infection for 1 month. The subcutaneous fat thickness was divided into three groups; I- 5.5 mm and below, II- 5.5 to 7.5 mm and III- more than 7.5 mm. Results: The results show that there was an increased association of surgical site infection in patients with increased subcutaneous fat thickness at incision site with mean of 6.25 and SD of 1.49. Conclusions: The study showed that subcutaneous fat thickness is a predictor for development of surgical site infection in open appendicectomy wounds. The subcutaneous fat thickness association in causing surgical site infection in open appendicectomy wounds is of linear association.

Mesenteric Teratoma in Adult Female: a Rare Case

Mesenteric teratomas are considered rare intra-abdominal tumors with minimum clinical symptoms, which turn difficult their preoperative diagnosis. They represent a poorly studied pathology that has been established with 1 in 26,794 to 250,000 frequency of hospital admissions. It is not frequent to think about this kind of lesion in a preoperative period, and the symptoms it presents can be very ambiguous. Therefore, in this study, we present a case of acute abdomen, in a 65-year-old Mexican woman, in which a mesenteric teratoma was obtained as a surgical finding. Sixty-five-year-old woman who presented a clinical picture of abdominal pain and distention, nausea and constipation, and absence of gas channelling in the last 24 h. After 48 h of conservative management, without favorable results and with a diagnosis of acute abdomen, surgery was entered to perform exploratory laparotomy and an intraoperative finding of mesenteric teratoma was made. Two ovoid specimens were extracted and sent to the pathology area, who confirms the diagnosis of mature cystic teratoma. Teratoma is commonly a germ cell tumor that originates in the gonads and is detected in women of reproductive age. This is extremely rare, with an estimated 21 cases reported to date. Despite the low frequency, it is suggested to consider these teratomas in the differential diagnosis against other pathologies, especially if they do not show a very clear data.

Surgery for acute abdomen in adult patients with severe motor and intellectual disabilities.

The present study aimed to examine the characteristics, outcomes, and problems related to surgery for acute abdomen in adult patients with severe motor and intellectual disabilities (MID). The clinical records of 35 adult patients with severe MID who received emergency surgery for acute abdomen between 2011 and 2020 were reviewed. The median duration from onset to surgery was 48 hours. There were 2 cases of in-hospital mortality (5.7%), and all the patients underwent surgery more than 72 hours after onset. The in-hospital mortality rate was significantly higher in patients who received surgery later than 72 hours after onset. Bowel obstruction was the most common disease among the acute abdomen cases (71.4%) and most often involved volvulus of the small bowel and cecum. Of the patients with bowel obstruction with severe MID, 72.0% had abdominal distention, 16.0% had abdominal pain, and 4.0% had vomiting. The median duration from onset to surgery was significantly longer in the patients with bowel obstruction with severe MID than in those without severe MID (24 hours vs. 16 hours). Acute abdomen in patients with severe MID was often due to bowel obstruction caused by volvulus. Because patients with severe MID have few symptoms, they are susceptible to adverse surgical outcomes associated with a prolonged duration from onset to surgery.

Unusual Case of Acute Abdomen in a Patient on Maintenance Hemodialysis

ABSTRACT Acute abdominal pain is not a frequent presentation in the emergency department in patients on maintenance hemodialysis (HD). Common causes of acute abdomen in these patients are bowel infarction, pancreatitis, and peritonitis. Splenic infarction presenting as acute abdomen is a rare entity. We report a case where a 38-year-old female on HD presented with acute abdomen and was found to have splenic infarction. On further evaluation, she was found to have infective endocarditis of the aortic valve as a complication of catheter-related bloodstream infection due to nontunneled catheter. The management of the patient comprised of prompt removal of catheter and intravenous antibiotics.

Curious Case of Acute Abdomen

A 35 year old male bank employee by profession presented with c/o pain in abdomen with abdominal distension and fullness since last 4 weeks. Intensity of pain had increased over the past 15 days. He had a history of fever intermittently for the past 3 months for which he had been taking medication initially .Off recent fever started subsiding even without medication. He complained of anorexia and weight loss over these 3 months.

Establishment and verification of LIPS score combined with APACHE II score and oxygenation index to predict the occurrence model of ARDS

To construct and verify the occurrence model of acute respiratory distress syndrome (ARDS) using lung injury prediction score (LIPS) combined with acute physiology and chronic health evaluation II (APACHE II) score and oxygenation index (PaO2/FiO2). Using a prospective cohort study method, 244 patients with complete medical records who were admitted to the intensive care unit (ICU) of Peking University Third Hospital from December 2020 to July 2022 were selected as research objects according to the inclusion and exclusion criteria. They were divided into training set (173 cases) and validation set (71 cases). Patients' gender, age, body mass index (BMI), various causes (shock, sepsis, craniocerebral injury, pulmonary contusion, multiple trauma, aspiration, pneumonia, acute abdomen, hypoproteinemia, acidosis, major surgery, etc.), underlying diseases (diabetes, malignant tumor, cerebrovascular disease, liver disease, kidney disease) and laboratory test indicators were collected. According to the above data, the LIPS score, APACHE II score, sequential organ failure assessment (SOFA) and PaO2/FiO2, etc within 24 hours after admission to the ICU were calculated. Univariate analysis was used to screen the influencing factors for the occurrence of ARDS, and the factors with P < 0.2 were included in the multivariate Logistic regression analysis to screen out the independent predictive factors for the occurrence of ARDS. According to the results of multivariate Logistic regression analysis, the risk score of patients with ARDS was obtained to construct the risk prediction model of ARDS, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. The established ARDS prediction model was externally validated, and ROC curves were drawn to evaluate the predictive accuracy of the prediction model for the occurrence of ARDS in critically ill patients, and the AUC of the validation set was calculated to analyze the predictive performance of each risk factor on the occurrence of ARDS. A total of 173 patients were enrolled in the training set, including 121 patients without ARDS and 52 patients with ARDS; 77 cases of acute abdomen, 64 cases of sepsis, 60 cases of shock, 51 cases of acidosis, 40 cases of hypoproteinemia, 37 cases of diabetes, 34 cases of craniocerebral injury, 34 cases of abnormal liver function, 28 cases of multiple trauma, 23 cases of malignant tumor, 23 cases of spinal orthopedic surgery, 17 cases of obesity, 12 cases of pneumonia, 11 cases of pulmonary contusion, and 7 cases of chronic kidney disease, chemotherapy in 6 cases, and aspiration in 2 cases. The rates of shock, sepsis, acute abdomen, acidosis, abnormal liver function, lung contusion, pneumonia and aspiration, gender, age, LIPS score, APACHE II score, and SOFA score in the ARDS group were significantly higher than those in the non-ARDS group (all P < 0.05), moreover, PaO2/FiO2 ratio was significantly lower than that of non-ARDS group (P < 0.01). Multivariate Logistic regression analysis showed that LIPS score, APACHE II score, and PaO2/FiO2 ratio were independent risk factors for ARDS in ICU patients with high risk factors for ARDS, and the odds ratio (OR) was 1.768 [95% confidence interval (95%CI) was 1.380-2.266], 1.242 (95%CI was 1.089-1.417), 0.985 (95%CI was 0.978-0.991), all P < 0.05. ROC curve analysis showed that the AUC of the ARDS prediction model training set was 0.920, the sensitivity was 86.5%, and the specificity was 86.8%; the AUC of the verification set was 0.896, the sensitivity was 96.8%, and the specificity was 76.6%. LIPS score, APACHE II score and PaO2/FiO2 are independent risk factors for the occurrence of ARDS in ICU patients with high risk factors for ARDS. The ARDS risk prediction model established based on these three indicators has a good predictive ability for the occurrence of ARDS in critically ill patients, wihich needs to be verified by multicenter cohort studies.

Trespassing bowel: A rare case of paraduodenal hernia

Para-duodenal hernias are the most frequent type of congenital internal hernia. It is observed that left para-duodenal hernia is about three times more common than right counterpart.This case serves as an example of how bowel obstruction brought on by a paraduodenal hernia typically manifests as severe abdominal pain that worsens quickly. Considering that it is a closed loop obstruction, early bowel damage results, which explains why this illness has a high death rate. The presentation is dramatic and frequently includes peritonitis and hypovolemic shock.It is concluded that while managing a case of acute abdomen, internal hernias must always be kept in mind.

Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report

BackgroundPerforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome.Case presentationA 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition.ConclusionsPerforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

An unusual case of acute abdomen

A 60 year old woman presented to A &amp; E complaining of abdominal pain and coffee ground like vomit. Her past medical history included type 2 diabetes, hypertension and a conjunctival melanoma with gastric and right adnexal secondarisms. So, she underwent a laparotomy and bilateral adnexectomy the year before with no further cytoreduction because of its metastatic nature.

A Comparative Analysis of Pre Operative and Operative Findings in Non Traumatic Acute Abdomen: A Prospective Observational Study

Acute abdomen remains the important cause of morbidity and mortality in emergency. It requires careful history taking and thorough evaluation of symptoms, clinical examination and judicious use of radiological investigation which simplify the evaluation of disease. Aim and Objectives: To assess the accuracy of radiological diagnosis in comparison to postoperative diagnosis in non-traumatic cases of acute abdomen. Materials and Method: A prospective observational study of non-traumatic acute abdomen was carried out at Sahyadri Narayana Multispeciality Hospital, Shimoga, Karnataka. Total of 78 cases of acute abdomen patients were evaluated and operated over a period from December 2018 to February 2020 and included in the study group. Pediatric age group (12 years and below), traumatic cases (blunt and penetrating), acute abdomen in pregnancy and gynecological causes of acute abdomen, urological cases, and conservatively managed cases were excluded from the study. Detailed history was taken and relevant physical examination performed. All patients underwent hematological and biochemical investigations, appropriate radiological investigation (USG, AXR and CT-scan) were performed based on clinical suspicion. Clinical and radiological diagnosis based on clinical examinations and radiological investigations was compared with post-operative diagnosis based on operative findings. Result: The most common age group was 20-60 years with male preponderance. Pain in abdomen was commonest symptom followed by vomiting, anorexia and fever. Tenderness was commonest clinical sign observed followed by rebound tenderness, tachycardia and guarding/rigidity. Acute appendicitis was the most common cause of acute abdomen followed by perforation peritonitis and intestinal obstruction. The overall diagnostic accuracy of clinical examination in acute abdomen was 81.8% and if radiological imaging techniques combined with this, the accuracy raised up to 94%. Conclusion: The study strongly suggested that with thorough history taking and proper clinical examination, clinical diagnosis was successfully achieved in 82% of patients. Radiological investigations help in confirming clinical suspicions and giving added information of underlying pathology with accuracy of 94%. Keywords: Abdomen Injury; Radiological Investigations; Trauma; Diagnostic Test; Perforation.

Thrombosis leading to acute abdomen in corona virus disease- 19:A case series

Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained.

Impact of low-molecular-weight heparin in the treatment of moderately severe and severe acute pancreatitis; a randomized, single blind, phase 3 control trial

IntroductionAcute pancreatitis is inflammation of pancreatic parenchyma which is an emergency condition. It is classified as mild, moderately severe, and severe categories. In severe acute pancreatitis, mortality is up to 10%–30%. Pancreatic abscess increases the mortality to 40%, and infected pancreatitis carries 100% mortality without surgical drainage. Anti-coagulant, anti-inflammatory and anti-protease activities of low-molecular-weight heparin are involved in preventing pancreatic necrosis and curbing the adverse outcomes of acute pancreatitis. AimTo determine the effect of low-molecular-weight heparin on the outcome of moderately severe and severe acute pancreatitis. Materials and methodologyHospital based, single centre, randomized, single blind, phase 3 control trial. First 140 patients with moderately severe and severe acute pancreatitis admitted in hospital in the given period who met the inclusion and exclusion criteria were taken. 70 patients were placed in the control and the trial group each by simple randomization (closed envelope method). The control group received conventional treatment for pancreatitis & the trial group received 1mg/kg body weight Enoxaperin, subcutaneously, 12 hourly for seven days along with the conventional treatment.Progression of disease in Computed Tomography Severity Index and incidence of pancreatic necrosis were the main outcomes studied at the end of 7 days of treatment. Results1386 acute abdomen cases were screened, of which 269 were diagnosed with acute pancreatitis. 147 patients with acute pancreatitis met the selection criteria and 7 were dropouts. Recruitment started on April 9, 2021 and closed on December 5, 2021. Computed Tomography Severity Index progressed in 22(31.40%) patients in control group and 6(8.6%) patients in the trial group and 18(25.71%) in the control group and 4(5.71%) in the trial group showed the presence of necrosis. The differences are significant (P value is 0.001 in each). No adverse events were seen. ConclusionUse of low-molecular-weight heparin in early stage of moderately severe and severe acute pancreatitis significantly reduces the chance of disease progression and pancreatic necrosis.

Biochemical and Radiological Parameters in Acute Pancreatitis among Patients from a Rural Community of South India

Background and Purpose: Acute pancreatitis is one of the major causes of acute abdominal pain that requires hospital admission worldwide. Our objective was to find the proportion of acute pancreatitis in acute abdomen cases among the rural population and to assess pancreatic enzymes (lipase and amylase) for the severity of acute pancreatitis. By doing so, we can establish the importance of a single enzymatic marker in acute pancreatitis. Methods: A retrospective and observational study was undertaken on men and women of all age groups admitted over 1 year with acute pancreatitis at a rural tertiary care hospital located at the tristate junction of South India. Pancreatic enzymes (lipase and amylase) were compared based on the grading and severity of pancreatitis according to the modified computed tomography severity index. Results: The proportion of acute pancreatitis was 40% among all acute abdomen cases. Most patients with acute pancreatitis were chronic alcoholic men (62.5%). The common finding in abdominal ultrasonography (USG) was the enlargement of the pancreas (97.5%). There was an overall rise in serum lipase levels in all acute pancreatitis patients, especially in alcoholic patients. The median lipase levels were higher in severe acute pancreatitis than in moderate acute pancreatitis, with P = 0.006. In comparison, there was no significant difference in amylase values between them. Conclusions: In this study, we could conclude that acute pancreatitis is one of the major emergency conditions in this region of rural India, especially among men who are chronic alcoholics. The enlargement of the pancreas was the most frequent finding in USG among these patients. We suggest that a single pancreatic marker (serum lipase) in acute pancreatitis can be cost-effective. Moreover, serum lipase can also be a marker for assessing the severity of acute pancreatitis.

Wandering spleen with torsion presenting as a rare case of acute abdomen

Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy

Jejunal diverticular disease complicated with spontaneous perforation: A rare case of acute abdomen and literature review

Introduction: The jejunal diverticular disease is an uncommon clinical pathology. In general, these diverticula are an incidentaloma found on imaging exams that can be seen in elective surgeries for other purposes. In a minority of cases it causes symptoms which result from serious complications such as perforation. Case report: A 56-year-old male patient, previously healthy and without comorbidities, was admitted to the emergency department due to abdominal pain which had started 24 hours ago, without improvement. On examination, the patient was in pain and in Mohammedan prayer's position in bed and had a distended abdomen with signs of peritoneal irritation. An abdominal tomography showed massive distension of intestinal loops and free fluid in the peritoneal cavity. He underwent exploratory laparotomy which showed multiple diverticula in the jejunum and one of them was perforated. Segmental enterectomy with primary anastomosis was performed. Conclusion: Complicated jejunal diverticular disease should be ranked among the differential diagnoses in acute perforating abdomen. Segmental jejunal resection is the treatment of choice. Keywords: small bowel diverticulum; jejuno-ileal diverticula; diverticulitis; perforation; acute abdomen; surgery.

Uterine Perforation in Postmenopausal Woman – Case Report

Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of spontaneous postmenopausal rupture of uterus caused by pyometra. This can be associated with high morbidity if generalized peritonitis and sepsis occurs. The symptoms will be like acute abdomen similar to that caused by ruptured bowel or gastric perforation. In case of postmenopausal rupture like ours, gynaecological symptoms are very less. Hence the diagnosis becomes difficult and challenging. Here we report a rare case of uterine rupture that occurred in a postmenopausal woman because of pyometra. The patient landed up in the surgical department as case of acute abdomen. Definitive diagnosis was made at the time of laparotomy only when exploration was done and gynaecologist called.

A Case of Recurrent Acute Abdomen in a Young Lady Masquerading as Somatoform Disorder

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. It usually presents with short duration of gastrointestinal symptoms followed by rapidly progressivefulminant neurological syndrome. It is a neurological emergency and mimics many other psychiatric and medical disorders and can be fatal if it remains undiagnosed and untreated. Further, specifictreatment in the form of Heme arginate is not universally available and very costly, so high clinical suspicion and early diagnosis and management of acute attack and prevention of further attacks are very important. Here, we report a 23 years old married female nurse presenting with recurrent acute abdomen requiring frequent hospital admissions along with convulsion during her last attack. The presence of porphyrins in urine confirms the diagnosis of AIP.

Spontaneous Rupture of Hepatocellular Carcinoma at First Presentation

Hepatocellular carcinoma (HCC) is the leading primary malignancy of the liver and typically develops in the background of chronic liver disease, particularly those with cirrhosis due to viral hepatitis B and C. Ruptured tumor is the most serious complication of HCC primarily occurring in older patients with significant mortality rate. In this report, we present a case of acute abdomen with the features of impending shock as the first presentation of a spontaneously ruptured HCC in a previously healthy young man.