Cause Of Acute Abdominal Pain Research Articles

Left side perforated appendicitis with intestinal non-rotation: a case report

BackgroundAcute appendicitis is the most common cause of acute abdominal pain, requiring emergency surgery. Symptoms and signs of acute appendicitis usually occur in the right lower quadrant. However, approximately one-third of cases have pain unexcepted location due to its various anatomical locations. Acute appendicitis is a very rare cause of left lower quadrant pain; if it occurs, situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate its diagnosis and management.Clinical presentationHere we present a 23-year-old Ethiopian male patient who presented with epigastric and left paraumbilical abdominal pain, fever, and vomiting of a day duration. On examination at admission, the patient had left lower quadrant tenderness. Later, with the help of imaging studies, the patient was diagnosed with left-side acute perforated appendicitis with intestinal nonrotation, and he was operated on and discharged improved after 6 days of hospital stay.ConclusionPhysicians should be aware that acute appendicitis in patients with intestinal mal-rotation may be present with left-side abdominal pain. Although it is extremely rare, acute appendicitis should always be considered in the differential diagnosis of left-side abdominal pain. An increase in awareness of this anatomical variant is essential for physicians.

Visual Image Annotation for Bowel Obstruction: Repeatability and Agreement with Manual Annotation and Neural Networks

Bowel obstruction is a common cause of acute abdominal pain. The development of algorithms for automated detection and characterization of bowel obstruction on CT has been limited by the effort required for manual annotation. Visual image annotation with an eye tracking device may mitigate that limitation. The purpose of this study is to assess the agreement between visual and manual annotations for bowel segmentation and diameter measurement, and to assess agreement with convolutional neural networks (CNNs) trained using that data. Sixty CT scans of 50 patients with bowel obstruction from March to June 2022 were retrospectively included and partitioned into training and test data sets. An eye tracking device was used to record 3-dimensional coordinates within the scans, while a radiologist cast their gaze at the centerline of the bowel, and adjusted the size of a superimposed ROI to approximate the diameter of the bowel. For each scan, 59.4 ± 15.1 segments, 847.9 ± 228.1 gaze locations, and 5.8 ± 1.2 m of bowel were recorded. 2d and 3d CNNs were trained using this data to predict bowel segmentation and diameter maps from the CT scans. For comparisons between two repetitions of visual annotation, CNN predictions, and manual annotations, Dice scores for bowel segmentation ranged from 0.69 ± 0.17 to 0.81 ± 0.04 and intraclass correlations [95% CI] for diameter measurement ranged from 0.672 [0.490–0.782] to 0.940 [0.933–0.947]. Thus, visual image annotation is a promising technique for training CNNs to perform bowel segmentation and diameter measurement in CT scans of patients with bowel obstruction.

Atypical Ovarian Tumor: Mixed Sertoli–Leydig Cell Tumor of Retiform Variant with Focal Heterologous Elements

ABSTRACT Ovarian torsion is an uncommon cause for acute abdominal pain in children while the possibility of malignancy presenting as ovarian torsion is even rarer. We report here an atypical case of ovarian neoplasm presenting as ovarian torsion in a 5-year-old child. The highlight of this case is the epithelial component staining positive for both CK 7 and CK 20 in addition to Sertoli–Leydig cell component indicating it as mixed Sertoli–Leydig cell tumor of retiform variant with focal heterologous elements. The heterologous element is the CK7 and 20 being positive epithelium. The ovarian torsion should make one suspect malignancy in and around the ovary and subject it for detailed histopathologic study and manage accordingly; lest, one’s failure to suspect the same may compromise patient management and prognosis.

Acute appendicitis complicated by ovarian vein thrombosis

Ovarian vein thrombosis (OVT) is a rare cause of acute abdominal pain and is mainly related to pregnancy and affects approximately 1 in every 2,000 deliveries and abortions. However, this diagnosis should be considered not only in postpartum patients but also in women with pelvic inflammatory disease (PID), malignancy, women who have recent abdominal surgery and who have a known hypercoagulable state. Anticoagulation and antibiotics are the mainstays of treatment for OVT. Complications of OVT include sepsis, the extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main cause of mortality due to OVT. We report a case of 40-years old female patient presenting with OVT, which was accompanied by acute appendicitis. In this woman, OVT was not related to pregnancy. The patient underwent an appendectomy, which proved positive on histopathology result. Patient symptoms improved after appendectomy with antibiotics and anticoagulation therapy. A month later, a follow-up computed tomography (CT) scan of the abdomen revealed a complete resolution of OVT. OVT, though a rare presentation, should be included in the differential diagnosis for women presenting with acute abdomen. Proper diagnosis and timely management can prevent catastrophic complications. Our case thus highlights the importance of considering the rare diagnosis of OVT with acute appendicitis.

Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis.

Appendicitis is a common cause of acute abdominal pain, and treatment with laparoscopy has become increasingly common during the past two decades. Guidelines recommend that normal appendices are removed if operated for suspected acute appendicitis. It is unclear how many patients are affected by this recommendation. The aim of this study was to estimate the rate of negative appendectomies in patients undergoing laparoscopic surgery for suspected acute appendicitis. This study was reported following the PRISMA 2020 statement. A systematic search was conducted in PubMed and Embase for retrospective or prospective cohort studies (with n ≥ 100) including patients with suspected acute appendicitis. The primary outcome was the histopathologically confirmed negative appendectomy rate after a laparoscopic approach with a 95% confidence interval (CI). We performed subgroup analyses on geographical region, age, sex, and use of preoperative imaging or scoring systems. The risk of bias was assessed using the Newcastle-Ottawa Scale. Certainty of the evidence was assessed using GRADE. In total, 74 studies were identified, summing up to 76,688 patients. The negative appendectomy rate varied from 0% to 46% in the included studies (interquartile range 4-20%). The meta-analysis estimated the negative appendectomy rate to be 13% (95% CI 12-14%) with large variations between the individual studies. Sensitivity analyses did not change the estimate. The certainty of evidence by GRADE was moderate due to inconsistency in point estimates. The overall estimated negative appendectomy rate after laparoscopic surgery was 13% with moderate certainty of evidence. The negative appendectomy rate varied greatly between studies.

Isolated Fallopian Torsion: A Pediatric Case Series.

Isolated fallopian tube torsion is a rare cause of acute abdominal pain in adolescent females. It is known to be a surgical emergency as it may lead to ischemia of the fallopian tube which can result in necrosis, infertility or infection. Presenting symptoms and radiographic findings are vague making diagnosis difficult, often requiring direct visualization in the operating room to make the definitive diagnosis. There has been an increase in this diagnosis at our institution in the previous year prompting compilation of cases and a literature review.

Evaluation and Comparison of the Accuracy and Efficacy of Alvarado and Appendicitis Inflammatory Response Scoring in Acute Appendicitis

INTRODUCTION
 Acute appendicitis (AA) is one of the most common causes of acute abdominal pain. Early surgery for acute appendicitis may lead to inadequate evaluation of differential diagnoses of acute abdominal pain and increases the chances of negative appendectomy, whereas delaying it leads to potential complications. Appendicitis inflammatory response (AIR) score, has been created to overcome shortcomings of the Alvarado score. In this, a mathematical model focused on detecting perforated appendicitis has been used. Unlike previously reported scores, this included C-reactive protein (CRP), which had been previously reported to have high accuracy in discriminating between simple and advanced acute appendicitis.
 MATERIAL AND METHODS
 Observational Cross sectional study was done in all patients admitted to UCMS hospital diagnosed to have acute appendicitis from October 2019 to March 2021. The primary objective was to determine if use of Appendicitis Inflammatory Response Score is better suited for planning management of patients with acute appendicitis. Comparison between groups was done with one-way Analysis of Variance (ANOVA). Receiver Operating Curve (ROC) was used to identify whether Appendicitis inflam- matory response (AIR) score or Alvarado score was good predictor of acute appendicitis. Sensitivity, Specificity and Area under Curve (AUC) was used as indicators to predict the acute appendicitis.
 RESULTS
 In our study, the sensitivity of Appendicitis inflammatory response (AIR) score is high (85.4%) as compared to 82.3% of Alvarado score.
 CONCLUSION
 We concluded that Appendicitis inflammatory response (AIR) score is more reliable scoring system for the diagnosis of acute appendicitis and its use can be justified over the pre-existing Alvarado scoring.

Isolated superior mesenteric artery dissection: An updated review of the literature

Isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially life-threatening cause of acute abdominal pain. Owing to the availability of computed tomography angiography, more cases have been detected during screening for acute abdomen in recent years. With increasing knowledge of ISMAD, a better management strategy is being developed. To enhance our understanding and improve treatment outcomes of ISMAD, a systematic literature review was conducted with a focus on diagnosis and management strategies based on existing evidence.

Epiploic Appendagitis: A Frequent Cause of Misdiagnosis

Acute epiploic appendagitis is a rare self-limited cause of acute abdominal pain, resulting from the torsion of the colonic appendage around itself. It is a critical differential diagnosis as the clinical presentation often mimics that of appendicitis or diverticulitis [1].

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

Abstract Background Nontraumatic acute abdominal pain (AAP) accounts for a large proportion of emergency department (ED) admissions. This study aimed to explore the underlying correlations among basic information, imaging examinations, and diagnoses. Methods A total of 7453 patients complaining of AAP, admitted to the ED of Zhongnan Hospital of Wuhan University, were enrolled in this retrospective study from January 1 to December 30, 2019. We collected the following information from the patients: sex, age, date of visit, pain location, nature of pain, level of severity, imaging (computed tomography, x-ray, and ultrasound), diagnosis, and outcomes (release from the hospital, transfer to another hospital, transfer to another department, observation room, hospitalization, or death). Results According to this study, AAP was more common in female than male. A total of 82.11% patients of AAP were in level 3 of severity, while 0.19% patients were in level 1. A total of 77.20% of the patients had undergone imaging. Swelling pain and colic are the 2 most common types of AAP. Nonspecific abdominal pain (NSAP) is the most common diagnosis. In the diagnosis of NSAP and gastroenteritis, female patients were more prevalent than male patients, but for renal colic, male patients were 3 times as many as female patients. Nonspecific abdominal pain, biliary colic, and cholecystitis are the 3 leading causes in patients 65 years or older. Nonspecific abdominal pain, renal colic, and gastroenteritis are the 3 leading causes of AAP in patients younger than 65 years. Conclusion With the help of imaging, clinicians can specify a diagnosis and perform corresponding treatment in most cases. However, making a precise diagnosis of AAP within a short period is still challenging. Further research should be conducted to seek safer and more effective techniques to streamline clinicians’ work.

An Unusual Cause of Acute Abdominal Pain: A Case Report and Review of the Diagnostic Reasoning

Spontaneous bladder rupture is a rare cause of acute abdominal pain. This case report reviews the clinical presentation of a patient with this unusual disorder and discusses the steps that the clinician used to reach the diagnosis. The concept of how clinicians use problem representations and illness scripts to arrive at a differential diagnosis, and ultimately a diagnosis, is discussed.

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.

A rare cause of acute abdomen: Ovarian torsion due to dermoid cyst

Dermoid cysts are one of the most common causes of ovarian torsion. The causes of acute abdominal pain are mostly caused by the diagnosis of acute appendicitis, acute pancreatitis, and mesenteric ischemia, and the incidence of ovarian torsion is not known exactly. Although ovarian torsion is very rare, it ranks first among the indications for gynecological emergency surgery. A rare case of a non-ruptured dermoid cyst causing ovarian torsion in the emergency room is presented.

Case Report: A Child With Omental Infarction

BackgroundOmental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis. Case ReportHere, we present a case of OI in a child with acute severe right upper quadrant pain. Why Should an Emergency Physician Be Aware of This?Correct diagnosis of OI via imaging can prevent unnecessary surgery.

Case Report on Diffuse Large B-Cell Non-Hodgkin Lymphoma with a Spontaneous Bowel Perforation

Background: Intestinal Non-Hodgkin lymphoma is an uncommon cause of acute abdominal pain. The main objective of the present case report is to share our experience with Diffuse Large B Cell Non-Hodgkin Lymphoma with spontaneous bowel perforation in a setting of HIV. Method: Description of a Case Report Diffuse Large B-Cell Non-Hodgkin Lymphoma with a spontaneous bowel perforation: A 39-year-old female patient presented with a one-day history of acute abdomen. She is known retroviral disease reactive with CD4 count 534, Viral Load 131 on Antiretroviral Treatment-Fixed Dose Regimen duration of more than 5 years and was being treated for Peptic Ulcer Disease. Chest X-ray: showed pneumoperitoneum consistent with a perforation. A Laparotomy was performed and found a perforated Jejunum leaking small bowel contents. Resection and primary anastomosis were performed, and washout was done. Post-Operative condition was uneventful, and she was discharged four days after the operation. The resected portion was sent for histology, which showed perforation of the Jejunum secondary to a Diffuse Large B Cell Non-Hodgkin Lymphoma. Conclusion: The diagnosis of Intestinal Lymphoma poses a diagnostic challenge for both developed and developing countries; however, coupling the risk factors with signs and symptoms can assist one in making a diagnosis. It is therefore important to always have a high index of suspicion, particularly for HIV patients with lymphadenopathy. Doi: 10.28991/SciMedJ-2023-05-01-05 Full Text: PDF

Intussusception among Children Admitted in a Department of Pediatric Surgery of a Tertiary Care Centre: A Descriptive Cross-Sectional Study.

Intussusception is the second most common cause of acute abdominal pain in infants and preschool children. The aetiology for intussusception is idiopathic at this age. Hydrostatic reduction and exploratory laparotomy with proceed are the options for the management of intussusception. The aim of this study was to find out the prevalence of intussusception among patients admitted to the Department of Pediatric Surgery of a tertiary care centre. This is a descriptive cross-sectional study conducted among admitted patients in the Department of Pediatric Surgery of a tertiary care centre after ethical approval from the Ethical Committee (Reference number: A37-77/78). Data were collected from 1 January 2018 to 31 December 2020 from admitted children aged 6 months to 5 years of age. Data collection was done from the hospital record section using the convenience sampling method. Point estimate and 95% Confidence Interval were calculated. Among 1785 admitted patients, 267 (14.96%) (13.31-16.61, 95% Confidence Interval) were found to have intussusception. Among them, the hydrostatic reduction was successful in 246 (92.13%). Meanwhile, 21 (7.86%) of cases underwent laparotomy. The peak age of patients was seen in 148 (55.43%) in the age group of 1-3 years. Intussusception is one of the common surgical emergencies in children. Hydrostatic reduction of intussusception is a simple and effective method for the treatment of intussusception in children. intussusception; laparotomy; paediatrics; prevalence; ultrasound.

Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis.

Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.

Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric emergency department.

Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients. The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared. Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA. Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.

Relato de caso de infarto esplênico em uma criança com atresia biliar

This case report is intended to describe a rare case of splenic infarction (SI) associated with biliary atresia, which contributed to the worsening of the prognosis. In this case study, a boy diagnosed with biliary atresia underwent the Kasai procedure at the age of 3 months. The patient presented an intense abdominal pain, ascites and fever at the age of 6 years. A computed tomography (CT) scan showed enlargement of the spleen and an image suggestive of SI. The symptoms improved with the administration of antibiotics, analgesics, while ascites decreased with the use of diuretics. Liver transplantation was indicated. SI is an extremely rare event characterized by vessel occlusion, parenchymal ischemia and tissue necrosis. The symptoms are non-specific and may be confounding factors with other causes of acute abdominal pain. Splenomegaly-inducing diseases may be a risk factor. There are few case reports of SI and cirrhosis of different etiologies in childhood. Abdominal CT scan with intravenous contrast is the imaging modality of choice and the treatment ranges from supportive care to splenectomy. Despite being a rare condition, its knowledge is extremely important, as it allows early clinical suspicion, with immediate institution of treatment, which may interfere with the prognosis.

Lesser Omental Infarction Presenting with ST-Segment Changes on Electrocardiography in A 37-Year Old Male: Coincidence or Causation?

Background: Omental infarction is a rare cause of acute abdominal pain. While the clinical presentation and diagnostic workup of omental infarction have been well-described in the literature, there is currently no published data on the relationship between omental infarction and Electrocardiogram (ECG) changes. Case presentation: A 37-year-old male presented with acute onset of epigastric pain, He had associated ECG changes, including ST elevation in V1 (1 mm), ST depression in leads II, aVF, and V4 so he was diagnosed with omental infarction after exclusion of acute coronary syndrome (ACS) via cardiac catheterization and echocardiography. The patient was managed conservatively with pain control and close observation and was discharged home in stable condition, The ECG changes resolved on follow-up 2 weeks later. Conclusion: Omental infarction should be considered in the differential diagnosis of patients presenting with acute abdominal pain and ECG changes. Further studies are needed to elucidate the pathophysiology of ECG changes in omental infarction and to develop optimal management strategies for these patients.