Cause Of Acute Abdominal Pain Research Articles

Clinico-pathological Profile and Immediate Hospital Outcome of Acute Pancreatitis

Background: Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity andhospitalization. Knowing the details of the clinico-pathological presentation and outcome of the diseasemay aid the better understanding of the disease.Objective: The study was designed to assess the clinico-pathological profile and to estimate immediatehospital outcome of acute pancreatitis patients admitted into a tertiary care hospital. Materials and Methods: This hospital based cross-sectional type of observational study was conductedat Dhaka Medical College Hospital (DMCH), for one-year period (June 2018-May 2019).Total 106established cases of acute pancreatitis were included in this study. Data was analyzed by the SPSS 22Windows version and graph & chart were expressed by using SPSS 22 and MS Excel. The Result waspresented with tables and charts. Results: Among 106 patients, mean age of the patients was 42.5 ±11.3 SD (years), with male predominance(male: female-1.2:1). All of the patients complained abdominal pain (100%) while anorexia (48.1%), 43.4%had vomiting and 31.1% had fever. Regarding clinical signs, abdominal distension (45.3%), paralytic ileus(34.9%) and dehydration (43.4%) were found to be the major clinical signs. The common location of painwas in epigastric region (73.6%) with radiation to back in 20.8% patients. Pain was severe agonizing innature in 76.4% cases. Of all, gall stone disease (17.0%) was the most prevalent cause. According toAPACHE-II score, 74.5% patients had mild pancreatitis (APACHE-II <8) while according to Glasgowcriteria, 66.0% had mild disease (Glasgow score <3). Mean APACHE-II score was 7.07±2.50 and Glasgowscore was 2.90±2.33. Mean hospital stays were 8.9±3.6 days and NPO (nothing per oral) 4.9±1.9 days.Among the patients, 77.4% patients were alive and mortality rate was 22.6%. Conclusion: Although, a larger portion of the patients had no identifiable cause but gall stone was themost common etiology. Pain commonly located in epigastric region with radiation to back. Of all thecases, more than sixty percent of the patients had mild pancreatitis estimated by APACHE II score andGlasgow score. Mean hospital stays were about 9 days and nothing per oral was about 5 days. Overallmortality rate was 22.6%. J MEDICINE 2022; 23: 24-29

Heparin-induced rectus sheath hematoma in a COVID-19 patient with pulmonary emboli: a case report and literature review

Introduction: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities. Case presentation: The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated Covid-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism; therefore, the therapeutic dose of heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical; nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7.9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle. Conclusion: In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.

Evaluation of preoperative predictive factors that determine difficult laparoscopic interval appendectomy

Background: Appendicitis is one of the most widely recognised causes of acute abdominal pain. A wide range of treatment from medical management using antibiotics to a minimal invasive surgery can be done for appendicitis. The usual classical open approach of appendectomy is time tested treatment. However laparoscopic appendectomy is being increasingly preferred these days over classical open approach in majority of patients suffering from appendicitis. This study was undertaken to evaluate preoperative data that can serve as predictors of difficult laparoscopic appendectomy and help in planning of surgery.Methods: This was a prospective observational study that was done at department of surgery, government medical college, Srinagar for a period of three years. A total of 50 consecutive patients who underwent laparoscopic interval appendectomy were enrolled in this study. Various preoperative factors such as age, gender, body mass index, history of recurrent episodes, history of previous surgery, ultrasonographic findings and a few investigation results were studied to find their association with the difficulty in performing laparoscopic appendectomy and results were tabulated and analysed.Results: This study found a significant relation between body mass index, history of previous surgery, history of multiple episodes, C reactive proteins and difficulty in doing a laparoscopic interval appendectomy. However, we didn’t find any significant relationship between age, gender, ultrasonographic findings, serum bilirubin, transaminase levels, WBC counts and difficult laparoscopic interval appendectomy.Conclusions: Knowledge of these positive factors for difficult laparoscopic appendectomy could help surgeons during pre-operative assessment and take necessary precautions during laparoscopic appendectomy.

Accuracy of point-of-care ultrasonography compared to abdominal X-ray in the diagnosis of small bowel obstruction in emergency patients

Background: Small bowel obstruction (SBO) is a common cause of acute abdominal pain. Many diagnostic modalities are used to diagnose or rule out SBO. Objective: This study aimed to compare the diagnostic accuracy of SBO for point-of-care ultrasound (POCUS) to that of abdominal X-ray (AXR) using computerized tomography (CT) and/or patients' follow-up as the gold standard. Methods: This was a prospective, cohort study of a convenience sample of adult patients, who presented to the emergency department (ED) with signs and symptoms suggestive of SBO. Emergency medicine residents performed POCUS looking for sonographic signs of SBO. Abdominal X-ray and CT results were based on the radiologist's final report. Results: A total of 77 patients were enrolled in the study. The mean age was 56 years, and the mean BMI was 28 kg/m2. Point-of-care ultrasound had a sensitivity of 90%, specificity of 61%, +likelihood ratio (LR) of 2.3, and -LR of 0.159, compared to AXR, which had a sensitivity of 57%, specificity of 62%, +LR of 1.5, and -LR 0.69. Conclusion: POCUS performed by ED residents for the diagnosis of SBO has high diagnostic accuracy as compared to that of AXR, with a p-value of 0.046. The accuracy is higher if all the sonographic signs are present or absent.

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.

Rupture of Spleen During Pregnancy with Intrauterine Fetal Death Mimicking Rupture Uterus: A Case Report

Background: Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed event. The splenic rupture during pregnancy is difficult to diagnose because it shares signs and symptoms with other conditions such as uterine rupture and abruptio placentae. Case report: We report a case of a 26 years G3P2L2 who had splenic rupture following accidental fall from the stairs. She presented with acute abdominal pain with hemoperitoneum and intrauterine fetal death. Ultrasonography confirmed moderate amount of free fluid and fetal demise without any evidence of retroplacental clots. She was taken up for emergency laparotomy with a provisional diagnosis of rupture uterus. On laparotomy, massive hemoperitoneum due to splenic injury was noted. Hence, Splenectomy was done and she recovered without further complication. Splenic rupture should be considered in cases of trauma to the abdomen during pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss. The aim of the article is to highlight the fact that rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal complications. Conclusion: Sudden abdominal pain, pallor, and hypotension following any trauma may be a sign of splenic rupture. Resuscita-tion of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and uterine rupture in suspected cases of haemorrhagic shock.

Comparison Of C-Reactive Protein And High-Sensitivity C-Reactive Protein in Acute Appendicitis Patients With Normal White Blood Cells Counts

Objective: Acute appendicitis is one of the main causes of acute abdominal pain. The main goal of treatment is early diagnosis and emergency surgical intervention. Late diagnosis leads to complex acute appendicitis (gangrene, abscess, and perforation). Although the signs and symptoms of acute appendicitis are well known, it is sometimes difficult to diagnose. Various laboratory markers have been studied for the diagnosis of acute appendicitis, but none showed superiority over physical examination or imaging. In addition, the superiority of high-sensitivity C-reactive protein (hs-CRP) over C-reactive protein (CRP) in patients diagnosed with acute appendicitis has not been evaluated in any study to date. With the current study, we aimed to compare CRP and HsCRP values in patients with acute appendicitis whose white blood cells (WBC) are in the normal range. Materials and methods: In this study, serum levels of CRP and hs-CRP were measured in 45 patients with acute appendicitis (who had normal WBC values) and 42 healthy controls. The results obtained were statistically evaluated in terms of significant differences between the two study groups. In addition, ROC (Receiver Operating Characteristic) analysis was performed to determine the power of CRP and HsCRP in the differential diagnosis of acute appendicitis. Results: CRP and HsCRP levels of the patient group were significantly higher than the control group (0,002 and <0,001 respectively). ROC analysis results revealed that HsCRP has higher diagnostic power than CRP in discriminating between AA patients and healthy people. Conclusion: This study showed that HsCRP may be a more effective biochemical marker in the diagnosis of acute appendicitis instead of CRP.

Diagnosing and managing acute abdominal pain in children.

Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.

An effective and reliable marker in gradıng the severity of acute cholecystitis: Increased immature granulocyte percentage.

Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC at hospital admission is extremely important to choose the most effective treatment method and predict vital prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in grading AC severity. This retrospective study was carried out on 528 patients hospitalized due to AC diagnosis. Demographic data, white blood cell (WBC) count, neutrophil lymphocyte ratio (NLR), IG%, C-reactive protein (CRP) levels, and imaging results of patients were recorded. Furthermore, patients' length of hospital stay was determined. Tokyo Guidelines were used to grade AC severity. According to this grading, patients were classified into three groups as grade 1 (mild), grade 2 (moderate), and grade 3 (severe) AC. Differences among groups were analyzed statistically. There were 386 patients (73.1%) in the mild AC group, 102 patients (19.3%) in the moderate AC group, and 40 patients (7.6%) in the severe AC group. WBC, NLR, CRP and IG% were significant parameters in discriminating mild AC from moderate and severe AC. However, only IG% was a significant parameter in discriminating moderate AC from severe AC. Moreover, the power of IG% to discriminate between patients with mild and moderate AC and those with severe AC was dramatically higher than the other parameters. Increased IG% is seen as an effective and reliable predictor in the early determination of AC severity.

Biochemical and Radiological Parameters in Acute Pancreatitis among Patients from a Rural Community of South India: A Retrospective and Correlational Study

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.

Appendicitis Inflammatory Response Score in Acute Appendicitis: A Study at a Tertiary Care Center in North India.

Appendicitis is a common cause of acute abdominal pain. The diagnosis is eminently clinical and the cause is surgically correctable. However, a decision of surgery based on the clinical presentation only has a 15%-30% chance of the removal of a normal appendix. Thus, the diagnosis involves a corroboration of clinical, laboratory, and radiological findings. Appendicitis scoring systems can be considered to expedite the diagnostic and decision-making process. The present study was conducted to study the efficacy of Appendicitis Inflammatory Response (AIR) score in the diagnosis of acute appendicitis and its correlation with the histopathological findings. A cross-sectional study was conducted at a tertiary care center in North India comprising patients who presented to the surgery department with a provisional diagnosis of acute appendicitis and required appendectomy. Appendicitis was histopathologically proven in 54 patients. Patients with an AIR score ≥5 were 2.18 times more likely to have appendicitis. The probability of having appendicitis with AIR score ≥5 was 92.16% (positive predictive value). The diagnostic accuracy of AIR score was 82.81%. AIR score has a high sensitivity and positive predictive value in the diagnosis of acute appendicitis. It is a quick and convenient system for clinical evaluation of patients in primary care or peripheral hospitals where advanced facilities such as USG scan or CT scan are not available all the time. The application of this scoring system definitely improves diagnostic accuracy and reduces negative appendectomy rate.

Efficacy of Prednisone in Children with Acute Nonspecific Mesenteric Lymphadenitis: A Pilot Study.

Acute nonspecific mesenteric lymphadenitis (ANML) is a common cause of acute abdominal pain in children with no specific treatment. A total of 13 patients (6 boys, 7 girls) aged 7.3 (5-13.5) years with severe acute abdominal pain were evaluated using ultrasonography and laboratory tests to establish the diagnosis of ANML. They were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. The intensity of abdominal pain was evaluated before and after treatment using a numeric rating scale. All patients had pain scores above 6/10 before, and below 4/10 after treatment with prednisone. Intensity of abdominal pain after treatment for 1-5 days decreased significantly (p < 0.001), with no recurrence at follow-up within 3 months. All other pre-existing signs and symptoms, such as nausea, vomiting, anorexia, fever, diarrhea, and constipation were found to disappear with no adverse effects of corticosteroid therapy. These results suggest that the treatment with prednisone in selective patients with ANML can reduce the duration of abdominal pain.

Evaluation of validity of scoring systems in diagnosing acute appendicitis: a single centre prospective observational study

Background: Acute appendicitis is a very common cause of acute abdominal pain, requiring surgical intervention with a 7% life time risk. Various clinical scoring systems like Alvarado, appendicitis inflammatory response (AIR), Tzanaki scores enables risk stratification. In this study, we have validated the diagnostic accuracy of various scoring systems like Alvarado, Tzanaki and AIR scores. Methods: We conducted a prospective observational study for patients admitted in a tertiary care hospital. A total of 81 patients were selected based on the inclusion and exclusion criteria. A detailed clinical history, physical examination, relevant blood investigations and necessary imaging were done for all the patients. Using the above data, the probability of acute appendicitis is calculated using the Alvarado, Tzanaki and AIR scores. The various scores obtained were compared with the histopathological examination (HPE) reports (reference standard) and values like sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.Results: With regard to scores, Alvarado scores has a sensitivity 95.24%, specificity 77.78%, PPV of 93.75%, NPV of 82.35%. Tzanaki score has a sensitivity of 100%, specificity 23.5%, PPV of 83.12% and NPV of 100%. AIR score has a sensitivity of 95%, specificity of 66.67%, PPV of 89.06% and NPV of 82.35%. Conclusions: Alvarado score (cut off 7) has the best PPV (93.75%) and hence is the best scoring system to “rule in” a positive diagnosis. However, Tzanaki score (cut off 8) has the best NPV (100%) and hence is the best score to “rule out” a diagnosis of acute appendicitis.

A retrospective case series study for acute abdomen in general surgery ward of Aliabad Teaching Hospital

IntroductionAcute abdomen means, the patient complains of acute abdominal symptoms that suggest a disease, which definitely or possibly threatens life and may or may not demand immediate operative interference, but often requires emergency surgical therapy. The diagnosis and management of acute abdomen forms a large part of routine duties of a general surgeon throughout his career. ObjectiveThe aim of this study was to clarify the clinical profile of acute abdomen and their frequency according to age and sex in general surgery ward of Aliabad teaching hospital. Patients and methodThis descriptive retrospective study was performed by reviewing medical records (In-patient file) of 299 patients who admitted with diagnosis of acute abdomen between March 21, 2018 and March 21, 2019 in general surgery ward of Aliabad teaching hospital. ResultsMales were affected more than females with male to female ratio being 1,14:1. Highest number of patients were in 15–24 years of life (n = 122, 40,8%). The most common cause was found to be acute appendicitis for acute abdomen, accounting for 57,5% of total admission. It was followed by acute intestinal obstruction (20,7%) and acute cholecystitis (10,4%). The most common symptom was abdominal pain and most common surgical procedures were open appendectomy for acute appendicitis followed by explorative laparotomy. The complications (Clavien-Dindo = IIIb) and mortality rate in our study were 17% and 3.6% respectively. ConclusionAbdominal pain is one of the cardinal and common symptom of acute abdomen in the emergency department. The causes of acute abdominal pain have a wide range and their relative incidence varies in different populations. Clinicians think seriously multiple diagnoses, especially in those cases that require immediate intervention to limit morbidity and mortality.

Non-surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis.

Background:Ectopic pregnancy (EP) is a common cause of acute abdominal pain in the field of gynecology. Because the majority of women with EP are hemodynamically stable, non-surgical therapy is a viable option. The goal of this study was to determine the most effective non-surgical therapy for hemodynamically stable EP.Methods:We performed a systematic review and meta-analysis. We searched PubMed, LILACS, SciELO, CINAHL, Embase, and the Cochrane library in May 2020, with no starting date restrictions.Studies were restricted to randomized controlled trials, which were included if the target population contained women with tubal EP and the intervention was non-surgical management. The primary outcome measure was treatment success defined by a decrease in serum hCG to a level ranging from five mIU/mL to 50 mIU/mL. Secondary outcome measures were side effects, time needed to treat, number of injections and operative rate.Results:We conducted a meta-analysis of 15 studies that included 1573 women who were diagnosed with EP and managed non-surgically. There was no significant difference in treatment success in the matched groups; however, single-dose MTX was associated with fewer side effects than multiple-dose (relative risk 0.48, 95% confidence interval 0.28–0.80, P = .006) and two-dose therapies (relative risk 0.74, 95% confidence interval 0.55–1.00, P = .05).Conclusions:We highly recommend that single-dose MTX without mifepristone be used first-line in patients who require conservative therapy due to the inherent negative effects of mifepristone. An EP woman with a low -hCG level that is falling or plateauing should receive expectant treatment to reduce adverse effects.

Torsion of the omentum: A rare cause of acute abdomen.

Omental torsion is a rare cause of acute abdominal pain. Diagnosis of omental torsion is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common preoperative diagnosis is acute appendicitis and the proper preoperative diagnosis is important for the appropriate treatment option. Diagnosis of omental torsion is difficult and mainly based on ultrasound and computed tomography (CT) scan analysis. Case Presentation: A 26 years old male patient presented to emergency department with acute abdomen mimicking acute appendicitis. The chest and abdominal X-rays were normal. Due to intense clinical signs and worsening of the symptoms the patient underwent an operation with the probable diagnosis of acute appendicitis. In this case patient explored via gridiron incision, the omentum was found to be gangrenous that had encased the appendix so midline incision given. Post-operative recovery was uneventful. Conclusion: Omental torsion is highly uncommon cause of right lower abdominal pain and difficult to diagnose preoperatively. It presents with non-specific symptoms, mimicking other abdominal conditions presenting a similar clinical settings. CT scan is very helpful in diagnosis. Surgical treatment is the procedure of choice with laparoscopy being the preferable approach.

A case report of an isolated superior mesenteric artery dissection caused by childbirth

BackgroundThe isolated superior mesenteric artery dissection (SMAD) is a rare and sporadic cause of acute abdominal pain. It most frequently affects male patients in their fifth to sixth decades, while our patient was a young woman who delivered a baby before the onset of abdominal pain. Possible risk factors for SMAD include hypertension, arteriosclerosis, abnormalities in elastic fibres, trauma, and pregnancy. In our case, delivery was suggested as a risk factor, which has not been reported previously.Case presentationA 27-year-old woman complained of acute severe upper abdominal pain and vomiting for 2 days after delivery. The patient had no significant medical history. Physical examination revealed epigastric mild tenderness. All routine blood tests, blood coagulation analysis, liver function tests and abdomen computed tomography showed no remarkable findings. Computed tomography angiography revealed a marked dissection 3.5 cm below the superior mesenteric artery ostium. Since distal blood flow existed and the patient was in a puerperal state with no evidences of mesenteric ischemia, she was managed conservatively, including intestinal rest by fasting, parenteral nutritional support and antibioticis, without anticoagulants or antiplatelet agents. Fortunately, she recovered smoothly and had no recurrence.ConclusionsSMAD is a rare and sporadic cause of acute abdominal pain that occurs in young women after delivery.

Causes and Management of Acute Abdominal Pain in Children: A Review Article

Acute abdominal pain is one of the commonest prevalent grievances in children, and it frequently requires emergency room diagnosis and management. Abdominal pain in children differs with age, concomitant symptoms, and pain site. While most cases of acute abdominal embarrassment are self-limiting and benevolent, there are certain diseases that can be life-threatening and necessitate instant care, such as appendicitis, intussusception, or intestinal obstruction. To decide the cause of acute abdominal pain and recognize children with surgical conditions, scrupulous history taking and numerous physical checkups are mandatory.The most important and realistic first goal in the evaluation of acute AP is to distinguish between surgical and nonsurgical situations, which are further divided into urgent and non-urgent categories. A thorough history and physical examination, laboratory investigations to evaluate comorbidity, and imaging scans are usually used for these purposes. Management decisions should necessitate teamwork between the emergency room physician, a surgeon, and a radiologist. Consecutivereassessment and symptomatic treatment with hardworking follow-up are necessary for management as soon aspossible in urgent disorder.

Neutrophil-to-lymphocyte ratio for the diagnosis of pediatric acute appendicitis: a systematic review and meta-analysis.

Acute appendicitis (AA) is one of the most common surgical emergencies and causes of acute abdominal pain in the pediatric population. However, it can be difficult to diagnose in children. We aimed to provide updated evidence on the diagnostic utility of the neutrophil-to-lymphocyte ratio (NLR) for AA, along with other conventional biomarkers, in pediatric patients. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for eligible articles published up to May 16, 2021. We included 19 studies comprising a total of 5,974 pediatric cases. The overall sensitivity and specificity of the NLR were 0.82 (95% confidence interval [CI]: 0.79-0.85) and 0.76 (95% CI: 0.69-0.81), respectively. The overall diagnostic odds ratio was 14.34 (95% CI: 9.05-22.73). The area under the summary receiver operating characteristic curve was 0.86 (95% CI: 0.83-0.89). The pooled sensitivity and specificity of other biomarkers were as follows: 0.79 (95% CI: 0.71-0.86) and 0.66 (95% CI: 0.54-0.77) for the white blood cell count, 0.73 (95% CI: 0.69-0.77) and 0.68 (95% CI: 0.55-0.79) for the C-reactive protein level, 0.75 (95% CI: 0.65-0.82) and 0.78 (95% CI: 0.72-0.83) for the absolute neutrophil count, and 0.83 (95% CI: 0.79-0.87) and 0.68 (95% CI: 0.53-0.80) for the neutrophil percentage, respectively. The NLR has moderate predictive power for AA and can be used as a simple, auxiliary tool for diagnosis. NLR can also help clinicians decide whether to perform imaging testing when the clinical symptoms or physical examination findings are vague.

Etiologies of abdominal pain emergencies in pediatrics

Reports showed that children usually complained of acute abdominal pain, which indicated the presence of severe underlying conditions and can have significant clinical importance. Serious challenges have been reported in healthcare settings where an urgent evaluation of the cases was necessary to adequately manage the patient before developing serious complications that might even end up with death. Some of these conditions included intussusception, appendicitis, volvulus and adhesions. Although estimates indicated that only around 1% of pediatric patients with acute abdominal pain usually required surgical intervention, concerns regarding the overlooking and misdiagnosis of significant conditions that might have severe prognostic outcomes were aroused among the different emergency departments. This study reviewed the common causes of acute abdominal pain among children admitted to the emergency department. Our results indicated that various etiologies can develop acute abdominal pain and therefore, establishing an adequate diagnosis by differentiating between the different etiologies should be done by the attending physicians to enhance the outcomes and adequately manage the admitted patients. Gastrointestinal causes of acute abdominal pain were the commonest to cause admissions to the emergency department. However, care should also be provided to the less common conditions, which might include genitourinary and pulmonary disorders and therefore, a thorough examination of children should be provided not to conduct a misdiagnosis of the underlying condition.