Cause Of Lower Abdominal Pain Research Articles

THE EFFICACY OF ANTIBIOTICS IN ACUTE APPENDICITIS TREATMENT : A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Acute appendicitis has been the most common cause of lower abdominal pain leading to emergency visits worldwide. To avoid major complications, appendectomy has remained the standard treatment for uncomplicated acute appendicitis for over a century. The aim: The aim of this study to show about the efficacy of antibiotics in acute appendicitis treatment. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Sciencedirect were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: The therapeutic effects of antibiotics and appendicectomy were comparable for the treatment of acute appendicitis.

Amyand's hernia unveiled: a case report on perforated appendix within the inguinal hernia sac

Background: Acute appendicitis (AA) is still a common cause of lower abdominal pain, which frequently leads to emergency room (ER) visits. A case of perforated appendix within the inguinal hernia sac was presented. Case presentation: The clinical journey of a 30-year-old male patient with acute right iliac fossa pain suggestive of recurrent appendicitis was detailed in this case report. The patient\'s complicated medical history, which included dostinex-treated hyperprolactinemia and a previous episode of conservatively managed appendicitis in 2017, sets the stage for complex diagnostic challenges. The patient complained of acute localized tenderness and pain in the right iliac fossa, but no gastrointestinal symptoms, fever, or diarrhea were present. The admission laboratory results showed elevated white blood cells (WBC) (15.2), hemoglobin (Hb) (15.8), and platelet (PLT) (191) levels. Computed tomography scans exposed a perforated appendix within the right inguinal hernial sac surrounded by inflammatory changes. Laparoscopic appendectomy revealed a perforated appendix within the inguinal hernial sac, necessitating omental dissection and drainage. The postoperative course was uneventful, with a 7-day hospital stay and subsequent OPD follow-up. Microscopic examination confirmed acute suppurative appendicitis with periappendicitis aligning with clinical and radiological assessments. Conclusions: Amyand\'s hernia is a rare type of hernia that involves the appendix. A perforated appendix within a groin hernia is unusual and necessitates immediate source control to manage infection and prevent sepsis.

RESEARCH ON DESCRIPTION OF ACUTE APPENDICITIS OF ULTRASONOGRAPHIC CHARACTERISTICS

Background: Acute appendicitis is one of the most common causes of lower abdominal pain leading patients to admit the emergency department. Besides those developed paraclinical tests, ultrasound is the priority to support the diagnosis. Objectives: To survey and update the ultrasonographic characteristics of acute appendicitis in diagnosis at Can Tho University of Medicine and Pharmacy Hospital. Materials and methods: A cross-sectional descriptive study of 115 acute appendicitis patients diagnosed at Can Tho University of Medicine and Pharmacy Hospital from December 2021 to July 2022, using SPSS 20 software to analyze data. Results: Among 115 patients that were diagnosed with acute appendicitis by ultrasound, the right iliac fossa was the most frequent location of the appendix (98.3%) and 1.7% of patients with acute appendicitis located behind the cecum. The direction signs suggested acute appendicitis on ultrasound were described by target sign and finger sign at 100%, appendiceal diameter >= 6mm at 97.4% and the average appendiceal length was 7cm ± 2cm. The indirection signs were fluid around the appendix (9.6%), fluid around right iliac fossa (4.3%), fecal stones in the appendix (8.7%), fluid in the appendix (16.5%), infiltrating around the appendix (74.8%) and lymph nodes response (7.8%). Conclusion: Our study updates data about acute appendicitis ultrasonographic image characteristic figures as well as a reference for clinical doctors to diagnose acute appendicitis by ultrasonography.

Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study.

Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.

Non-surgical management of acute appendicitis: a systematic review

Acute appendicitis (AA), one of the most common causes of lower abdominal pain, is the most common diagnosis given to young children admitted to the hospital with acute abdominal pain. According to statistics, the lifetime risk for AA was 9% in the USA, 8% in Europe, and 2% in Africa. Over the past 20 years, a rise in interest in the non-operative care of uncomplicated AA care has developed, most likely due to a more accurate analysis of postoperative complications and costs of surgical interventions, which are primarily connected with minimally invasive techniques, which are on the rise. This study aimed to evaluate the current literature on the non-surgical management of AA, thus, studies discussing the non-surgical management of AA between 2009 and 2022 were included. Initially, the non-operative treatment seemed possible to avoid appendectomy, reducing the need for surgery, surgical risks, and overall costs. Antibiotic therapy has a high success rate and is both feasible and effective; the risk of treatment failure is higher than the risk of appendectomy. Although the conservative treatment had a low overall failure rate, individuals who received upfront surgery had a greater complication risk.

Familial imperforate hymen among three sisters of varying ages from the same mother: Case report about an unusual family event

Imperforate hymen is a rare condition, occurring in 1 in 2000 females in childhood period. However, it is not an uncommon cause of lower abdominal pain in girls. Without careful history taking and a thorough examination, the diagnosis can easily be missed. We report three cases of girls aged 8 years, 6 years and 33 months born of the same mother with imperforate hymen, who presented with varying symptoms. It should be noted that the mother also had a history of imperforate hymen. The diagnosis of imperforate hymen was made by history, physical examination and abdominopelvic ultrasound scan. All girls had a successful hymenectomy followed by a complication free recovery. No other abnormalities were diagnosed. A high index of suspicion is paramount among girls born in families that have a history of imperforate hymen to ensure timely diagnosis and management. Exhaustive physical examination at birth or during puberty is mandatory which often guides the timing of hymenectomy and prevents the complications in this category of patients.

The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study.

Background Acute appendicitis remains the most common cause of lower abdominal pain leading to emergency visits. Even though the standard treatment of acute appendicitis remains appendectomy, in recent times, multiple randomized control trials and meta-analyses have deduced conservative treatment as a successful alternative treatment.During the coronavirus disease (COVID) pandemic, with a shortage of staff and resources, treatment with conservative management of uncomplicated acute appendicitis became very beneficial under certain circumstances and conditions. This study aimed to assess whether it is effective to manage patients with uncomplicated acute appendicitis with antibiotic therapy. Methodology This was a single hospital based retrospective, cross-sectional study from Jan 2015 to May 2020. Patients with clinical and radiological features of uncomplicated acute appendicitis with Alvarado's score >6 were included in the study. Patients were kept on antibiotics, intravenous fluids, and analgesia as part of a conservative regime. Those who failed to respond to conservative therapy were managed surgically. The follow-up period was six months. Results One hundred eighty-two cases of uncomplicated acute appendicitis were included and managed conservatively, of which 52.2% were males while 47.8% were females. The median age of the patients was 26 years. Conservative treatment was successful in 26.2% of the patients, with a recurrence of 5.5% in the six-month follow-up period. The mean number of days of hospital stay was three days in patients treated with conservativeor surgical treatment. Conclusion Conservative management is gaining popularity, and many centers are inclined towards non-operative management; however, appendectomy remains the gold standard treatment for appendicitis.

A study of incidental appendectomy during diagnostic laparoscopy performed to evaluate the causes of lower abdominal pain

Background: Diagnostic laparoscopy is a minimally invasive method for the diagnosis of intra-abdominal diseases by direct inspection of intra-abdominal organs whenever there is a diagnostic dilemma even after routine diagnostic workup. Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery. The study is performed to evaluate the causes of lower abdominal pain during diagnostic laparoscopy and to determine the benefits of incidental appendectomy.Methods: This study, performed at the department of surgery, B. J. medical college, Ahmedabad from May 2012 to October 2014 is a prospective study. Incidental appendectomy was performed during diagnostic laparoscopy in 30 patients with abdominal pain. Criteria such as symptomatology, aetiology of pain as found on laparoscopy, post-operative pain relief and complications were analysed.Results: Nearly two third of the patients who presented with intractable lower abdominal pain were females. Mesenteric lymphadenopathy was the commonest per-operative finding affecting half of the patients, followed by adhesions present in about one quarter of the patients. Gynaecological conditions represented about one third of the cases. All, except one patient, had satisfactory pain relief and no complications of incidental appendectomy over a one year follow up.Conclusions: We conclude that diagnostic laparoscopy is a very good and accurate tool to diagnose the causes of abdominal pain and should be routinely used where radiological investigations are inconclusive. Incidental appendectomy indeed has many advantages when performed in an appropriate age group and proper setting.

Meta-Analysis the Effect of Acupressure in Lowering Pain of Dysmenorrhea

Background: Dysmenorrhea is the most common cause of lower abdominal pain and has a negative impact on women's quality of life resulting in activity limitations. Non-pharmacological management can be used as an intervention in the management of dysmenorrhea. Acupressure is a therapy that is given by massaging or pressing certain points. The purpose of this study was to analyze the effect of acupressure therapy on reducing dysmenorrhea pain. Subject and Method : This study was a meta-analysis with the following PICO, population: Women aged 16-30 years old with primary dysmenorrhea. Intervention: administration of Acupressure Therapy. Comparison: Acupressure therapy was not performed. Results: Decreased pain in primary dysmenorrhea. The articles used in this study were obtained from three databases, namely Google Scholar, Pubmed, and Science Direct. Keywords to search for articles “Acupressure” OR “Acu­pressure Therapy” AND “Sanyinjiao Point (SP6)” AND “Hequ Point (LI4)” AND “Dysmenorrhea” OR “Primary Dysmenorrhea” OR “Menstrual Pain” AND “Randomized Controlled Trial”. The articles included are full-text English with a Randomized Control Trial study design from 2007 to 2022. The articles were selected using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application. Results : Meta-analysis of 9 randomized controlled trial articles from Asia and Europe concluded that acupressure therapy can reduce pain in primary dysmenorrhea (SMD= -0.66; 95% CI = -0.96 to -0.36; p < 0.001). Conclusion: Acupressure therapy can affect pain reduction in women with complaints of primary dysmenorrhea. Keywords: Acupressure, pain relief, primary dysmenorrhea Correspondence: Anisya Fajar Rahmawati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Mobile: +6285715840985. Email: anisyafajar25­@gmail.com. Indonesian Journal of Medicine (2022), 07(01): 51-60 https://doi.org/10.26911/theijmed.2022.07.01.06

Management of hemoperitoneum due to rupture of the ovarian cyst

Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.

Giant Ovarian Tumor Presenting as a Huge Abdomino-Pelvic Mass in a Teenage Girl: A Case Report

Ovarian cysts are common causes of lower abdominal pain and abdominal distention in females. While most of them are benign and rarely grow immensely to achieve a huge size, they may be neoplastic in origin, reaching enormous dimensions with minimum or without raising any symptoms.Here, we present an interesting case of a 19-year-old female,who presented with huge abdominal swelling and pain in whole abdomen from whom a 9.1 kg borderline mucinous ovarian cyst, occupying the whole abdominal cavity was removed.
 J Bangladesh Coll Phys Surg 2021; 39(2): 137-141

The Case Files

The Case Files

Diagnostic Efficiency of Multidetector Computed Tomography in the Evaluation of Clinically Equivocal Cases of Acute Appendicitis with Surgical Correlation.

Acute appendicitis is one of the most frequent causes of lower abdominal pain and requires immediate surgical intervention. The diagnosis often poses a lot of challenge even to experienced surgeon. Those patients with equivocal symptoms may require different imaging modalities like radiography, contrast examination and ultrasound with limited utility. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, however, resulted in improved diagnostic accuracy and also reduction of negative surgeries.ObjectiveWe intend to determine the diagnostic efficiency of MDCT in clinically equivocal cases of acute appendicitis correlating it with surgical/histopathological findings.Materials and methodsA group of 116 patients was included in this study. Spiral MDCT was performed in all these cases after administration of oral and intravenous contrast. All these patients underwent surgery and the CT findings were correlated with histopathology. Out of these 116 patients, 60 patients were male and 56 female. The age range was from three to seventy years and mean age was 28+1 years.ResultsThe results proved that MDCT had a sensitivity of 97.5%, specificity of 97.0%, and accuracy of 97.4% for the diagnosis of appendicitis with one false positive and two false negative cases. The study showed 100% accuracy in diagnosing acute appendicitis in children. In 33 patients, an alternate cause was identified with CT. The alternate diagnosis made on CT findings was consistent with the final diagnosis in 27 (81.8%) of 33 patients in whom there was no evidence of acute appendicitis. The clinical diagnosis disagreed with the CT diagnosis in six patients (18.18%).ConclusionOur study verifies that MDCT plays an important role in evaluation and consequent management of equivocal cases of acute appendicitis. MDCT is also able to diagnose appendicitis or detect alternative diagnosis in pediatric population.

A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)

Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. All adult patients in the age range 18 to 65years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Clinicaltrials.gov ID: NCT03080103.

Colonic ischemia: usual and unusual presentations and their management.

To provide an update on the epidemiology, pathophysiology, clinical presentation, and management of colonic ischemia. Formerly regarded as a rare cause of lower gastrointestinal hemorrhage, colonic ischemia is now recognized to be the most common manifestation of intestinal vascular compromise. In contrast to ischemic events in the small intestine wherein thrombotic and embolic events predominate, colonic ischemia typically results from a global reduction in blood flow to the colon and no occlusive lesion(s) are evident. Several risk factors for colonic ischemia have been identified and, together with an appropriate clinical presentation and patient demographics, create a context in which the clinician should have a high level of suspicion for its presence. Imaging with computerized tomography, in particular, may be highly supportive of the diagnosis, which where appropriate can be confirmed by colonoscopy and colonic biopsy. For most patients, management is supportive and noninterventional, and the prognosis for recurrence and survival are excellent. Colonic ischemia is a common cause of lower abdominal pain and hemorrhage among the elderly typically occurring in the aftermath of an event which led to hypoperfusion of the colon. For most affected individuals the ischemia is reversible and clinical course benign.

The comparison between the serum level of interleukin-6 in women with acute ovarian torsion and other causes of lower abdominal pain

The aim of this study was to investigate the role of serum Interleukin-6 (IL-6) as a predictive value to make decision for surgical interventions when ovarian torsion (OT) is suspected. This study was performed on 284 women with lower abdominal pain. IL-6 levels were compared between OT (n = 67, 23.6%) and control groups (n = 217, 76.4%). For the purpose of diagnosis of OT, sensitivity and specificity of IL-6 at the cut-off point of 9.6 pg/ml were 41.79 and 82.49%, respectively. Patients with ovarian masses on ultrasound and IL-6 >9.6 pg/ml were found to be 24 times more likely to develop OT. Patients with serum IL-6 >9.6 pg/ml who lacked blood flow in ovarian Doppler ultrasound had 40.75 times higher risk of developing OT. It seems that simultaneous use of Doppler ultrasound and serum IL-6 levels can be helpful for early diagnosis of OT and making decision for surgical intervention.

Isolated Tubal Torsion in a Postmenopausal Woman

Isolated Tubal Torsion in a Postmenopausal Woman Isolated torsion of the fallopian tube is an uncommon cause of lower abdominal pain. Most cases are reported in women of reproductive age and it is quite rare in pre-menarchal and postmenopausal women. Isolated tubal torsion has no pathognomonic clinical findings. Usually these cases may mimic an acute abdomen, and may be misdiagnosed as torsion of ovarian cyst, ectopic pregnancy, PID, acute appendicitis or degenerated myoma. In differential diagnosis, imaging methods such as ultrasonography, computerized tomography and magnetic resonance imaging are widely used. Laparoscopy or laparotomy should be performed for definitive diagnosis. Here we present a rare case of isolated torsion of the fallopian tube in a postmenopausal patient. This entity should be considered in the differential diagnosis in female patients presenting acute lower abdominal pain, even in the postmenopausal period.

Isolated Tubal Torsion in Adolescence: Case Report and Review

Background: Isolated torsion of the fallopian tube is a rare cause of lower abdominal pain in adolescence. Lack of specific clinical signs, images, and laboratory data make preoperative diagnoses difficult. This article presents a case of isolated torsion of the fallopian tube in an adolescent girl. Case: A 15-year-old girl presented with right lower abdominal pain for 6 days, and ultrasonography and magnetic resonance imaging (MRI) revealed a cystic mass on the left side of her uterus. Urgent laparoscopy was carried out according to the diagnosis of torsion of the left ovarian cyst. The procedure revealed torsion of the right fallopian tube with necrosis and swelling, so a laparoscopic salpingectomy was performed. Results: She was discharged, uneventfully, on the third day after surgery. Conclusions: During the reproductive period of life, prompt diagnosis and treatment are needed to preserve fertility for women. On MRI, the coiling-up sign described by Park et al. might be useful for diagnosis, while laparoscopy is also helpful for diagnosis and treatment. (J GYNECOL SURG 29:39)

Laparoscopic Treatment of Isolated Salpingeal Torsion in Children: Case Series and a 20-Year Review of the Literature

Isolated torsion of the Fallopian tube, without ovarian torsion, is a rare cause of lower abdominal pain. We report our experience with 4 recent cases, along with data from a 20-year review of the pediatric literature. The records of 4 cases encountered during a 3-year period were reviewed. A literature review was completed by searching Medline, Medline in Process, Embase, Current Contents, and BIOSIS from 1990 to 2010. All 4 patients were diagnosed on laparoscopy. Laparoscopic salpingectomy was performed in 3 cases and laparoscopic detorsion in 1. All three resected specimens revealed hemorrhage and gangrene of the salpinx, with an associated cyst in one. The pediatric literature review, including our report, revealed 33 case reports and case series with 45 patients. Fifty-six percent of cases represented primary torsion, and 44% were secondary to underlying tubal pathology. Thirty percent of girls were premenarchal. The mean age at presentation and symptom duration were 13.2±2.1 years and 5.8±12.5 days, respectively. Fever and leukocytosis were present in 27% and 63%, respectively. Ultrasound, computed tomography scan, and magnetic resonance imaging showed a sensitivity of 22% (8/36), 14% (1/7), and 40% (2/5), respectively. A correct preoperative diagnosis was considered in only 13%. Eighty-eight percent of cases were treated by salpingectomy, and 12% were treated by tubal detorsion. Long-term outcomes of detorsion were not reported. Isolated salpingeal torsion in girls is rarely diagnosed preoperatively, regardless of imaging technique. Laparoscopy is the intervention of choice for definitive diagnosis and management. Salpingectomy is the most frequent treatment. Detorsion without resection may be considered for selected cases, but the long-term outcomes of this approach are unknown.

O6 Seniority improves specificity: differences in PID diagnosis between different grades of clinician

BackgroundPelvic inflammatory disease is difficult to diagnose; dependent on interpretation of clinical symptoms and signs that lack sensitivity and specificity. Differences in the rates of PID diagnoses have been noted...