Cause Of Lower Abdominal Pain Research Articles

Torsion of a fallopian tube: a rare cause of lower abdominal pain in a female of reproductive age

Isolated unilateral torsion of a fallopian tube is an infrequent but significant cause of acute lower abdominal pain in a female of reproductive age. We present a literature review and the case of a 41-year old lady who presented with sudden onset right-sided lower abdominal pain radiating to right thigh. Clinical examination revealed tenderness in the right lower quadrant of the abdomen and a tender right adnexal mass was noted on vaginal examination. Transvaginal scan revealed an elongated, multiloculated right adnexal mass and a normal left ovary. No free fluid or ascites were noted. Torsion of a right hydrosalpinx was suspected and an emergency laparoscopy was performed which confirmed the diagnosis and a right salpingectomy was carried out. Isolated torsion of a fallopian tube should be considered in the differential diagnosis of lower abdominal pain in any female of reproductive age, particularly when she has a history of tubal sterilisation, oophorectomy and/or pelvic adhesive disease. <strong>Key words: </strong>torsion; fallopian tube; hydrosalpinx; adnexal mass; salpingectomy. DOI: <a href="http://dx.doi.org/10.4038/sljog.v33i2.4009">http://dx.doi.org/10.4038/sljog.v33i2.4009</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2011; <strong>33</strong>: 63-64

Epiploic appendagitis as an uncommon cause of lower abdominal pain

Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibility of diverticulosis.

Chronic Right Lower Abdominal Pain Due to Lumbar Ossification of the Posterior Longitudinal Ligament

To the Editor: As shown in this case, chronic right lower abdominal pain could be induced by ossification of the posterior longitudinal ligament (OPLL)-evoked damage in the lumbar nerve root. Lumbar OPLL should be considered to be one of the causes of lower abdominal pain. A 46-year-old Japanese man presented to the outpatient department with a 6-month history of right lower quadrant abdominal pain that had worsened over 1 month before presentation. The pain had no relationship to eating or bowel function but often had a relationship to posture. The pain increased when he moved from a supine to a sitting position. He underwent appendectomy when he was 12 years old. His height was 180 cm and body weight was 102 kg (body mass index 31.5). Physical examination revealed severe local tenderness over the right lower quadrant. Carnett's test (1), a clinical test in which abdominal tenderness is evaluated for differentiating abdominal wall pain from intra-abdominal pain, was positive, suggesting that the pain came from the abdominal wall but it was not intra-abdominal pain. Laboratory tests such as white blood cell count, C-reactive protein (CRP, transaminase, lactate dehydrogenase, creatine phosphokinase, lipase, and urine analysis were normal. The patient underwent computer tomography of the abdomen, which showed no abnormal findings in the abdominal cavity (Figure 1). However, computer tomography of the abdomen (arrows in Figure 1a,b) revealed L2–L3 OPLL, which occupied a part of the circumference of the spinal cord (Figure 1). This evidence led us to speculate that the lumbar OPLL might be related to the abdominal pain. As shown in Figure 2, a lumbar X-ray study showed a marked ossification of L2 (arrow) and a coronal computer tomography showed that OPLL was mainly located in the right side of L2 (triangle), which could narrow the right intervertebral foramina, which should pass through the spinal nerve root. The pain was completely relieved after an accurately placed nerve block to right L2 root. From these findings, we diagnosed that the abdominal pain could be induced by OPLL-evoked damage in the right lumbar nerve root. To our knowledge, there is no report describing abdominal pain in association with lumbar OPLL. OPLL is more frequently noted in males and elderly, and is more common in East Asian populations, particularly in the Japanese as in this case. The prevalence of OPLL is highest in Japan, at a rate of 1.9–4.3% (2). OPLL is a multifactorial disease and several gene loci may be involved in the pathogenesis of this disease (3). Although a number of authors have reported on OPLL of the cervical and thoracic spine, few have discussed OPLL of the lumber spine (4). It has been demonstrated that obesity and diabetes mellitus may have a role in the development of OPLL (5). In the present case, his body mass index was 31.5, suggesting that obesity might be involved in the development of OPLL in this case. Okada et al. (6) have reported that out of the 6,127 patients who underwent operations for degenerative lumbar spine diseases during the past 27 years, only 10 patients underwent surgery for lumbar OPLL, indicating that lumbar OPLL is very rare even in Japan. According to their analysis of the 10 patients with lumbar OPLL, unilateral radicular symptoms were most frequently observed and only two patients exhibited typical lumbar claudication caused by the canal stenosis although the rate of maximum canal stenosis brought about by OPLL was relatively high (mean 45.1%) in the 10 cases. These findings suggest that its clinical condition varies greatly among patients depending on the localization and degree of ossification. In fact, the present patient complained of right but not left lower abdominal pain, which could be explained by its unilateral radicular involvement by OPLL. In conclusion, in patients with lower abdominal pain of undetermined cause, OPLL should be considered as a possible underlying disorder.Figure 1.: Computer tomography (CT) of the abdomen showed no abnormal findings in the abdominal cavity but revealed L2 (a: arrow)–L3 (b: arrow) ossification of the posterior longitudinal ligament (OPLL).Figure 2.: A lumbar X-ray study (left panel) showed a marked ossification of L2 into intervertebral foramina (arrow) and a coronal computer tomography (CT) (right panel) showed that ossification of the posterior longitudinal ligament (OPLL) was mainly located in the right side of L2 (triangle).CONFLICT OF INTEREST The authors declare no conflict of interest.

A differential diagnosis in chronic lower abdominal pain

INTRODUCTIONSpigelian hernias represent 0.12–2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. PRESENTATION OF CASEA 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. DISCUSSIONA SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. CONCLUSIONIt's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center.

Gerota′s fascia over a pelvic ectopic kidney: Myth or reality?

Objective:To prospectively evaluate for the presence or absence of Gerota's fascia in a pelvic ectopic kidney, as this is not well documented.Materials and Methods:Between January 2007 and July 2011, all patients with normal renal functions presenting to the Urology Clinic with pelvic ectopic kidney were evaluated for the presence of fascia similar to Gerota's fascia. Specific evaluation included a contrast-enhanced computed tomography (CT) scan and open surgery where indicated. A literature search using PubMed was also done for the period between 1990 and May 2011 using the terms ‘Gerota's fascia’, ‘perirenal fascia,’ and ‘pelvic kidney’.Results:Eleven patients were evaluated. The mean age was 28.6 years (range 7 to 50). The presentation included stone disease in six, pelvi-ureteric obstruction in three, and as part of the evaluation for other causes of lower abdominal pain, it was found in two. A CT scan performed on eight patients did not show any evidence of fascia, while surgical exploration done on seven showed a well-defined fascial layer, at least on the ventral aspect of the kidney. A literature search also did not show any information about Gerota's fascia in the pelvic kidney.Conclusion:Further anatomical / radiological studies are needed to definitively document the presence of Gerota's fascia around a pelvic kidney. Our data is more in favor of the presence of such a perirenal fascia similar to Gerota's fascia.

Laparoscopic management of a fallopian tubal torsion complicated by a large hydrosalpinx

Clinical presentation of an adnexal mass is often non-specific and may mimic a range of gynecological pathology, as well as renal or gastrointestinal causes of lower abdominal pain. While a common entity, its association with a fallopian tube pathology is very uncommon. Imaging such as ultrasound has been diagnostic in the evaluation of a pelvic mass, and has been reported as assisting the diagnosis of fallopian tubal torsion. A pelvic mass of cystic nature can be removed by cystectomy, while treatment options for a torted fallopian tube include surgical detorsion if detected early, or a salpingectomy should there be evidence of necrosis. We report a rare case of fallopian tube torsion complicated by a large hydrosalpinx which was managed by laparoscopic surgery.

Infected Urachal Cyst Initially Misdiagnosed as an Incarcerated Umbilical Hernia

BackgroundUrachal abnormalities are a rare cause of lower abdominal pain. They are often initially mistaken for more common causes of lower abdominal pain, and the diagnosis is usually made during evaluation for one of these more common conditions. Case ReportWe report a case of a painful periumbilical mass ultimately diagnosed as an infected urachal cyst. Although the cyst was evident sonographically, it was misidentified as an umbilical hernia, and the correct diagnosis was not made until the patient underwent computed tomography of the abdomen and pelvis before surgery. ConclusionEmergency physicians should consider urachal disease in patients presenting with lower abdominal pain and should also be familiar with both the clinical and radiologic findings characteristic of this disease.

Acute Appendicitis

The term ‘appendicitis’ was first described by Reginald H. Fitz in 1886 and has since become the most common surgical emergency that can affect people of any age. Appendicitis is usually a clinical diagnosis so it is important for GPs to have a good understanding of the symptoms and signs of appendicitis in order to differentiate it from other causes of lower abdominal pain. GPs can play an invaluable role in the outcome of this condition as early referral can result in timely surgical intervention that leads to reduced morbidity.

Lumbo Sacral Spinal Pathology (L.S.S.P)- a Cause of Lower Abdominal Pain

Purpose: To analyze the cause of lower abdominal pain due to Non Abdominal Etiology. Methods: In our outpatient department a four year trial was conducted in more than 3,675 patients who had lower abdominal pain. These patients had been getting treatment in various centers for the same and had undergone elaborate investigations including routine blood, urine, stools, X-ray analysis, Gynec, Urological and C-T Scan of abdomen, with even virtual colonoscopy. Results: We examined all these patients with detailed Questionnaires including queries about their occupation and work activities. Of the 3,675 patients 80% ranged from 40 to 60 years of age with a female predominance of 78%, the females being mainly homemakers of medium income group family and the rest were males who were either farmers or with other occupations. The remaining 20% of the 3675 gave history of either fall from a medium high place or from a two wheeler or an accident 3 to 4 years earlier which was ignored. These were the main points of attraction from our questionnaires which was not revealed in any other centers where they underwent the earlier treatment. Conclusion: All these patients were screened with the help of our orthopaedic surgeons and were submitted for a skeletal evaluation with M.R.I. Scan of mainly LumboSacral Parts. As per the scans all these patients had either Disc prolapse indending on the Thecal sac or severe Osteoporosis leading on to the anterior Radiclitis. They were given adequate bone traction, mild painkillers and advised change in life style. Most of the patients were free from symptoms after Eight weeks. The rest required a bone bracing for one year. Hence patients with Lower abdominal pain not responding to conventional treatment require an Orthopaedic evaluation.

Isolated tubal torsion: specific signs on preoperative computed tomography and magnetic resonance imaging

Isolated torsion of the fallopian tube is a rare cause of lower abdominal pain and commonly occurs after menarche. Prompt identification of this entity can prevent irreversible vascular damage, but the diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging features on preoperative computed tomography and magnetic resonance imaging.

Akutes Abdomen aus gynäkologisch-sonographischer Sicht – Eine Darstellung der häufigsten Ursachen

In gynecological settings, a sensible approach to diagnosing acute abdomen or lower abdominal pain is to classify the cases into positive pregnancy tests (if the patient is known to be pregnant) and negative pregnancy tests (or if the patient is postmenopausal). Various forms of ectopic pregnancy and abortion are associated with early pregnancy. Once a pregnancy has been excluded, diagnostics should focus on pain in conjunction with adnexal findings, adnexal torsions, fibroids and infections. Sonography for evaluating morphology and blood circulation to organs and structures has a high diagnostic value, but should always be judged together with medical history, clinical, laboratory and any other imaging findings. Indeed, abdominal pain requires intensive interdisciplinary collaboration. Not rarely, there are several relevant causes of lower abdominal pain.

Adnexal torsion of mature cystic teratoma with hemorrhagic infarction: helpful findings on successive plain abdominal radiographs

Adnexal torsion is a relatively rare cause of lower abdominal pain in women, but in many cases it leads to a serious condition. We present a case of adnexal torsion of a mature cystic teratoma in which hemorrhagic infarction was reflected by progressive enlargement and wall thickening on successive plain abdominal radiographs. There has been no other report describing such changes of adnexal torsion on plain abdominal radiographs.

Torsion of bilateral paramesonephric cysts in young girls

Torsion of bilateral paramesonephric cysts in young girls

Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examination demonstrated a pericecal cystic mass (11 cm x 3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needle aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patient underwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The patient is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management; however, it is difficult on imaging studies.

Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis. A case report

The authors report the case of a 60-year-old male patient (B.S.). In November 2001 he developed intestinal symptoms: bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19–9), mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic with upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with moderate activity, gastroscopy revealed chronic gastritis, laboratory data were normal. Treatment was amended with mesalazine clisma and methylprednisolone (16mg), orally. Symptoms ameliorated, however, right lower abdominal pain persisted. US and CT examination demonstrated a pericaecal cystic mass (11×3.5cm). The final diagnosis of mucocele was based on fine needle biopsy and cytology. The patient underwent right hemicolectomy and excision of the mucocele. He recovered well; final histology revealed cystadenoma of the appendix. Follow-up was started: the patient is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, however, it is difficult on imaging studies and fine needle biopsy.

Postpartum Lower Abdominal Pain

Pains after labor can be as severe as those experienced during labor, particularly the commonly occurring lower abdominal “after-pains” that are associated with prolonged uterine contractions during breast feeding. Other causes of lower abdominal pain may not be physiologically based but are either direct complications of parturition, such as genital infection, or fortuitous, such as appendicitis. Although the focus of pain control during pregnancy has been on labor and delivery, pain thresholds decrease postpartum. Maternity services have identified postpartum pain symptomatology to be a current health care issue. Anesthesiologists and physical health therapists must therefore develop an active role in this neglected area of women’s health.

Lower abdominal pain syndrome in national hockey league players: a report of 11 cases.

Groin injuries are a major diagnostic and therapeutic challenge in sports medicine. The aim of this review is to describe the clinical and surgical findings associated with an atypical lower abdominal pain syndrome occurring in elite ice hockey players. Eleven professional ice hockey players from various National Hockey League teams were referred to the Montreal General Hospital between 1989 and 1996, suffering from atypical refractory pain and paraesthesia in the lower abdomen. Despite the use of conventional investigative procedures such as physical examination, ultrasound, bone scan, computed tomography scan, and magnetic resonance imaging scan, preoperative findings were consistently negative. Operative findings revealed varying degrees of tearing of the external oblique aponeurosis and external oblique muscle associated with ilioinguinal nerve entrapment. Repair of the external oblique tear, ablation of the ilioinguinal nerve, followed by a 12-week planned course of physiotherapy allowed all to return to professional ice hockey careers. While soft tissue injuries are the most common cause of groin pain in the athlete, tears of the external oblique aponeurosis and superficial inguinal ring have rarely been cited as a consistent cause of lower abdominal pain in athletes. Inguinal nerve entrapment is also rare in patients without a history of previous lower abdominal surgery. These 11 cases emphasize the importance of including another diagnostic possibility in the differential diagnosis of chronic overuse injuries of the lower abdomen.

Scar endometriosis: An unusual cause of lower abdominal pain in an adolescent

A 16-year-old primigravida presented with a 3-year history of right lower quadrant pain. Physical examination revealed a mass lateral to the edge of a low transverse abdominal incision from her cesarean section. Following surgical excision, histological examination revealed tissue consistent with endometriosis. The patient was discharged without complications with a diagnosis of scar endometriosis.

Differential diagnosis of appendicitis and pelvic inflammatory disease: A prospective analysis

Diagnosis of the cause of lower abdominal pain in women may be difficult because appendicitis and pelvic inflammatory disease often present similarly. In a prospective study of 118 women, we found that several criteria are useful in establishing this differential. These include (1) duration of symptoms, (2) the presence of nausea, vomiting or both, (3) a history of venereal disease, (4) cervical motion tenderness, (5) adnexal tenderness, and (6) isolated peritoneal signs in the right lower quadrant. Although no single finding can define the diagnosis, the history and physical findings reported herein provide a number of criteria which, when taken together, will usually allow a confident diagnosis of either appendicitis or pelvic inflammatory disease to be made. Attention to these items can improve precision in diagnosis and lessen the incidence of unnecessary laparotomy, which carries a well-documented complication rate of 10 to 20 percent.

Radiculitis Distress as a Mimic of Renal Pain

It is the experience of the urological author that radiculitis secondary to costovertebral joint derangement is the most common cause of lower abdominal pain. However, this pain is sometimes made worse when the patient is subjected to a flank incision for presumed renal disease, since the aftermath of a flank incision may be a downward pull on a rib owing to detachments of muscles attached to its superior surface. Emotional problems, too, befall many patients with radiculitis—despondency over delayed diagnoses or sensitivity at having been told their complaints are psychosomatic. Most often these difficulties disappear spontaneously once the pain is relieved. Definitive diagnosis requires orthopedic techniques. Unfortunately, few orthopedists are well versed or interested in the syndrome of renal pain. When they are, erroneous diagnosis can be corrected and a course of conservative or surgical treatment prescribed, with excellent results.