Cause Of Upper Abdominal Pain Research Articles

EP-34 A rare cause of upper abdominal pain – left gastric artery trapped in gastric band

Abstract Introduction Gastric banding has become one of the most commonly performed bariatric operations worldwide. Recognised complications are divided into; the laparoscopic approach, the band or the procedure itself. Gastric band misplacement is a rare but recognised early complication. Case description A 58-year-old patient presented to a district general hospital with a 6 day history of epigastric pain, incomplete dysphagia, vomiting, and constipation. Gastric band surgery had been performed 10 years prior in a UK tertiary centre. Diagnostic workup suggested the left gastric artery was trapped in the gastric band with no features of necrosis, perforation or obstruction. The patient was referred to the upper gastrointestinal surgical team and the band was removed laparoscopically and the patient had an uneventful recovery. Discussion Symptoms of gastric band misplacement may include nausea, vomiting, dysphagia, and upper abdominal pain. It is unusual that a malpositioned gastric band resulted in symptoms over 10 years after the procedure. Radiological evidence of gastric band misplacement in the literature is only reported in 0.07% of cases in plain radiograph. Surgical technique and experience are important to prevent band slippage, especially when considering the chosen placement and securing method. Conclusion This case describes an important late rare finding of complication following gastric band surgery. Consideration should be made in management for patients with gastric band presenting with gastrointestinal symptoms and a high level of clinical suspicion is needed to investigate and manage these patients.

Rare cause of duodenal obstruction in a young-age female: a case report

BackgroundGastrointestinal tract can be compressed by many vascular structures in the abdomen; such compressions may be incidentally found or may result in compression symptoms like abdominal pain and vomiting.Case presentationWe illustrate an uncommon cause of extrinsic compression of the third part of the duodenum by jejunal branches of the superior mesenteric artery in an 18-year-old female, presented with dull-aching epigastric pain and vomiting. Contrast Enhanced Computerized Tomography (CECT) showed atypical origin of the jejunal branches of superior mesenteric artery with relative space narrowing between it and the aorta, causing significant compression on the third part of the duodenum. Barium follow-through confirmed indentation of the duodenal lumen at the same level of the aberrant vessel. Conservative treatment failed to control her symptoms, and the patient referred to the surgery.ConclusionHigh index of suspicion is required for diagnosis of atypical causes of upper abdominal pain and vomiting. CECT guided by a well-descriptive comment of the treating doctor is very helpful diagnostic tool for detecting such rare condition. Barium studies still have a valuable role for determining the level of obstruction and confirming the diagnosis of such rare cases.

Right hypochondrial pain leading to diagnosis of cholestatic jaundice and cholecystitis: a review and case study

The gallbladder stores bile from the liver and releases it into the duodenum. Imbalance in bile components (typically, cholesterol) can lead to cholelithiasis, the crystallisation of choleliths (gallstones). Cholelithiasis is common, affecting a fifth of people in Western countries. The stones can become lodged in the biliary duct and obstruct bile flow. Bile obstruction affects levels of bilirubin, causing cholestatic jaundice. Associated symptoms include nausea, dark urine and pale stools. Gallstones can also cause cholecystitis, the inflammation of the gallbladder. They also often cause pain (biliary colic), especially sudden-onset, episodic, radiating right hypochondrial pain, and biliary pathology is the main cause of upper abdominal pain. Diagnosing these presentations requires a multispectral, holistic assessment comprising numerous investigations, including clinical history, liver function tests, Murphy's sign and abdominal ultrasound. Treatment is usually gallbladder removal surgery (laparoscopic cholecystectomy), with either bile duct exploration or endoscopic retrograde cholangio-pancreatography (ERCP). Good nurse–patient communication is essential to ensure quality of care. The case study presented here covers the assessment and biliary diagnosis of a female patient presenting with severe right hypochondrial pain. The review of existing evidence and the case study should help hepatobiliary nurses deliver quality care for patients presenting with symptoms of gallstones.

Upper abdominal pain

Abdominal pain is a frequent presentation to general practice; it comprises a wide range of different abdominal and extra-abdominal causes. Upper abdominal pain can be located in the epigastrium, the right and left upper quadrants, and renal angles. It may be associated with back or shoulder tip pain. Causes of abdominal pain can be benign or malignant, and may be life-threatening. Patients with upper abdominal pain may need urgent hospital admission, but many patients can be managed in the community. This article gives an overview of the important causes of upper abdominal pain, their assessment and management.

Antenatal cough-induced rib fractures: an uncommon cause of upper abdominal pain

Rib fractures secondary to cough are an uncommon cause of thoracic or abdominal pain in pregnancy. There is little in the literature describing this accidental phenomenon during pregnancy and why fractures occur so easily. In most cases, they are diagnosed fortuitously during the course of investigation for other more common causes of acute chest and upper abdominal pain. We report the case of a 38 year old, G11P5 who was 35 weeks pregnant, admitted with sudden onset right upper quadrant and right sided chest pain post coughing. This pain was caused by a 10th right rib fracture which was managed conservatively with analgesia. Despite numerous reviews, the fracture was not diagnosed. The patient also suffered a rib fracture on the contralateral side in a previous pregnancy.

Oesophagogastroduodenoscopy in patients with incidental cholelithiasis, its significance and therapeutic value: an observational study

Background:Cholelithiasis along with other causes of upper abdominal pain, have a similar mode of presentation. Often the cholelithiasis is an incidental finding not causative. Aims and objectives of this study was to determine the role of oesophagogastroduodenoscopy (OGDscopy) in patients presenting with upper abdominal pain and sonographically documented cholelithiasis being considered for cholecystectomy and to eliminate the confounding causes of pain and avoiding cholecystectomy in incidental cholelithiasis.Methods: 200 patients with upper abdominal pain (typical/atypical) and sonographically documented gallstones underwent OGDscopy. Patients with normal OGDscopy underwent cholecystectomy while it was deferred in those with positive OGDs copy findings. These patients were appropriately managed and followed up with a repeat OGDscopy at 6 weeks. All patients were re-assessed for resolution of symptoms at 6 weeks and those with persistence of symptoms in spite of a normal OGDscopy on reassessment were then subjected to cholecystectomy. Pearson’s chi-square test was applied to study association between type of pain (typical/atypical) and OGDscopy findings and type of pain (typical/atypical) and requirement for cholecystectomy.Results:Of the 200 patients, 120 presented with typical and 80 with atypical pain. Among those with atypical pain (n = 80), a significant 95% (76/80) had positive findings on OGDscopy while none of those with typical pain had positive finding on OGDscopy (p<0.005). Cholecystectomy to relieve pain was needed in all 120 patients with typical pain while only 17.5% (14/80) of those with atypical pain required cholecystectomy (p<0.005).Conclusions:The study shows that OGDscopy in patients with cholelithiasis can suggest alternative management plan particularly in those with atypical pain.

Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature.

Introduction. Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case. Methods. We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed. Results. Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure. Conclusions. In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis.

Imaging sketch of bedside ultrasonography to improve the diagnosis of rupture of splenic artery aneurysm

Not available.

Peptic Ulcer Disease and Misuses of Ulcer Healing Drugs in a Tertiary Care Hospital in Dhaka City

This prospective cross sectional study was conducted in Dhaka Medical College Hospital, Dhaka during July, 2013 to December, 2013. Hundred patients were included in this study. Peptic ulcer disease, presented as upper abdominal pain is one of the common disease with a number of underlying causes. Prospective analyses of 100 patients with upper abdominal pain were studied at medicine units of Dhaka Medical College Hospital, Dhaka. Of these 36 patients belonged to peptic ulcer, 20 patients to irritable bowel syndrome and 22 patients to non-ulcer dyspepsia. Next in order were helminthiasis (5 patients), cholelithiasis (4 patients), gastric carcinoma (4 patients), liver abscess (5 patients) chronic pancreatitis (3 patients) and acute pancreatitis (1 patient). Mean age incidence in this series was 39.47 years. Male and female ratio was 1.54:1. Forty patients were smoker with male and female ratio of 3.44:1.All patients had presenting feature of upper abdominal pain. Commonest site of pain was in the epigastrium in 48.08% of cases.Pain was burning in 43.27% cases, periodic pain in 24.03%, and nocturnal hunger pain in 33.65% of cases.Relief of pain after taking food were observed in 38.46%. Epigastric tenderness was present in 56.73% patients.The diagnosis of peptic ulcer disease, irritable bowel syndrome and non-ulcer dyspepsia, the three leading causes of upper abdominal pain, were suspected by history and physical examination but it was difficult to interpret these on clinical ground alone .Some routine and some selected investigation were done for confirmatory diagnosis.In this series, significant disparity detected between clinically diagnosed peptic ulcer diseases 90.38% and endoscopically confirmed peptic ulcer disease, 34.62% cases. As a consequence of wrong diagnosis of PUD, there are huge misuses of ulcer healing drugs and a great economic burden on patients (300 taka per month) and on the nation.DOI: http://dx.doi.org/10.3329/jom.v16i1.22386 J MEDICINE 2015; 16 : 27-34

A Rare Cause of Acute Upper Abdominal Pain: Diverticulitis of the 3rd Portion of the Duodenum

Duodenal diverticulitis is a rare cause of upper abdominal pain and is usually not considered when evaluating patients with acute upper abdominal pain. Furthermore, the duodenum is located near the pancreas and bile duct, and duodenal diverticulitis can be misdiagnosed as acute pancreatitis, cholangitis, cholecystitis, or other pancreatobiliary disorders such as pancreatic cystic neoplasms. Recently, we experienced a rare case of duodenal diverticulitis in the 3rd portion of the duodenum. The patient presented with deep seated upper abdominal pain aggravated by supine posture and relieved by sitting up. The patient was initially diagnosed with acute pancreatitis. However, serum levels of pancreatic enzymes were normal and abdominal CT scan revealed diverticulitis in the 3rd portion of the duodenum. The patient was successfully managed conservatively. Delayed diagnosis of duodenal diverticulitis can result in substantial morbidity and mortality if duodenal perforation occurs and should be considered as a possible cause of upper abdominal pain. (Korean J Helicobacter Up Gastrointest Res 2015;15:132-135)

Hereditary angioedema involving the duodenum. An unusual cause of upper abdominal pain

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 8 octobre 2014

Efficacy of Low-Fat Diet Against Dyspepsia Associated With Nonalcoholic Mild Pancreatic Disease Diagnosed Using the Rosemont Criteria

The objective of this study was to examine the efficacy of low-fat diet against dyspepsia in patients who had endosonographic evidence of nonalcoholic mild pancreatic disease. Patients with unknown cause of upper abdominal pain suggesting pancreatic disease without a history of alcohol consumption were prescribed a low-fat diet (<20 g of fat/d) for 4 weeks. Based on endoscopic ultrasonographic findings and the Rosemont criteria, the patients were distributed into those with 5 or more minor features of chronic pancreatitis (suggestive group), those with 3 or 4 (indeterminate group), and those with 2 or less (control group). Patients with major features were excluded. Symptom severity was recorded before and after the diet therapy using a 10-cm visual analog scale. Improvement of symptoms was compared among the 3 groups. Of 45 patients, 14 were in the suggestive group, 18 were in the indeterminate group, and 13 served as controls. Improvement of visual analog scale score was significantly greater in the suggestive group than in the indeterminate group (P < 0.001) and the control group (P < 0.001). A low-fat diet may be effective in patients with dyspepsia associated with endosonographic evidence of mild pancreatic disease, who do not habitually drink alcohol.

Rapid 13C Urea Breath Test to Identify Helicobacter pylori Infection in Emergency Department Patients with Upper Abdominal Pain

Introduction: In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing.Methods: We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February 2011 until February 2012 at a single academic urban ED. Enrolled subjects were tested for H. pylori using a rapid point of care 13C Urea Breath Test (UBT) [Exalenz Bioscience]. We compared patient characteristics between those who tested positive versus negative for the disease.Results: A total of 205 patients with upper abdominal pain were tested over 12 months, and 24% (95% confidence interval: 19% to 30%) tested positive for H. pylori. Black subjects were more likely to test positive than white subjects (28% v. 6%, P < 0.001). Other factors, such as age and sex, were not different between the 2 groups.Conclusion: In our ED, H. pylori infection was present in 1 in 4 patients with epigastric pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy.

Microlithiasis, endoscopic ultrasound, and children: not just little gallstones in little adults

PurposeBiliary microlithiasis is an uncommon but recognized cause of upper abdominal pain, cholecystitis, cholangitis, and pancreatitis in adults. Gallstones smaller than 3 mm may not be seen on transabdominal ultrasound and may only be seen on endoscopic ultrasound. This condition is poorly described in children. The aim of this study is to review the results of laparoscopic cholecystectomy to treat biliary microlithiasis in a pediatric case series. MethodsWe performed a retrospective case review of children with biliary microlithiasis who were treated with laparoscopic cholecystectomy. ResultsThree children were diagnosed with biliary microlithiasis. Two patients had recurrent right upper quadrant pain and nausea. A third patient had midepigastric pain and idiopathic pancreatitis. All 3 had a normal gallbladder on transabdominal ultrasound. Additional imaging with hepatobiliary scan, computed tomography, and magnetic resonance cholangiopancreatography revealed no biliary source for symptoms. Endoscopic ultrasound was performed on all 3 children, demonstrating microlithiasis of the gallbladder. Each child had a laparoscopic cholecystectomy with intraoperative cholangiogram. No abnormalities were seen on intraoperative cholangiogram. All 3 children had alleviation of pain and improvement of symptoms in postoperative follow-up. ConclusionChildren with biliary microlithiasis and associated clinical symptoms can be successfully treated with laparoscopic cholecystectomy. Endoscopic ultrasound should be considered in the evaluation of the child with clinical biliary symptoms and a negative transabdominal ultrasound result.

Stellenwert der routinemäßigen präoperativen Ösophagogastroduodenoskopie vor elektiver Cholezystektomie

Symptomatic gallstones and inflammatory diseases of the gastroduodenum are common causes of upper abdominal pain. PATIENTS / MATERIAL AND METHODS: We evaluated the data of 766 patients who underwent pre-operative oesophagogastroduodenoscopy before elective surgical treatment of cholelithiasis between January 1, 2003 and March 31, 2008. Pathological findings of an inflammatory nature were seen in 43.1 % (330 / 766), 25.2 % (197 / 766) of the patients had a chronic gastritis, 14.9 % (114 / 766) an acute gastritis and 3 % (54 / 766) a gastroduodenal ulcer. Non-specific upper abdominal pain was not significantly related to an inflammatory gastroduodenal dis-ease (p = 0.0755). Independent of the history (p = 0.1065), the therapy concept had to be -changed in favour of a primary non-surgical therapy in 16.3 % (125 / 766) of the examined patients due to relevant gastroscopic findings. The case history is not sufficient for identifying gastroduodenal disease requiring treatment in patients with symptomatic gall-stones. Therefore, contrary to the current leading concepts, preoperative oesophagogastroduodenoscopy should be discussed as a matter of -routine in patients undergoing elective cholecystectomy in order to treat pathological gastroduodenal findings.

Unusual Differential Diagnosis of Upper Abdominal Pain

We here present an interesting unusual case of upper abdominal pain. The patient was a 38-year-old man, who was admitted to our hospital complaining of right upper quadrant pain caused by a toothpick that perforated the anterior gastric wall and penetrated segment I of the liver. After endoscopic removal and an initially uneventful course, computed tomography revealed a perigastric abscess that was treated by repeated gastroscopic rinsing via an endoscopically placed catheter. After another three uneventful weeks, a liver abscess with minor tendency to constrict the portal vein was diagnosed, and a segment I liver resection together with abscess drainage was performed. The peculiarity of this case is the rarity of toothpick ingestion and gastric perforation in a young and healthy white Caucasian followed by development of a liver abscess after primary uneventful endoscopic removal. In light of this case, gastric perforation due to ingested foreign bodies such as toothpicks can be considered a rare cause of upper abdominal pain.

Small-bowel Diverticulosis: Imaging Findings and Review of Three Cases

Complicated small-bowel diverticulosis is a rather uncommon cause of upper abdominal pain. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis) and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we present clinical and morphological findings in three patients where small-bowel diverticulitis was surgically proven. The relevant literature is reviewed, and typical imaging properties are discussed.

Sclerosing mesenteritis as a rare cause of upper abdominal pain and digestive disorders

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery of unknown etiology, which can be mistaken for malignancy. We report a case of a 60-year-old male patient with sclerosing mesenteritis as a rare cause of upper abdominal pain and digestive disorders, and present the corresponding magnetic resonance imaging (MRI) findings indicative of the underlying disease.

Esophagogastroduodenoscopy Prior to Laparoscopic Cholecystectomy

Peptic ulcer disease and gallstones are common causes of upper abdominal pain. The benefits of routine gastrostroscopy before laparoscopic cholecystectomy have been controversial. Some cases of persistent abdominal pain after laparoscopic cholecystectomy have been attributed to peptic ulcer disease. We reviewed the significance of preoperative esophagogastroduodenoscopy in patients scheduled for laparoscopic cholecystectomy. We compared a group of patients who underwent esophagogastroduodenoscopy before laparoscopic cholecystectomy and a group of patients who underwent laparoscopic cholecystectomy with no preoperative esophagogastroduodenoscopy. Postoperative residual abdominal pain, esophagogastroduodenoscopy findings, hospital stay, and other variables were examined. There were 400 patients in this study: 218 (54.5%) patients underwent esophagogastroduodenoscopy while 182 (45.5%) did not. The mean age was 49.8 years, 311 were female and 89 were male patients. One hundred and twenty seven (31.7%) patients were diagnosed with acute cholecystitis and 273 (68.2%) were nonacute. In the esophagogastroduodenoscopy group, there were normal findings in 98 (45%) patients. Disorders such as hiatus hernia (21%), acute duodenal ulcers (3.6%), esophagitis (3.6%), gastric ulcer (0.4%), and Barrett's esophagus (0.4%) were among the findings. Laparoscopic cholecystectomy was avoided in six patients with chronic cholecystitis. Preoperative esophagogastroduodenoscopy did not reduce the incidence of postoperative residual abdominal pain; in fact, patients who underwent esophagogastroduodenoscopy had longer hospital stays (P = 0.02). Unlike chronic cholecystitis, esophagogastroduodenoscopy did not change the course of the planned surgery in acute cholecystitis. Esophagogastroduodenoscopy prior to laparoscopic cholecystectomy does not have an impact on postoperative residual abdominal pain; however, it can disclose other gastroesophageal disorders with similar symptoms to gallstones and may change the course of the planned surgery in chronic cholecystitis.

Is EUS with Doppler Comparable to Transabdominal Ultrasound As a Screening Test for Chronic Mesenteric Ischemia (CMI)?

Background: EUS has been proposed as a single test to evaluate persistent upper abdominal pain as it can diagnose virtually all of the common causes of upper abdominal pain. CMI, a potential cause of upper abdominal pain, has not been previously evaluated by EUS. As Doppler flow in the celiac artery (CA) and superior mesenteric artery (SMA) can be measured, we propose that EUS can be used to screen for CMI. Doppler transabdominal ultrasound (TUS) has been validated as a non-invasive imaging modality used to screen for CMI. A peak systolic velocity above 275 cm/s in the SMA and 200 cm/s in the CA predict >70% stenosis in the mesenteric vessels. Methods: Patients undergoing evaluation for chronic abdominal pain with suspicion of CMI who underwent either EUS or TUS were reviewed. Doppler measurements of the peak systolic velocity of the CA and SMA were recorded. In addition, any other diagnoses discovered during the EUS examination were recorded. If MRA was performed, the findings were compared with the values obtained during EUS or TUS. MRA was considered as the gold standard when available. A stenosis >70% was considered a positive test. Alternatively, if MRA was not available, a negative TUS and EUS was considered as a negative gold standard. Kappa statistics were used to compare the agreement between each diagnostic modality. Results: A total of 42 patients were included in the study (38 underwent EUS, 24 underwent TUS, 22 underwent MRA and 28 had a gold standard result available). Doppler measurements of the CA could be performed in all 38 patients (100%) and the SMA could be measured in 29 patients (76%). EUS and TUS had comparable accuracies evaluating the presence of abnormally elevated flow in the CA (85% vs. 88%) and SMA (96% vs. 95%). EUS and TUS had moderate concordance with MRA for the CA (kappa = 0.54, 0.54) and the SMA (kappa = 0.64, 0.63). When either the CA or SMA was positive, EUS predicted the presence of stenosis in the CA or SMA with a sensitivity of 80% as compared to TUS, which had a sensitivity of 67%. Of the 38 patients undergoing EUS, 19 examinations yielded additional diagnoses, which included chronic pancreatitis, pancreatic cyst, gastric and duodenal ulcer, choledocholithiasis and pancreatic cancer. Conclusions: CA and SMA Doppler flow measurements can be obtained during EUS examination. EUS measurements of the CA and SMA are as reliable as TUS in the detection of CMI. EUS has an advantage over TUS as it can yield alternative disorders that may be contributing to chronic upper abdominal pain. EUS with Doppler has the potential to be used as a single comprehensive test in the evaluation of persistent upper abdominal pain.