Chronic Pain Abdomen Research Articles

Audit of Diagnostic Laparoscopy in Tertiary Care Hospital

Objective: To conduct a thorough audit of laparoscopy as a diagnostic and therapeutic modality in patients with chronic pain abdomen.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Multan, from Jul 2015 to Dec 2021.
 Methodology: One hundred fifty-three patients with chronic abdominal pain were included in this study. The cause of pain in all patients was unknown despite undergoing thorough history, examination and appropriate investigations. Laparoscopy was performed in all patients, and findings were recorded accordingly.
 Results: A total of 153 patients were included in this study 67(43.8%) patients were male, and 86 (56.2%) were female. The mean age was 33.268±12.171 years (ranging from 15 to 60 years). The average duration of pain was 10.23±2.204 weeks. The diagnosis was confirmed laparoscopically in 143 patients (93.33%). Ten patients remain undiagnosed (6.66%). The most common cause was chronic appendicitis in 68(44.4%), followed by ovarian disorders 35(22.9%). There was a significant improvement in mean pain scores between the pre-and post-operatively periods [6.765±1.116 Vs. 2.961±1.572 (p-value< 0.001)].
 Conclusion: Diagnostic laparoscopy has a higher diagnostic and therapeutic accuracy in patients with chronic abdominal pain. It significantly improves post-operative pain.

Functional constipation: A commonand often overlooked cause for abdominal pain in children.

The most common causes for chronic pain abdomen in pediatric practice are functional abdominal pain disorders, a subgroup of functional gastrointestinal disorders under the Rome IV classification. Constipation is usually associated with painful defecation, but abdominal pain as a predominant or presenting symptom of functional constipation (FC) is not very well recognized. We conducted this study to ascertain the prevalence of FC in chronic pain abdomen and proportion of FC children presenting with predominant complaints of pain abdomen. Prevalence of FC and functional abdominal pain was ascertained separately over a1-year in children > 4 years of age in our hospital. The number of children with FC presenting with abdominal pain was noted. Abdominal pain site and duration werenoted in the FC group and werecompared with those in the functional abdominal pain group to find out any significance. Diagnosis was based on Rome IV criteria, but relevant investigations to rule out organic pathology were done whenever clinically indicated. The prevalence of abdominal pain was 22% in our gastroenterology service and that of FC was 27%. Among the children presenting with chronic abdominal pain, FC was seen in 10% of the patients and functional abdominal pain disorders in 34%. Among children presenting with constipation, 12% had pain as the sole complaint. However, some form of pain or pain as one of the symptoms was seen in 47.5%. FC is a major cause for abdomen pain in children and is often overlooked. Not attributing pain to constipation may delay the diagnosis, which may have poor prognosis.

TORSION OF NON- GRAVID UTERUS:ACUTE ON CHRONIC PAIN ABDOMEN IN FIBROID UTERUS

Torsion of non-gravid uterus is a rare condition. Clinical features are non-specic and the diagnosis is made at laparotomy. A 34 year old nulliparous woman , known case of broid uterus with chronic pain abdomen of 2 months duration, experienced sudden pain abdomen and vomiting of 2 days duration and she was provisionally diagnosed as red degeneration and managed conservatively. USG showed right cornual subserous broid of 7x7.2 cms with minimal blood ow and another 3.6x3.1 cm posterior wall intramural broid. Torsion of subserous broid was suspected and she was taken up for surgery. On opening the abdomen, the uterus was torted at isthmus by 180º in clock wise direction and the large subserous broid ≥ 15 cms was in POD . Detortion occurred while exteriorizing the broid and there were other multiple broids of type 7 to 2. Myomectomy was performed . Histopathology showed leiomyomas with extensive areas of infarction without any atypia.

Chronic pain abdomen in children: A prospective clinical study

Chronic pain abdomen in children: A prospective clinical study

Wandering spleen with torsion: a rare cause of acute abdomen in a 14-year-old girl

Wandering spleen is a rare condition and defined as the spleen that is not in its normal anatomical position due to lack or laxity of suspensory ligaments. Etiological factors are congenital and acquired. Splenic torsion, infraction, and rupture are life-threatening complications of wandering spleen. A 14-year-old girl patient presented to the emergency department with severe pain abdomen for 2 days. On physical examination, a large palpable mass in the mid of the abdomen was found, and CECT confirmed it as torsion of wandering spleen. Emergency exploration is done and splenectomy was done due to non-viability of the spleen. The Post-op period was uneventful. Acute torsion of wandering spleen is an extremely rare clinical entity and patient present in an emergency with clinical features of acute abdomen. They may also present with chronic pain abdomen and abdominal mass. Early diagnosis is vital for the preservation of the spleen. Radiological studies have an important role in an accurate diagnosis. Surgery is the gold standard treatment of wandering spleen. Surgery for splenopexy or splenectomy depends on the condition of the spleen during surgery. Timely diagnosis and interventions are crucial to prevent life-threatening complications of wandering spleen.

THE IMPACT OF ELECTIVE DIAGNOSTIC LAPAROSCOPY IN DIAGNOSING CHRONIC ABDOMINAL PAIN

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work ups, their pain remains a challenge to all known diagnostic and treatment methods. Objectives Of The Study: To study the advantages of diagnostic laparoscopy in identifying the etiology of undiagnosed chronic abdominal pain. Materials And Methods: Study Centre: Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. October 2019 to October 2020. Single-center cross-sectionalDuration Of Study: Study Design: study. All the patients who came to general surgery OPD during my one-year study period 35 {n = Z2 1-α/2 P (1-P)Sample Size: /e2 P=3% e= 5% Z=1.96}. All cases of undiagnosed (by conventional methods and investigations such asInclusion Criteria: detailed history, clinical examination, blood counts, urine examination, USG abdomen, Plain x ray abdomen) chronic abdominal pain>3months duration of both sex. All cases of undiagnosed chronic abdominal pain in patients >14years of age. Cases of clinically diagnosed chronic abdominal pain of >3 months duration not responding to the treatment given. Exclusion Criteria: Results:Persons suffering from any kind of cognitive dysfunction are excluded from the study. All 35 patients underwent Diagnostic Laparoscopy under General anaesthesia after all the conventional investigations did not yield any diagnosis. 35 patients in the age group of 15 – 69 years were involved in the study with the average age of presentation being 35 years. 66% of the study population were females. The most common nding at laparoscopy in our study was postoperative adhesions (51.42%). It was followed by patients who had a normal abdominal nding at laparoscopy (17.14 %) and recurrent appendicitis in 14.28 %. The average duration of hospital stay being 5.5 days. Therapeutic intervention done at the time of diagnosis relieved 70% of patients of their pain at the end of three months. DiagnosticInterpretation And Conclusion: laparoscopy has an effective diagnostic accuracy and therapeutic efcacy in the management of patients who present to us with chronic abdominal pain especially in whom conventional methods of investigations have failed to elicit a cause for the pain. Ability to pin point a cause for the abdominal pain or exclude a more major cause for pain not only avoids further investigations but also plays a signicant role in alleviating the fears in the minds of the patients. Laparoscopy prevents unnecessary laparotomy in a signicant number of cases. Diagnostic laparoscopy has a denitive role in the management of patients with chronic pain abdomen and should be an important investigative tool in the armamentarium of all practicing surgeons.

A Multicenter Cross Sectional Study to Evaluate the Role of Duodenal Bulb Biopsy in the Diagnosis of Celiac Disease

Background and Aim: A systemic immune disorder elicited by dietary gluten in people who are genetically predisposed to it is referred to as a celiac disease. D1 had been ruled out as a biopsy site due to concerns about Brunner's glands, peptic duodenitis, gastric metaplasia, and presumed reduced villous height. Due to histological confounding factors, the duodenal bulb (D1) as a biopsy site was traditionally avoided. The present study aimed to assess the duodenal bulb biopsy role in the diagnosis of celiac disease. Methodology: This multicenter cross sectional study was conducted on 108 celiac disease patients in the department of Gastroenterology, Bacha Khan Medical Complex, Swabi, North West General hospital Peshawar and Pir Abdul Qadir Shah Jilani Institute of Medical Science Gambat Khairpur, Sindh from September 2020 to July 2021. All the celiac disease patients were clinically symptomatic and had anti-tissue transglutaminase (anti TTG IgA) positive antibodies. Endoscopically, six mucosal biopsies were taken from each patient, four each from the distal duodenum and two additional biopsy separately labelled was taken from bulb. Modified Marsh grading was used for morphological grading. Results: Of the total 108 Celiac disease patients, 60 (55.6%) were females and 48 (44.4%) were male patients. the overall mean age was 32.62±6.4 years. Prior to diagnosis of Celiac disease, symptoms median duration was 5.4 years with a range of 6 months to 40 years. The most prevalent clinical presentation were iron deficiency anemia 43% (n=46) and chronic diarrhea 32% (n=35) respectively. Other clinical presentation were chronic pain abdomen, infertility, short stature, and cirrhosis. Elevated TTG of 117.1 ± 49.82 U/ml was measured in all the patients with a range of 20 to 250 U/ml. The incidence of similar and different modified Marsh grade was in 66 (61.1%) and 42 (58.9%) respectively at both site. Out of 42 different modified March grade patients, higher mucosal atrophy in bulb and descending duodenum showed higher grade in 16 and 26 patients respectively. Isolated bulb involvement was seen in nine patients. Due to bulb biopsy, Celiac disease diagnosis was correctly done in these patients. Conclusion: The present study supported the villous atrophy and intraepithelial lymphocytosis patchy nature in biopsy specimens of celiac disease. The diagnosis of celiac disease improved with inclusion of duodenal bulb biopsies in our sampling protocol. Celiac disease patchy nature and distribution demonstrated different Marsh grades in different biopsy sites. The celiac disease diagnostic yield is increased by combining the bulb and the descending duodenum biopsy. Keywords: Celiac Disease, Duodenal bulb biopsy, Modified Marsh grade

Unsuspecting Lead Points Causing Nonobstructing Intussusceptions in Pediatric Patients Presenting with Chronic Pain Abdomen

AbstractIntussusception is one of the common causes of bowel obstruction in pediatric age group and is of idiopathic variety in most of the cases. Nonobstructing intussusception presenting with nonspecific symptoms (or chronic pain abdomen) is rare and usually clinically misdiagnosed/difficult to diagnose. The authors present a pictorial review of 10 cases of pediatric nonobstructing intussusception presenting with acute/chronic abdominal pain which were not suspected clinically but diagnosed with a pathologic lead point radiologically.

STUDY TO EVALUATE THE ROLE OF LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN

INTRODUCTION : Chronic abdominal pain can be diagnostic challenge. Chronic abdominal pain is a signicant clinical problem that often leads to repeated laparotomies. Laparoscopy has a signicant diagnostic and therapeutic role in patients with chronic abdominal pain. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis and helps to plan surgical treatment. The main function of laparoscopic evaluation is to detect the presence or absence of intra abdominal organic lesion. AIMS AND OBJECTIVES : To determine the diagnostic and therapeutic role of laparoscopy in chronic abdominal pain. MATERIALS AND METHODS : All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2018 to Oct. 2019 in SHANTIRAM Medical College and General Hospital. The patient's demographic data, length of time with pain, diagnostic studies, intraoperative ndings, interventions and follow-up were determined. INCLUSION CRITERIA: Patients with history of abdominal pain for 3months or more, if physical examination and diagnostic tests are unrevealing. Patients with previous history of abdominal operation are included. RESULTS : A total of 25 patients (19 women and 6 men) with an average age of 34.64yrs underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral mbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. CONCLUSION : Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen

Laparoscopy in management of surgical causes of acute verses chronic pain abdomen in adults visiting tertiary care hospital in Telangana, India

Background: Pain abdomen accounts for about 14.2% of all emergency hospitalization. Many patients remain undiagnosed even after excluding the common disorders by meticulous investigations. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis. The current study aimed at comparing the role of laparoscopy in management of surgical causes of acute and chronic pain abdomen.Methods: A prospective study was done in 168 adult patients attending tertiary care hospital, selected by convenience sampling method. After clinical examination and relevant investigation, patients in need of diagnostic and therapeutic laparoscopic management were included in study. Laparoscopic findings and postoperative status of patients, with acute and chronic pain abdomen were compared with relevant statistical tests.Results: Mean age of patients was 35.8 years. Majority of the patients were females (58.3%). 41.1% and 58.9% patients had acute and chronic pain abdomen, respectively. Though more patients with chronic pain abdomen (58.9%) underwent laparoscopy when compared with acute pain abdomen (41.1%) it was not statistically significant, also post-operative status though found to be better in patients with chronic pain abdomen was not statistically significant.Conclusions: Though prevalence of laparoscopic intervention and better outcome was found more in patients with chronic abdominal pain in the present study it was not statistically significant.

TO FIND OUT THE THERAPEUTIC ROLE OF DIAGNOSTIC LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN AND COMPARING ITS EFFECTIVENESS WITH OPEN PROCEDURES.

Background & Method: All the patients with chronic pain abdomen admitted in general surgery under the Department of surgery Index Medical College and Hospital, Indore. The patient is placed on the operating table with the legs straight or lithotomy position if female. The operating table is tilted head up or down by approximately 15 degree depends on the main area of examination. Compression bandage may be used on leg during the operation to prevent thromboembolism especially if patient is in lithotomy position.
 Result: Laparoscopy has been proved diagnostic as well as therapeutic in 82% of the cases enrolled in our study.
 Conclusion: Laparoscopy (diagnostic and therapeutic) is simple, safe, available and diagnostically accurate procedure but it is not non-invasive, non traumatic, nor the first choice for diagnosis. It should be reserved for those situations after non invasive methods fail to make a diagnosis.
 Keywords: laparoscopy, therapeutic, abdominal & diagnostic.

A study on the impact of elective diagnostic laparoscopy in diagnosing chronic abdominal pain

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work ups, their pain remains a challenge to all known diagnostic and treatment methods. Aims and Objectives: We aim to evaluate the diagnostic and therapeutic efficacy of laparoscopy in the management of such patients in this prospective study. Materials and methods: Thirty five patients with chronic pain abdomen were included in this study. The pain in all these patients was either of unclear etiology or not responding to the treatment given after clinical assessment and lasting for more than 3 months duration. Pain of shorter duration and patients less than 14 years of age were excluded from the study. All patients were subjected to diagnostic laparoscopy and procedure. The results were tabulated and analyzed. Results: Females were more affected by this condition and the most common site of pain being the peri -umbilical region. A definitive diagnosis was made per operatively in 29 patients (82.85%) while in the remaining 6 (17.14%), no obvious pathology was detected. The most common findings in our study was post-operative adhesions (50%), followed by recurrent appendicitis (13.33%), Carcinoma (5.71%), Mesenteric lymphadenopathy and Tuberculosis (2.85% each). Pain assessment done at 1 month follow up showed pain relief in 80.55% and 3 month follow up showed pain relief in 70% of patients. Conclusion: Post-operative adhesions form a majority of cause for causing chronic pain abdomen. Diagnostic laparoscopy is a safe and effective modality for the diagnostic and therapeutic management of such patients.

Exploratory laparotomy in chronic non-specific pain abdomen in lieu of therapeutic and diagnostic aspect: a prospective non randomized trial on 40 patients

Background: A significant number of patients attending surgical or medical out doors and clinics of prominent doctors, we find them having thick record files visiting from one doctor to another. Majority of such patients diagnosis remain “chronic pain abdomen” in spite of all possible investigations and all sort of recent and ancient medicines. Aim of this study is to analyze the diagnosis and therapeutic value of exploratory laparotomy.Methods: A prospective non randomized study was done on 40 patients who follows our strict criteria and in spite of all relevant investigations’ diagnosis remain chronic nonspecific pain abdomen (CNSPA). Exploratory laparotomy was done and findings were recorded and analyzed to see its diagnostic and therapeutic value.Results: Patients of appendicular (maximum 27.5%) and tubercular disease present within one year of first appearance of pain whereas those having bands and adhesions after two years. Overall exploratory laparotomy was diagnostic and therapeutic in 80% patients.Conclusions: In selected patients of CNSPA exploratory laparotomy is therapeutic in 87.5% and diagnostic in 92.5% patients.

Inflammatory Fibroid Polyp of ileum causing Ileo-Ileal intussusception in a 38 year old female : A case report

Adult intussusception is a rare entity that is almost always associated with a demonstrable lead point. There has been a notable association between adult intussusception and inflammatory fibroid polyp (IFP) or Vanek’s tumour. These polyps are benign tumours arising from submucosa, comprising of mesenchymal cells like fibroblasts and numerous variably prominent small blood vessels along with chronic inflammatory cells commonly eosinophils. Inflammatory fibroid polyps are uncommon; moreover, these polyps causing secondary intussusception in an adult is still rarer. Clinical manifestations of IFP vary based on size and location within the GI tract. Here, we report a case of inflammatory fibroid polyp of ileum, presented as acute on chronic pain abdomen in a 38-year-old woman. The rareness of the disease made it a clinical challenge to subject the patient to laparotomy. However this patient underwent resection of the intussuscepted small bowel with primary anastomosis. The rareness of non-malignant condition being the cause for adult ileo-ileal intussusception and the clinical challenge associated with it makes it a case worth reporting.

A study of evaluation of chronic pain abdomen in pediatric patients by laparoscopy

Background: Pain in abdomen of chronic nature is common in children but being so common difficult to determine the exact cause. It has been estimated that around 2-4% of all the pediatric patients attend the outpatient department are due to pain in the abdomen that is of chronic nature in children. It has been seen that routine diagnostic and therapeutic procedures fail to make a justice of the diagnosis and management for the pain in the abdomen of chronic nature. The aim was to study the role of laparoscopy in children with chronic pain abdomen.Methods: Interventional follow up study was carried out among 19 children with pain in the abdomen of chronic nature. Detailed history pertaining to pain in the abdomen, history of surgical explorations was taken. As a part of the work up of a patient the investigations were done routinely. All children were evaluated by laparoscopy.Results: Majority of the children were in the age group of 11-12 years i.e. 42.1%. Male and female children were almost equal in distribution. USG was diagnostic in 9 patients (47.36%). Laparoscopy was diagnostic in all 18 other cases (95% cases). 73.68% had not complication after the procedure. Only four patients had fever after the surgery and only one patient had wound infection. Thus, overall the laparoscopic procedure was very successful. Laparoscopy and USG were equally effective in diagnosing inguinal hernia.Conclusions: Laparoscopy had better diagnostic value compared to ultrasonography. Laparoscopic intervention was successful with minimum complications.

Efficacy of Diagnostic and Therapeutic Laparoscopy in Chronic Abdominal Pain - A Hospital Based Prospective Study

Background: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. Methods: All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from July 2015 to June 2016. The patient’s demographic data, length of time with pain, diagnostic studies, intraoperative findings, interventions and follow-up were determined. Results: A total of 50 patients with an average age of 35.75 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 4 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 18, appendicitis in 16, cholecystitis in 2, cirrhosis in 2; ovarian cyst in 2, bilateral fimbrial cyst in 2 and 8 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. Conclusions: Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen.

Ovarian tubercular abscess mimicking ovarian carcinoma: A rare case report

Although genito-urinary tuberculosis is common, reports of isolated ovarian tubercular abscess are rare. Ovarian tubercular abscess may mimics that of an ovarian tumor, leading to diagnostic difficulties. We reported a case report of 35 years woman presented with chronic pain abdomen, weight loss, low-grade fever and a right ovarian mass on ultrasound, with a significantly elevated CA-125 level. On clinical and radiological evidence, diagnosis of ovarian carcinoma was made, and laparotomy was performed with resection of the ovary. Postoperative specimen sent for histological examination that revealed classic epithelioid granuloma and acid-fast bacilli were present in Ziehl-Neelsen stain. Patient was put on antitubercular regimen from our Dots center. She is improving clinical after taking antitubercular drug and is on regular follow up at our chest outpatient department. Ovarian tubercular abscess is common in young women living in endemic zones, but case report of isolated tubercular abscess is rarely reported. CA-125 can be raised in both ovarian tubercular abscess and ovarian carcinoma, and only imaging is not always conclusive. Laparotomy followed by tissue diagnosis can be helpful in this situation. As the prognosis and treatment outcome of ovarian tubercular abscess and ovarian carcinoma is different, proper diagnosis by laparotomy should be done. Early diagnosis of ovarian tubercular abscess is vital as untreated disease can lead to infertility.

English

A 28-year-old male patient presented with chronic pain abdomen in the right iliac fossa, intermittent vomiting and frequent defecation. Trans-abdominal ultrasonography and CT abdomen pelvis revealed long segment diffuse circumferential wall thickening of distal ileum, caecum and adjacent ascending colon. Colonoscopy revealed ulcers in the ileo-caecal valve with terminal ileal stricture. Blood eosinophilia, tuberculosis and parasitic infections were excluded. A diagnosis of enterocolitis was suspected. Brush biopsy could confirm the rare diagnosis of an eosinophilic enterocolitis with predominantly mucosal and sub-mucosal infiltration. The patient was started on corticosteroids. Six months later the patient relapsed with symptoms and signs of intestinal obstruction. Repeat ultrasonography showed the persistent bowel wall thickening. Colonoscopy showed stenosed and deformed ileo-caecal valve with chronic ulceration. Diagnosing Primary Enterocolitis is based on colonic biopsies, which is especially challenging in the absence of diagnostic criteria. It is necessary to eliminate secondary causes by ultrasonography/ CT abdomen pelvis. CT/MR imaging provides valuable information for diagnosis, guiding treatment and assessing response to therapy.

Wilkie’s Syndrome:A Rare Cause Of Duodenal Obstruction

Introduction: Wilkie’s syndrome is a rare disorder causing obstruction to the third part of duodenum due to acute angulation of superior mesenteric artery. It’s a rare but surgically curable cause of duodenal obstruction. Case report: We present a case of 19year old male patient with chronic pain abdomen and vomiting which was correlated to obstruction of duodenum due to acute angulation of superior mesenteric artery on CECT abdomen. Patient’s symptoms were dramatically improved following duodenojejunostomy. Conclusion: Wilkie’s syndrome is more prevalent and underdiagnosed. Surgery is the treatment of choice.

Comparative evaluation of serum fluoride levels in patients with and without chronic abdominal pain

BackgroundFluorosis ranks high among the major environmental health problems in India. Non-ulcer dyspeptic complaints are common in humans and it is a known fact that fluoride in drinking water, food and other items can cause these symptoms. MethodsFifty adult outpatients (mean age: 35.2±12.7y) with chronic abdominal pain of unexplained origin were tested for their serum, urinary, and drinking water fluoride (F) concentrations. These concentrations were compared with those of 50 asymptomatic outpatients (mean age: 37.4±11.5y) and analysed statistically. ResultsSerum F concentrations were higher than normal in 62% of the study group I and in 42% of the control group II with a mean of 0.065±0.03ppm (range: 0.010–0.421) in the former and 0.023±0.028ppm in the latter. Statistical analysis of the data by Student's t-test (unpaired) revealed a significant correlation (p<0.05) between chronic abdominal pain and elevated serum F. Urinary fluoride concentrations in group I were 0.87±1.67 (0.01–3.7)ppm. Seventy-three percent of the patients examined for urinary fluoride concentrations were having higher values than normal, whereas 27% patients had normal range urinary fluoride concentrations despite raised serum fluoride concentrations. ConclusionsIn the cases of chronic pain abdomen, chronic fluoride ingestion from drinking water and other sources can be the cause and should be evaluated in patients in which other parameters are normal.