Clinical Signs Of Acute Abdomen Research Articles

Atraumatic splenic rupture in a child with COVID 19

BackgroundThe majority of children with COVID-19 have only minor symptoms or none at all. COVID-19, on the other hand, can cause serious illness in some children, necessitating hospitalization, intensive care, and invasive ventilation. Many studies have revealed that SARS-CoV-2 affects not only the respiratory system, but also other vital organs in the body. We report here a child with an atraumatic splenic rupture as the initial and only manifestation of COVID-19.Case presentationA 13-year-old boy with clinical signs of acute abdomen, left-sided abdominal pain, and hemodynamic instability was admitted to the PICU in critical condition. His parents denied any trauma had occurred. In addition to imaging tests, a nasopharyngeal swab was taken for COVID-19 testing, which was positive. The thoracic CT scan was normal, whereas the abdominal CT scan revealed hemoperitoneum, splenic rupture, and free fluid in the abdomen.ConclusionsThe spleen is one of the organs targeted by the SARS-CoV-2. Splenic rupture, a potentially fatal and uncommon complication of COVID-19, can be the first and only clinical manifestation of the disease in children. All pediatricians should be aware of the possibility of atraumatic splenic rupture in children with COVID-19.

P0100 / #666: SURVIVAL OF NEUTROPENIC ENTEROCOLITIS (NEC) ACCORDING TO THE DEGREE OF NEUTROPENIA IN PATIENTS TREATED IN THE INTENSIVE CARE UNIT (ICU).

Aims & Objectives: Introduction: NEC is a complication associated with neoplasms and manifests with sepsis and acute abdomen, mortality can increase up to 50%. The phenomenon is associated with bacterial translocation regardless of the degree of neutropenia. However, there is a relationship inversely proportional to the neutrophil count. Objectives: To determine the probability of survival according to the degree of neutropenia classified by the World Health Organization (WHO) in pediatric patients with hemato-oncological diseases with NEC. Methods: Retrospective prognostic cohort study between 2009 and 2017. Setting and Participants: Patients with cancer and NEC (defined by sepsis with neutrophils <1500 cel/mm3 and clinical signs of acute abdomen confirmed by an imaging studies) hospitalized in the ICU. Patients with previous NEC or digestive tract tumors were excluded. Time 0 was considered at the time of admission to the ICU and a follow-up was guaranteed until day 28. The outcome measure was death and the degree of neutropenia by WHO. Survival analysis by Kaplan Meier estimator. Results: 150 patients were included, median age of 93 months (36-147), 87 (57%) were females, mortality was 37%. Leukemia accounts for 52% of neoplasms included. The probability of survival by degree of neutropenia was:1500 cell/mm3 of 79%, 1000-1499 cell/mm3 of 65%, 500-999 cell/mm3 of 45%, 100-499 cell/mm3 of 42%, <100 cell/mm3 was 31% (p<0.001). The hazard ratio(HR) by degree of neutropenia was 3.7 (95% CI, 2.4-18) Conclusions: The mortality rate in these patients was similar to septic shock. We determine a decrease of survival directly proportional to the neutrophil count in our patients

CT-Guided Percutaneous Drainage of Pneumoperitoneum Presenting as Acute Abdomen

PurposeTo evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen. Materials and MethodsIn this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51–85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0–10). Patient records were reviewed to determine PD-related adverse events and median drain duration. ResultsThe median pneumoperitoneum volume was 891.1 (127.7–3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1–3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis. ConclusionsPD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

Emergency CT of abdominal complications of ingested fish bones: what not to miss.

Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED.

Jejunal perforation secondary to pulmonary mucoepidermoid carcinoma metastasis. Case report and review

Abstract Background The first reported case of intestinal perforation secondary to metastatic lung carcinoma was reported in 1957. Intestinal metastases are present in up to 1.8% of the cases, with small bowel obstruction as the most common clinical presentation. Clinical case An 89 year-old male, who was diagnosed with a high-grade pulmonary mucoepidermoid tumour 2 months previously. The patient was admitted to the hospital for 3 days due to diffuse colic abdominal pain of moderate to severe intensity, accompanied by nausea and gastric vomiting, as well as 2 episodes of bloody bowel movements. On physical examination, the patient was noted to have tachycardia and tachypnoea, as well as clinical signs of acute abdomen. He had white cells of 24,900 per mm 3 , and 87% neutrophils. Exploratory laparotomy was performed, which showed a bowel perforation associated with a tumour mass 15 cm beyond the angle of Treitz. Bowel resection and primary anastomosis were performed. The histopathological analysis reported the diagnosis of a high-grade mucoepidermoid tumour with small bowel and mesentery with disease-free surgical margins. Unfortunately the patient had a fatal outcome secondary to hospital-acquired pneumonia. Conclusion The cases of metastases to small bowel are extremely rare, and to our knowledge this is first case reported in Mexico. The patient described went to the emergency room with gastrointestinal bleed and intestinal perforation that required urgent surgical intervention with small bowel resection and primary anastomosis. Unfortunately the patient died secondary to hospital acquired pneumonia.

Evisceration in a horse submitted to orchiectomy: a case report

This case report describes an evisceration of a segment of the small intestine in a male, 15-years-old Mangalarga Marchador horse, which was submitted to elective orchiectomy in a stud farm in Alegre, ES, Brazil. Following sedation and local anesthesia, the patient was submitted to the surgical procedure. Fifteen minutes after the end of surgery, hemorrhage from the region of the scrotum was observed, with tissue protruding from the surgical wound in the right scrotal sac. Visual exam revealed that it was a segment of the small intestine protruding from the inguinal ring and surgical wound. The patient was immediately submitted to TIVA (total intravenous anesthesia) and an emergency median laparotomy was performed to reduce the evisceration. The procedure was carried out with success and the right external inguinal ring was sutured. Six hours after the second procedure, the patient presented clinical signs of acute abdomen, and rectal palpation revealed a right inguinal hernia. It was decided to perform euthanasia of the animal as there was no referral large animal surgery center in the region. During necropsy, a segment of the jejunum insinuated in the right inguinal canal was observed, evidencing strangulation and a greenish appearance. Orchiectomy is a relatively simple technique to execute, which can be performed by the veterinary surgeon in the field. However, it presents elevated rates of complications, ranging from 20 to 38% of the cases, which are predominantly associated to surgical technique errors. Intestinal evisceration following orchiectomy is considered an emergency situation, requiring a fast and efficient therapeutic conduct. Its incidence is rare, occurring in between 0.2 and 2.6% of the cases of orchiectomy. It is believed that rectal palpation prior to orchiectomy could aid in the detection of a dilated internal inguinal ring, or any other alteration in this structure. Nevertheless, this practice is not performed pre-operatively in cases of orchiectomy in the equine species.

Ultrasonographic examination in non-human primates with acute abdomen signs

The acute abdomen is any abdominal disorder resulting in pain, shock, or sepsis. Although it has a multifactorial etiology, the primary cause is gastrointestinal tract pathology. The aim of this study was to assess the contribution of abdominal ultrasound as a complementary diagnostic tool in non-human primates with an acute abdomen. Three different non-human primates with clinical signs of acute abdomen were evaluated as follows: a chimpanzee (Pan troglodytes), a tufted capuchin (Cebus apella), and a black-tufted marmoset (Callithrix penicillata). Ultrasonographic examination assisted in the identification of a variety of differential diagnoses and was used in decision-making for exploratory laparotomy, which was performed in two animals. Ultrasound examination confirmed the source of the acute abdomen as the gastrointestinal tract in the three animals studied. Abdominal ultrasound is a useful technique for the investigation of signs of acute abdomen in non-human primates.

Freie abdominelle Luft ohne Hinweis auf eine Hohlorganperforation unter nichtinvasiver Beatmung

A 19-year-old patient suffering from Duchenne muscular dystrophy was admitted to our hospital with an acute bronchopulmonary infection. Four months ago noninvasive ventilation was started because of hypercapnic respiratory failure. Mechanical ventilation had been used so far only at night. At the time of admission spontaneous breathing was not possible due to exhaustion of the respiratory muscles. The patient suffered from fever, limited cough strength and dyspnoea at rest. The abdomen was distended because of intestinal gas without clinical signs of acute abdomen. Blood gas analysis showed respiratory acidosis even under mechanical ventilation. Laboratory tests showed an elevation of the inflammation indicating parameters. X-rays of the chest showed elevated diaphragms. Within the next days pneumonia could be seen in the left lower lobe. The patient had to be under mechanical ventilation almost 24 hours per day. Hypercapnia and respiratory acidosis normalized and the patient was able to breathe spontaneously for longer periods. The following days cutaneous emphysema developed and X-rays revealed free abdominal air on day 9 of the hospital stay. The radiological findings have been confirmed during follow up X-rays without any clinical correlate. Inflammatory markers were decreasing. After the pneumonia had healed almost completely, the times on mechanical ventilation could be reduced. Subphrenic air resolved completely without any intervention. Free subphrenic air without any clinical signs of acute abdomen does not necessarily force a surgical exploration. Under frequent follow up investigations a wait-and-see strategy could be justified. An explanation for the subphrenic air could be an interstitial emphysema due to increased intrathoracic pressure caused by the prolonged noninvasive ventilation, releasing the air through the diaphragmatic gaps into the abdomen.

Vólvulo gástrico: ¿Por qué recordarlo? Revisión a propósito de un caso

Stomach volvulus: Why should we remember it? Case review Abstract: Stomach volvulus is a medical entity which has different implications in terms of clinical presentation, diagnosis, imaging support, and pathological behavior and evaluation. Analysis of features of these implica- tions is essential when deciding a course of action, which can vary from simple observation to aggressive and urgent resolutions in order to save the patient's life. Gastric volvulus represents an unusual rotation of the organ on its own axis, thus entailing risk of ischemia and necrosis. There are two major types of gastric volvulus, i.e., organoaxial and mesenteroaxial. It can occur in any stage of life, preferably in adulthood, with clinical signs of acute abdomen in most of the cases. Due to the risk of ischemia, necrosis, and vital compromise, an urgent response involves surgical resolution which can lead to the removal of the organ, with a high risk of mortality in the intra- and post-operative periods. We report the case of a patient presenting with the aforementioned clinical processes.

Multiple Bowel Perforations Requiring Extensive Bowel Resection and Hysterectomy After Microwave Endometrial Ablation

Heavy menstrual bleeding, or menorrhagia, is a primary cause of morbidity in women. Herein, we present the case of a 41-year-old woman who underwent day-surgery endometrial microwave ablation because of dysfunctional uterine bleeding. She had undergone previous laparoscopic sterilization, and had no other risk factors except for a retroverted uterus. The procedure was performed without any documented difficulties. The patient was readmitted the following day with clinical signs of acute abdomen. Emergency laparotomy revealed a large perforation on the anterior uterine wall, full-thickness burns in the distal ileum, and multiple ischemic areas in the ileum, cecum, and ascending colon secondary to microwave burns. A right hemicolectomy was required, with extended ileal resection and subtotal hysterectomy with ovarian conservation. Although microwave endometrial therapy seems to offer many advantages, in particular in terms of efficiency and technique, complications occur, and extensive safety measures must be implemented to prevent adverse effects such as occurred in this patient.

Neuromesenchymal hamartoma of small bowel - an extremely rare entity: a case report

Neuromuscular and vascular hamartoma (NMVH) is a very rare stricturing condition of the small intestine, occurring focally and causing recurrent obstructive symptoms or occult chronic gastrointestinal bleeding. Salas et al. (Neuromesenchymal hamartoma of the small bowel. J Clin Gastroenterol. 1990, 12 (6): 705-9) proposed the term of "Neuromesenchymal hamartoma" for the cases of NMVH with participation of mesenchymal tissues.We present the case of a 60-year-old male patient admitted twice in a month with abdominal pain. On the third admission with clinical signs of acute abdomen, an exploratory laparotomy was performed. The clinical and laboratory findings that occurred after the patient's evaluation, the intraoperative findings and the pathological features of this lesion are reported.

Orthotopic Liver Transplantation in a Patient With Acute Liver Failure Resulting From Aortic Dissection

We report a case of acute liver ischemia resulting in liver failure that occurred due to celiac trunk occlusion by an aortic dissection. A 53-year-old patient presented with clinical signs of acute abdomen. He underwent an urgent laparotomy, which revealed a splenic infarction and thrombosis of the celiac artery all the way to the porta hepatis. Imaging showed that an acute thoracoabdominal aortic dissection was present, resulting in compression of the celiac trunk. The aorta was repaired with an intervascular graft; however, an acute insufficiency of the liver ensued, and the patient was urgently transplanted. To the best of our knowledge, this is the first report of vascular compromise of the liver due to acute aortic dissection that would require liver transplantation.