Course Of Abdominal Pain Research Articles

An Unusual Presentation of Crohn’s Disease and Novel Use of Direct Peritoneal Resuscitation

Crohn’s disease is an inflammatory bowel disease characterized by transmural inflammation, with the majority of patients having small bowel involvement, usually the distal ileum. Typical manifestations include a prolonged course of abdominal pain, diarrhea, fatigue, and weight loss. We report a case of a 21-year-old male who presented with an acute abdomen and was in profound shock resulting in cardiac arrest. The patient underwent damage control, exploratory laparotomy complicated by acute hypoxic respiratory failure requiring veno-venous extracorporeal membrane oxygenation and the novel use of direct peritoneal resuscitation in the setting of an acute abdomen with an uncontrolled enterotomy and bowel spillage. Our case report illustrates the importance of prompt surgical intervention and critical care with the application of novel surgical techniques to minimize mortality in an unusual presentation of Chron’s disease.

Lupus Enteritis: An Uncommon Manifestation of Systemic Lupus Erythematosus as an Initial Presentation

ABSTRACTSystemic lupus erythematosus (SLE) is an autoimmune disorder generally affects young to middle-aged women, commonly presenting as a triad of fever, rash, and joint pain but can affect multiple organs and can present in a complex fashion, varying based on the degree and severity of organ involvement. The differential for abdominal pain and diarrhea in SLE is vast and can include VIPomas, serositis, pancreatitis, intestinal vasculitis, and protein – losing enteropathy, gluten – enteropathy, intestinal pseudo-obstruction, and infection. The pathology of lupus enterits thought to be immune-complex deposition and complement activation, with subsequent mucosal edema. We present a case of a woman with no history of SLE, but with a prolonged course of abdominal pain, diarrhoea and vomiting and eventual diagnoses of lupus enteritis.

IP045. Management of Abdominal Aortic Aneurysms With Atypical Renal Artery Anatomy

Renal artery anomalies occur at a rate of 1% to 2%, and with a growing number of renal transplants performed annually, we are more frequently faced with particular challenges to abdominal aortic aneurysm repair. We describe here adjuncts used to manage such anatomic variants. This is a retrospective review of a prospectively collected database of all abdominal aortic aneurysms repaired in a single academic vascular surgery practice. Patients with renal transplants, congenital single/pelvic kidneys arising from the distal abdominal aorta or iliac arteries, and horseshoe kidneys were included in the review. Over an 8-year period, 18 patients were identified (prior renal transplant, n = 9; horseshoe kidney, n = 3; congenital single/pelvic kidney, n = 6). All prior transplant patients were treated with endovascular repair, with four requiring aortouniiliac extension to the external iliac artery contralateral to the renal transplant for aneurysm exclusion (with retrograde flow via cross femoral bypass providing renal perfusion). Additionally, three transplant patients required carotid artery access for device deployment due to severe iliofemoral occlusive disease or origin of renal transplant off of the internal iliac artery. Two horseshoe kidney patients underwent open aneurysm repair with direct reimplantation of accessory renal arteries, while one underwent standard endovascular repair with exclusion of an isthmus branch. While there was no renal dysfunction noted, the patient did have a prolonged course of abdominal pain postoperatively due to infarct of the devascularized renal segment. Of the congenital single/pelvic kidney cohort, two underwent open repair with renal reimplantation, two underwent standard endovascular repair, one was treated with aortouniiliac and cross-femoral bypass, and one was treated in a staged fashion with initial ileorenal bypass and subsequent fenestrated endovascular repair. Intravascular ultrasound imaging was used to minimize contrast use in patients with chronic renal insufficiency (creatinine >1.2 mg/dL, n = 6). Over a mean follow-up of 41.7 months (range, 1-110 months), there were no aortic related deaths or reinterventions, no decline in renal function (measured by serum creatinine and glomerular filtration rate), and 100% patency of the preserved renal arteries. Atypical renal anatomy provides unique challenges to abdominal aortic aneurysm repair. The use of technical adjuncts can make repair of such aneurysms safe with good long-term outcomes that do not impair renal function.

Etiology and Clinical Course of Abdominal Pain in Senior Patients: A Prospective, Multicenter Study

The authors describe the epidemiology and clinical course of older persons examined in emergency departments (EDs) for abdominal pain. This was a prospective, multicenter, observational study of older persons (>or=60 years) examined in participating EDs for nontraumatic abdominal pain. Medical records were reviewed for demographics, ED diagnoses, findings of radiographic imaging, disposition, operative procedures, length of hospitalization, and final diagnoses. Patients were interviewed at 2 weeks to determine clinical course, final diagnoses, and mortality status. The authors compared ED diagnoses with final diagnoses, reporting the percentage change in aggregate and for the 12 most common diagnoses. Of 360 patients (mean age, 73.2+/- 8.8 years; 66% women; 51% white) who met selection criteria, 209 (58%) were admitted to the hospital and 63 (18%) required surgery or an invasive procedure. For patients with complete follow-up information (n=337), 37 (11%) had repeated ED visits and 23 (7%) were readmitted to the hospital. The case-fatality rate was 5%. Leading causes of abdominal pain were nonspecific (14.8%), urinary tract infection (8.6%), bowel obstruction (8%), gastroenteritis (6.8%), and diverticulitis (6.5%). The ED and final diagnoses matched 82% of the time. Older patients had higher mortality rates (odds ratio, 4.4; 95% confidence interval, 1.4--14) and lower diagnostic concordance rates (76% vs 87%; p=.01). Study limitations include inability to enroll all eligible persons and possible inaccuracies in participant-reported follow-up interviews. Abdominal pain in older patients should be investigated thoroughly as, in this study, nearly 60% of patients were hospitalized, 20% underwent operative or invasive procedures, 10% had return ED visits, and 5% died within a 2-week follow-up period.

Biliary Giardiasis in a Patient With Human Immunodeficiency Virus

A 41-year-old man with human immunodeficiency virus (HIV) (CD4 count, 446/mm3) developed a protracted course of abdominal pain, weight loss, and increasing liver function tests after undergoing a metronidazole treatment regimen for Giardia enteritis. Three months later, endoscopic retrograde cholangiography (ERCP) showed dilated common and intrahepatic bile ducts and luminal irregularities of the common bile duct. Seven months after the onset of his acute diarrhea, a repeat ERCP with aspiration demonstrated many Giardia trophozoites and cysts in the bile and continued structural abnormalities consistent with cholangiopathy. A 10-day course of high-dose intravenous metronidazole did not resolve these signs or symptoms. A gallbladder ultrasound showed a thickened wall. Laparoscopic cholecystectomy led to resolution of abdominal pain and normalization of serum alkaline phosphatase over an 8-month period. Gallbladder histopathology revealed chronic cholecystitis, but no parasites were seen on hematoxylin and eosin staining or with Giardia antigen enzyme immunoassay testing of the gallbladder. The patient refused to undergo a follow-up ERCP, but a right upper quadrant ultrasound and computed tomography of the abdomen were normal.

Recurrent abdominal pain

Recurrent abdominal pain is found in 10-25% of school-aged children, thus being one of the most frequent complaints in childhood. Despite that, our knowledge about this syndrome is still very incomplete. In the majority of cases, the traditional diagnostic approach understanding abdominal pain as a symptom of an underlying organic or psychological disease does not lead to a well-defined diagnosis with straightforward therapy. The natural course of abdominal pain in childhood seems to be less favorable than often assumed. Modern biopsychosocial models of recurrent abdominal pain are presented as a basis for future multimodal therapeutic concepts.

Chronic Non-Organic Upper Abdominal Pain: Diagnostic Safety and Prognosis of Gastrointestinal and Non-Intestinal Symptoms: A 5-to 7-Year Follow-up Study

To establish the diagnostic safety and the prognosis in outpatients with non-organic upper abdominal pain, 37 patients were followed up 5-7 years after the index investigation. In only one case had the diagnosis been changed during the follow-up period. This was in a man who erroneously had not been examined sufficiently before entry. He turned out to have gallstones. Eighty-one per cent still had abdominal pain, but 51% had improved (P less than 0.005). At the index investigation back pain was reported by 76% and headache by 60%. At the follow-up study back pain was unchanged in severity, but headache was significantly improved. The course of abdominal pain was significantly correlated with the course of back pain and headache. At the index investigation a psychic symptom score indicating vulnerability was significantly higher than in a matched patient group with well-defined pain. It was unchanged high at the follow-up study and unrelated to the course of the abdominal pain. Fifty-four per cent of the patients had symptoms of irritable bowel syndrome, but the course of the abdominal pain was unrelated to this.

Whipple's disease; report of a case with special reference to histochemical studies of biopsy material and therapeutic results of corticosteroid therapy.

IN 1907 Whipple1 first described intestinal lipodystrophy, an entity that has since been recorded but 37 times. Theories of the pathogenesis of the lipogranulomatosis of the small intestine and mesenteric lymph nodes have failed to suggest an effective form of therapy. The majority of reported cases have occurred in males, and most of the patients have died after a debilitating course of abdominal pain, steatorrhea, malnutrition with striking pigmentation and arthritis, despite various forms of treatment, including bile salts, pancreatic extract, choline, lecithin, folic acid, liver extract, aqueous adrenocortical extract, desoxycorticosterone, duodenal fluid, the fat-soluble vitamins and supportive measures.Whipple . . .

To the question of the treatment of typhoid fever with a vaccine on an Occasional basis

To combat typhoid fever, we still do not have a well-developed specific therapy. The serum offered by Chantemess had to be abandoned due to the severity of the phenomena associated with its use. The improvement of the methods of its preparation and application (the combined Rod method), although it gives very comforting results according to French authors, is still under development. The question of vaccine therapy has been developed in much more detail here, mainly by Prof. Lavrinovich and Prof. Granstrom, from whose works it is clear that the best effect is obtained from the intravenous method of administration of the vaccine, which in many cases gave an abortive course of abdominal pain. typhus. Nevertheless, despite this, the vaccine therapy of br. typhus has not become widespread enough due to a number of contraindications to it (heart weakness, tuberculosis, pregnancy), as well as due to the constraint of its use (no later than the 10th day) and the appearance of some complications. Therefore, it is quite understandable to turn to a simpler and less harmless method, namely to vaccinotherapy per os on an Occasional basis.