Cramp-like Abdominal Pain Research Articles

Incarcerated gallbladder in inguinal hernia: a case report and literature review

BackgroundTreating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date.Case presentationA 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confirmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confirmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory findings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the significantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely.ConclusionsFollowing a review of the literature, it can be concluded that the finding of incarcerated gallbladder in the content of an inguinal hernia is a rare finding. No other similar emergency case and successful surgical intervention have been reported before.

Dientamebiasi. Descrizione di un caso clinico in età pediatrica

Dientamoeba fragilis is a protozoan with an intestinal location and a cosmopolitan spread. Recent reports show its role in the appearance of intestinal syndromes (dientamebiasis). A clinical case of dientamebiasis is reported in a 7-year-old child suffering from cramp-like abdominal pain and diarrhoea with a protracted course and definitive resolution after a week’s treatment with paramomicin.

SAT-567 Hypertriglyceridem...From Mild to Fatal!... Is Time for Awareness

Hypertriglyceridemia… From mild to fatal! … Is Time for Awareness.Hypertriglyceridemia can be primary or acquired. High triglycerides are related to complications such as pancreatitis and there is a positive correlation between hypertriglyceridemia and atherosclerotic burden. In this case series we aim to discuss pancreatitis as a hypertriglyceridemia complication and to acknowledge the importance of prevention and management. Is there something we can do to raise awareness and avoid complications as in the cases?All cases present with chief complaint of epigastric cramp-like abdominal pain, radiating to the back, nausea/vomiting and with highly lipemic blood samples.38y/o F admitted after been found with lipase 268 U/L (n<60 U/L), amylase 131 U/L (n<100 U/L) and findings of pancreatitis on CT scan. Patient with one-year history of T2DM refers this is the 4th episode of pancreatitis and reports that last time she was told about having triglycerides in 4,000 mg/dL for which she went to her physician that prescribe her Fenofibrate. Patient triglycerides were 7,931 mg/dL (n<199 mg/dL) and found with poorly controlled diabetes with HgbA1c 8.4%. She was properly managed, and triglycerides decrease to 1,309 mg/dL.31y/o F with elevated lipase (237 U/L, n<60 U/L) and findings of pancreatitis on CT scan was admitted and found with 7,755 mg/dL triglycerides. She refers to have endometriosis for which she uses OCPs for >5years. She develops intractable abdominal pain along with abdominal distension and progress to Acute Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation. She had a prolonged ICU stay and after management triglycerides decrease to 95mg/dL, symptoms resolve, and patient was discharge.48y/o F with pancreatitis, lipase levels 1,452 U/L, amylase 744 U/L and positive imaging findings. Patient with uncontrolled diabetes (HgbA1c 11.0%) and breast mass s/p lumpectomy for which she used tamoxifen for the last 2 years. Triglycerides 7,444mg/dL on Gemfibrozil started due to previous levels found >4,000 mg/dL on outpatient evaluation. She deteriorates clinically and develops renal failure, abdominal compartment syndrome, respiratory distress and hypotension requiring mechanical ventilation and vasopressors. On repeated abdominal CT pancreas changes were suggestive of fulminant pancreatitis. Patient did not respond to treatment and passed away 48 hours after admission.Hypertriglyceridemia complications can be mild or fatal as in these cases. They were evaluated by a primary care physician before complications occur and had secondary causes that predispose them to hypertriglyceridemia, but they were not addressed, reason for which these scenarios raise concern of how much we know? How much we are doing to prevent these outcomes?... Awareness of hypertriglyceridemia management and adverse effects is necessary to avoid complications and fatal outcomes. Is time!

Masquerading in the midgut: a rare diagnosis in a patient with recurrent abdominal pain

A 38-year-old woman who had been previously diagnosed with irritable bowel syndrome was seen in the outpatient clinic with a 2-year history of intermittent cramp-like abdominal pain which was often...

Intussusception secondary to inflammatory myofibroblastic tumor of the small intestine. Case report

Introduction: Intussusception occurs when part of the intestine slides into an adjacent intestinal segment. Inflammatory myofibroblast tumor is a rare cause of this condition, and is observed in 5% -16% cases in adults.Case presentation: A 41-year-old woman presented with abdominal pain and distension. A exploratory laparoscopy was performed, finding ileocolic intussusception into the transverse colon. Due to uncontrollable bleeding, the procedure was converted to laparotomy; resection and latero-lateral ileocolic anastomosis were performed. Histopathology reported inflammatory myofibroblastic tumor, with a favorable postoperative evolution. The patient was discharged on the sixth postoperative day.Discussion: When located in the small intestine, 57% of the tumors that cause intussusception are benign, including the myofibroblastic tumor in this patient. The symptoms and signs associated with this neoplasm are cramp-like abdominal pain, nausea and vomiting. Although imaging studies may lead to suspect this diagnosis, in most cases it is made intraoperatively. Surgical resection of the affected intestinal segment is curative, with favorable prognosis.Conclusions: This case is considered as a rare cause of intussusception. It had a benign course and is still under study since its pathophysiology has not been fully understood.

Ultrasound findings in extragenital endometriosis.

We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations. Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain. Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity. Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.

Endometriosis within the sigmoid colon/extragenital endometriosis

Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Although it is common in women in the reproductive age, intestinal endometriosis is extremely rare and may lead to serious clinical problems. In this article, we present two rare cases of endometriosis localized in the sigmoid colon lumen. The first case is a 45 year-old female complaining of rectal bleeding for 6 months. A polypoid lesion with suspicion of malignancy, 3-4 cm in size was identified at colonoscopy. Laparoscopic anterior resection was performed since it was not suitable for colonoscopic polypectomy. The pathology examination revealed extragenital endometriosis. The second case is a 36 year-old female admitted for lower abdominal pain and rectal bleeding for the last 3 months. She was diagnosed with sigmoid diverticulitis. The patient's symptoms regressed with medical treatment, but due to early and multiple recurrent episodes it was decided to perform an elective laparoscopic anterior resection. The pathology report stated diverticulosis coli and intraluminal endometriosis. Intestinal endometriosis should be considered as part of the differential diagnosis in female patients of the reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhea and pelvic pain. In these patients, resection and anastomosis of the effected bowel segment is accepted as the choice of treatment.

RETRACTED: Gallstone ileus without bilioenteric fistula years after bypass surgery for Crohn's disease. Case report and clues to etiology of a neglected cause of obstruction

Gallstone ileus is a very rare cause of bowel obstruction. Patients suffering from Crohn's disease are at increased risk of developing gallstone disease, especially when terminal ileum is involved. Gallstone ileus can occur, but etiology remains controversial. We report on a case of such a rare condition, illustrating etiology and treatments. A patient with long-standing Crohn's disease, who had undergone ileotransverse bypass for ileocaecal involvement 40 years before, presented with cramp-like abdominal pain. Imaging was consistent with a gallstone ileus with no evidence of bilioenteric fistulae. At surgery, we found gallstones stuck at the site of ileotransverse anastomosis. No bilioenteric fistulae were found. Due to disease progression, many enteric fistulae were found, requiring a massive bowel resection. The diverted segment may have been responsible of gallstone formation, and etiology is discussed. Recovery after surgery was uneventful, but the patient required continued nutritional support. Physicians dealing with Crohn's disease patients with bypassed segments should keep in mind, the increased risk of gallstone formation, in order to not overlook gallstone ileus. Early suspect and diagnosis may allow for less aggressive approaches. A diverted segment should always be removed, and long-term follow-up encouraged.

Portal hypertension caused by postoperative superior mesenteric arteriovenous fistula

Arteriovenous fistula of the superior mesenteric blood vessels is a rare complicaton in abdominal surgery. We presented a 49-year-old man with cramp-like abdominal pain, abdominal distension and weight loss symptoms, with a history of previous small bowel resection and right colectomy, due to Crohn disease, 16 years ago. Clinical examination revealed a paraumbilical pulsation with systolic murmur and thrill. Ultrasonography and computed tomography revealed cystic dilatation of the superior mesenteric vein, hepatomegaly and ascites. Upper endoscopy revealed grade I esophageal varices with portal hypertensive gastropathy. The diagnosis of arteriovenous fistula between superior mesenteric artery and vein was confirmed by angiogram of the superior mesenteric vessels and resection of the fistula was performed. Control examination after nine months showed no signs of portal hypertension. Early diagnosis and treatment of mesenteric blood vessel arteriovenous fistula prevents portal hypertension development and its complications.

Cryptosporidiosis in immunocompetent patients. Epidemiology and clinical picture

Cryptosporidiosis species were demonstrated in stool of 1.9% of 1600 unselected patients with enteritis (practically evenly divided between children and adults). Further investigations revealed seven cases of enteritis among family members. In eight patients there was a double infection with Cryptosporidium plus another enteritis pathogen. The most frequent clinical symptoms were diarrhea, vomiting, cramp-like abdominal pain, fever and headache. The mean period of parasite excretion was 14 days. Spontaneous cure occurred in all patients. Since cryptosporidiosis is relatively common not only in those with lowered resistance but also those who are immune-competent, search for Cryptosporidium should be included in all tests for etiologically uncertain cases of enteritis.

Akute segmentale hämorrhagische Penicillin-assoziierte Kolitis

Four days after beginning a perioperative antibiotic prophylaxis with amoxicillin and clavulanic acid a 33-year-old patient developed an acute haemorrhagic diarrhoea with cramp-like lower abdominal pain. Coloscopy revealed diffuse mucosal oedema with map-like ulcerations, increased susceptibility to trauma and submucous haemorrhages extending from the middle of the ascending to the middle of the descending colon. Granulocytic inflammation with cryptal atrophy was seen histologically. Stool cultures, including tests for Clostridium difficile toxin, were normal. All symptoms disappeared within three days of discontinuing the medication. Coloscopy after one week revealed marked improvement, after three months nothing abnormal. Acute segmental haemorrhagic penicillin-associated colitis is rare and must be distinguished from antibiotic-associated pseudomembranous colitis.

Ileokolische Invagination bei Erwachsenen: Sonographische Charakteristika

An 86-year-old man was admitted to hospital because of transitory cramp-like abdominal pain of 6 days' duration. Immediately preceding admission he had suffered a short episode of vomiting and diarrhoea. There was no history of previous abdominal operation. On examination there were signs of incomplete mechanical ileus. Ultrasonography revealed an abnormal cockade with triple ring phenomenon at the ileocaecal junction and the "duck-beak phenomenon" as signs of enterocolic intussusception. Immediate laparotomy demonstrated a submucous lipoma of the terminal ileus as its cause.--If there is clinical suspicion of intussusception, even in the presence of atypical abdominal symptoms, ultrasonography is the procedure of choice to provide rapid diagnosis. In adults treatment is always surgical.

57-jährige, untergewichtige Patientin in Frührente mit intermittierenden Diarrhöen und krampfartigen Bauchbeschwerden

Underweight as a consequence of chronic diarrhoea may lead to fatigue, tiredness and impaired physical performance, especially when the underlying cause has not been evaluated. In spite of algorithms as a help in the differential diagnosis, an individual approach with critical consideration of diet history, laboratory data and imaging procedures is necessary. Additional difficulties may arise when the history of food intolerance is inconsistent and technical findings including endoscopy are inconclusive. We report on a 57-year-old female patient with underweight, chronic intermittent diarrhoea and cramp-like abdominal pain for more than 10 years following pelvic irradiation due to Hodgkin's disease of the ovary. A systematic diagnostic approach was not undertaken until very recently due to the deterioration of her clinical conditions pointing to jejunal malabsorption. In spite of the absence of a specific history of milk/milk product intolerance a lactose H (2)-breath test was performed showing lactase deficiency with lactose intolerance. The rapid improvement of all her symptoms after a lactose-poor diet had been started supported this diagnosis. Possible reasons for the long time period which had elapsed until the diagnosis was established and the discrepancy of the H (2)-breath test results with the absence of a clear-cut history for milk/milk product intolerance are discussed in terms of the importance of a structured history-taking with regard to nutrition and diet habits. In addition, potential explanations for radiation-induced functional damage in the absence of morphological abnormalities are provided. Based on the experience of this case and considerations regarding the consequences of radiation-induced jejunal damage, we recommend that a lactose-H (2) breath test be routinely included in the diagnostic work-up of patients with unclear chronic diarrhoea even if there is no defined history of milk/milk product intolerance.

Reduction of ileocecal intussusception by hydrostatic pressure.

Intussusception is the prolapse or invagination of one part of the intestine into an immediately adjoining segment; it occurs most frequently during infancy and early childhood. When the intussusception persists, it produces characteristic clinical signs and symptoms. In the individual case, vomiting, severe intermittent cramp-like abdominal pain, melena, and a palpable sausage-shaped mass within the abdominal cavity may be present. Surgical reduction has long been the treatment of choice in this country. Ravitch (1, 2), a surgeon, has reported successful reduction of ileocecal intussusception by barium enema in selected cases. This simple, safe hydrostatic procedure merits thorough clinical trial. During the past two years the barium enema has been used routinely at the Children's Hospital of Pittsburgh in the treatment of ileocecal intussusception. This paper describes the details of administration of the enema, discusses criteria for completeness of reduction, and offers suggestions concerning the role...

OBSTRUCTION OF THE SMALL INTESTINE BY CORPUS LUTEUM CYST

The preoperative diagnosis of the cause of obstruction of the small intestine is often difficult. The following case illustrates an apparently unique cause of this condition. REPORT OF CASE A 46-year-old white woman admitted to New York Hospital in April, 1952, had had increasing cramp-like abdominal pain, nausea, vomiting, abdominal distention, and constipation for four days. The patient had undergone elsewhere the following seven major operations: in January, 1931, appendectomy and suspension of uterus; in January, 1934, bilateral salpingectomy and right oophorectomy; in August, 1937, incision and drainage of left kidney; in January, 1940, amputation of cervix and suspension of bladder; in March, 1949, subtotal gastric resection and cholecystectomy; in February, 1950, hysterectomy; and in April, 1951, left oophorectomy. Following the last operation, the patient had episodes of cramp-like abdominal pain, usually occurring once or twice a month and subsiding within 24 hours. There had been no diarrhea, bloody or

Acute pneumocholecystitis; case report and brief review of the literature.

A Review of the literature revealed only 18 cases of pneumocholecystitis. To these the following case is added. A. D., a 45-year-old colored female, was admitted to the hospital Jan. 20, 1951, acutely ill. Three days earlier, after her evening meal, she had experienced cramp-like abdominal pain followed by vomiting. The pain soon became localized to the right upper quadrant, slowly radiating to the right lower quadrant. Vomiting occurred at intervals. The bowels had not moved in the past two days. There was no history of previous attacks of this nature. The patient had had the usual childhood diseases. She had undergone an appendectomy in 1934, a total hysterectomy in 1935, a tonsillectomy in 1939, a subtotal thyroidectomy and excision of a cervical polyp in 1947. The family history was non-contributory. Physical examination showed abdominal distention with generalized tenderness more marked on the right, with muscle guarding. The temperature was subnormal. The clinical impression was acute cholecystitis. Other laboratory findings were normal. The patient ran a low-grade fever throughout the period of hospitalization, with one rise to 103° (R). Improvement was obtained on a regime of intravenous fluids, antibiotics, sedation, antispasmodics, and other supportive measures, and the patient was discharged about the fifteenth day, to return in six weeks for operation. Unfortunately x-ray examination was not ordered until eight days after admission. After this, films were obtained daily until discharge. On the initial roentgenograms a dilated pear-shaped gallbladder was demonstrable, containing gas or air, with pericholecystic air infiltration. The biliary duct system could not be identified at any time. A gastrointestinal series was negative. No fistulous tract could be demonstrated. Examination by the Graham method showed a pathological non-filling gallbladder. Duodenal drainage was instituted on the fourth day, the Miller-Abbott tube being placed in position under fluoroscopic control. Fractional specimens were collected and cultured, showing non-hemolytie streptococcus, E. coli, a yeast-likc fungus (contaminant?), and a Gram-positive rod. After the tenth day there was a diminution in the size of the gallbladder, which progressed rapidly. On the fifteenth day all the gas had been absorbed. The patient was readmitted for operation on March 12. Except for slight tenderness in the right upper quadrant, there were no significant findings. At operation the gallbladder was found to be sub-acutely inflamed, imbedded in massive adhesions, and removable with difficulty. Cultures of the contents revealed hemolytic staphylococci. Though the patient was moderately ill for about a week, the postoperative course was more favorable than had been expected. The gallbladder was dilated and the serosa inflamed. At the extreme end of the fundus was a perforation 1.0 cm. in diameter. The mucosa was redundant, green, and edematous (appearing to stand up in bubbles as if under pressure by gas).

Intestinal Obstruction Caused by an Unusual Foreign Body

Case Report. J. L., a forty-two year old unmarried white male was admitted June 22, 1948 complaining of abdominal pain and vomiting. He had been well until six hours prior to admission when, while working at a power press, he was suddenly seized with severe intermittent cramp-like abdominal pain, worse in the right lower quadrant, and the vomiting of clear yellow fluid. Upon admission his rectal temperature was 101.8°F; pulse 115 per minute, regular; respirations 22 per minute. He was markedly dehydrated and in severe pain. The abdomen was slightly distended and tender throughout, with muscle spasm in the lower half. The maximum tenderness was in the right lower quadrant. The blood and urine were normal. A tentative diagnosis was made of acute appendicitis and the patient was operated on. The appendix was slightly reddened and swollen, but did not appear to be the cause of the patient's trouble. The gallbladder, gastroduodenal and colonic regions seemed to be normal. Several inches of terminal ileum were reddened, swollen and edematous with moderate thickening of the intestinal wall. While palpating this area of intestine there was noted a small localized distended area of terminal ileum which could not be propelled toward the cecum. This was interpreted as being a small loculation of air and intestinal fluid entrapped in the lumen. There was no dilated intestine proximally, nor was there collapsed intestine distally, and a diagnosis of intestinal obstruction was therefore not considered. The assumption was that we were dealing with a mild case of regional ileitis with a good chance for resolution. An appendectomy was done and the abdomen closed. The postoperative course was consistent with regional ileitis. Distention, pain, and vomiting were present, requiring the use of Wangensteen suction. The temperature gradually rose each evening to reach a maximum of 105°F on the fourth postoperative day. On the sixth postoperative day the patient passed many copious brown liquid stools. The abdomen receded somewhat and the patient felt better. However, this condition of marked relief from the obstruction did not last very long, and the patient was again troubled with distention, and intervals of frequent liquid brown stools. Even though it was possible to remove the Miller-Abbott tube ten

Carcinomatous Cirrhosis of the Liver with Sarcomatosis of the Peritoneum

The following case is reported because of the occurrence of two different types of malignant neoplasm with typical portal cirrhosis of the liver. That a pathogenetic relationship exists between Laennec9s cirrhosis and primary carcinoma of the liver is generally recognized. Whether the association of a peritoneal sarcoma with the cirrhosis in this case was more than a coincidence seemed an interesting point for discussion. Report of Case E. G., a white Italian male fifty-seven years old, was admitted to the Buffalo General Hospital on the service of Drs. N. G. Russell and A. H. Aaron, Nov. 25, 1934. He died Nov. 29, 1934. All his adult life he had partaken of large amounts of wine and whiskey daily. At the age of seventeen years he had suffered an attack of jaundice of several weeks9 duration. The patient first began to lose weight and strength in 1932 and noticed that his skin was becoming dark. In March 1934 he complained of cramp-like abdominal pain, diarrhea, and bloating. The stools were watery. There was no nausea or vomiting. Upon hospitalization, April 9, 1934, physical examination revealed that the pupils reacted to light and accommodation. The chest was emphysematous; breath sounds were diminished in both bases. The heart was regular; a systolic murmur was heard. The blood pressure was 118/70. The liver and spleen were palpable three finger breadths below the costal margin. The surface of the liver felt irregular but not nodular. No other masses were palpated. Fluid was present in the abdominal cavity. The legs were edematous.

A Case of Leiomyosarcoma of the Cecum

F. M., a male bookkeeper, aged nineteen, was admitted March 24, 1931. His family history was negative for cancer. At the age of six years he had had scarlet fever and bilateral mastoiditis. The present illness had begun one month previously with severe cramp-like abdominal pain, nausea, and vomiting, which were relieved to some extent by a laxative. During the previous twelve days he had had many such attacks. They were not relieved by calomel, although its administration had resulted in bowel movements. The pain was localized in the left side of the abdomen. There had been no loss of weight. Physical examination revealed a palpable tumor in the left lumbar region, the size and shape of a kidney, slightly tender, and freely movable. There were a moderate leukocytosis and a low septic temperature. Exploratory laparotomy revealed a tumor at the ileo-cecal junction, about 6 cm. in diameter and almost blocking the lumen of the bowel. There was intussusception of the distal portion of the ileum, the cecum, and the ascending colon into the transverse colon. The cecum was resected, and the ascending colon and ileum anastomosed end-to-side. There were no postoperative complications.

SUBMUCOUS LIPOMA OF COLON

History. —Mrs. H. S., aged 47, was admitted to the wards of the General Hospital on June 27, 1927, with the following history: In September, 1926, she had been taken ill rather suddenly with cramplike abdominal pain accompanied by vomiting, without other associated symptoms. A diagnosis of appendicitis had been made; operation performed within twelve hours disclosed negative evidence in the appendix. Following the operation, however, she was well until March, 1927, when she had a similar attack of cramplike pain, which lasted about thirty hours. In the middle of the attack, she passed a blood stained stool. From that time until admission to the hospital, she had ten attacks of shorter duration than the first. In four of these, she passed stools containing blood and mucus. Between attacks, the bowels moved regularly without the aid of a laxative, and she felt well in every way. She had not lost