Diagnosis Of Acute Abdomen Research Articles

Epiploic appendagitis of caecum: a diagnostic dilemma.

Epiploic appendagitis is a rare cause of acute abdomen. Depending on the site of occurrence, it can mimic any cause of acute abdomen or disease of the colon and caecal appendix; making its preoperative diagnosis very difficult. We present here a case of a 7-year-old boy misdiagnosed preoperatively as acute appendicitis and later on, upon surgical exploration, found to have caecal appendagitis. The affected epiploic appendage was removed and the patient had an uneventful recovery. We also review the relevant literature and discuss the measures to overcome this diagnostic dilemma. General surgeons should be aware of this self-limiting disease and consider it as a differential diagnosis of acute abdomen.

Preoperative CT imaging as an accurate diagnostic modality for negative laparotomy for patients with acute right lower abdominal pain

Objectives: Evaluation of the diagnostic yield of preoperative abdominal CT imaging of patients presenting by acute right lower abdominal pain and the probability for reduction of negative appendectomy rates in these patient. Patients & methods: The present study aimed to include patients presenting with acute right lower abdominal pain who were admitted as acute abdominal emergency under observation. All enrolled patients underwent clinical examination and laboratory investigations to provide a probable clinical diagnosis.All patients underwent abdominal ultrasonography (US) and then scanning with multi-detector row CT. All patients with clinical suspicion for need of surgical exploration underwent laparotomy and excised specimens were examined pathologically. Patients who became stable with negative US and/or CTwere maintained under-observation till 24 hours and were discharged. Results: One hundred and seventeen patients underwent surgical exploration including 81 patients who had emergency surgery and 36 who had surgery on elective basis during observation period. Pathological examination confirmed positive diagnosis of acute abdomen in 78 patients and 39 patients were pathologically free (Negative laparotomy).Clinical diagnosis defined 79, abdominal US defined 83 and CT defined 74 patients as having positive acute abdominal condition. Preoperative CT showed a significantly higher test validity characters in comparison to abdominal US and clinical examination with sensitivity rate of 94.6%, specificity rate of 90.7% and accuracy rate for diagnosis of93.2%. Statistical analysis defined preoperative CT as the best predictor for negative laparotomy. Conclusion: Preoperative CT for patients with acute right lower abdominal pain reduces the negative laparotomy rate, improves true positive surgical rate and is mandatory especially in suspicious cases. Moreover, preoperative CT could help di.fforential diagnosis of the underlying pathology and so can modify surgical decision

Perforation of Meckel's diverticulum with enteroliths.

Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.

Spontaneous Perforation of Pyometra: Total Abdominal Hysterectomy

Background: This case report describes an uncommon complication of generalized peritonitis following spontaneous perforation of pyometra. Case: A 60-year-old postmenopausal woman presented with clinical features of acute abdomen, and she was later diagnosed with pyometra perforation after a computed tomography scan. Laparotomy was performed, followed by a total abdominal hysterectomy with a bilateral salpingo-oopherectomy. Results: The patient died on her third postoperative day. Conclusions: Spontaneous pyometra perforation is a rare clinical condition; yet, it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. (J GYNECOL SURG 28:234)

Ileocolic Intussusception Precipitated by Diagnostic Colonoscopy

Only 5% of all cases of intussusceptions occur in adults. Intussusception complicating colonoscopy is an extremely rare event. Herein, we present a case of a 58-year-old man who developed ileocolic intussusception after a colonoscopy during which an adenomatous polyp was discovered in the terminal ileum. Eight hours after colonoscopy, the patient developed diffuse abdominal pain associated with vomiting and bloody diarrhea. A contrast-enhanced abdominal computed tomography scan revealed features of mechanical intestinal obstruction and a round soft tissue mass inside the right colon, followed by the wall of the intussusceptum. Emergency laparotomy revealed extended ileocecal intussusception with the polyp incarcerated by the ileocecal valve. A typical right hemicolectomy was performed, and the patient had an uneventful recovery. Histologic examination of the surgical specimen revealed an inflammatory fibroid polyp. Ileocolic intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonoscopy.

Abdomen agudo e hiperparatiroidismo: descripción de un caso

Hypercalcaemia secondary to primary hyperparathyroidism may present with an insidious clinical picture and involve multiple organs, which may lead to a delay in its diagnosis and erroneous therapeutic actions, due to its similarity to other different conditions. We describe the case of a patient who was admitted to our hospital with the diagnosis of acute abdomen. A laparotomy was performed which was negative. The slow post-operative progress and the clinical neurology of the patient was resolved after checking for the presence of a significant hypercalcaemia secondary to a parathyroid lymph node.

Bilateral ovarian teratoma presenting with a clinical picture of acute abdomen

We describe the case of a 30-year-old patient with bilateral mature cystic teratoma (MCT) of the ovaries. The patient had been complaining of mild abdominal pain for several months that had suddenly become severe. Early diagnosis at the emergency room was acute appendicitis, but definitive diagnosis was bilateral ovarian teratoma. We therefore recommend considering ovarian teratomas in the differential diagnosis of acute abdomen in young women in an emergency care setting.

Life-threatening spontaneous splenic rupture with systemic lupus erythematosus: case report and literature review

Although involvement of the reticuloendothelial system in systemic lupus erythematosus (SLE) is a well-recognised concomitant of the disease, spontaneous splenic rupture is an unusual occurrence. We observed a 54-year-old woman with SLE who had spontaneous splenic rupture during the late course of the disease and showed some changes histopathologically. The courses and the clinical characteristics of such patients are reviewed, and the diagnosis and treatment of these cases are discussed. Early evaluation for SLE patients with spontaneous splenic rupture should be considered and included in the differential diagnosis of acute abdomen, as it may affect follow-up and treatment, although the condition is rare.

Acute Cardiovascular Collapse Secondary to Massive Hemoperitoneum from a Bleeding Uterine Fibroid

Abstract Background: This case report illustrates that spontaneous vascular rupture in a fibroid can cause acute cardiovascular collapse, and that this should be borne in mind in the differential diagnosis of acute abdomen, especially in the presence of an abdomino-pelvic mass. Case: A 41-year-old nullipara presented in the Casualty Department at Obafemi Awolowo University Teaching Hospitals Complex with a 5-hour history of severe abdominal pain, dizziness, and fainting attack. She was in hypovolemic shock with generalized peritonitis. After resuscitative measures, an emergency exploratory laparotomy was performed. It revealed a ruptured big blood vessel at the top of a 30-week-sized uterine fibroid and 2 L of hemoperitoneum. The vessel was ligated, and 2 units of blood were transfused intra-operatively. The patient had an emergency myomectomy. Results: Her postoperative recovery was uneventful. Conclusions: Sudden rupture of a vascular supply to a uterine fibroid can mimic acute ruptured ectopic pregnanc...

Isolated Torsion of the Fallopian Tube in a Perimenopausal Woman: A Rare Entity

Background: Isolated torsion of the fallopian tube is a rare occurrence, which generally presents in the reproductive age group. It is difficult to diagnose on imaging, and diagnosis is established after surgery. Case: This report describes an unusual presentation of an uncommon condition in a perimenopausal 48-year-old woman who presented with acute abdomen. The clinical and imaging features led to suspicion of ovarian cyst with appendicitis. Laparotomy revealed torsion of hematosalpinx, with both the ovaries being normal. Results: The postoperative period was uneventful, and the patient was discharged on the 5th postoperative day. Histopathology report showed hemorrhagic infarction of tubular structures. Conclusions: Torsion of the fallopian tube is a rare event in the perimenopausal age group. It should, however, be included in the differential diagnosis of acute abdomen, and recognition of imaging features may allow early surgical intervention. (J GYNCOL SURG 28:31)

The Diagnostic Value of D-dimer, Procalcitonin and CRP in Acute Appendicitis

BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT) and C-reactive protein (CRP) measurements in the acute appendicitis.METHODS: This prospective study was conducted between March 1st, 2010 and July 1st, 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1), gangrenous appendicitis (Group 2), perforated appendicitis (Group 3) and negative appendectomy (Group 4) according to the surgical findings and histopathological results.RESULTS: Of 78 patients, 54 (69.2 %) were male and 24 (30.8 %) were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years). 66 (84.6 %) patients had increased leukocyte count (white blood cell count). The PCT values were higher than the upper normal limit in 20 (25.6%) patients, followed by D-dimer in 22 (28.2 %) patients and CRP in 54 (69.2 %) patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p<0.05). However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively).CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

Spontaneous gall bladder perforation: a rare condition in the differential diagnosis of acute abdomen in children

Spontaneous gall bladder perforation: a rare condition in the differential diagnosis of acute abdomen in children

Pneumatosis cystoides intestinalis: A single center experience

To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI). The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d. Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

Acute abdomen and ascites as presenting features of autosomal dominant polycystic kidney disease

We describe a patient with sudden onset of abdominal pain and ascites, leading to the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness. A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented. This case alerts physicians that ADPKD could occasionally present as an acute abdomen; cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.

Small-Bowel Perforation Caused By A Swallowed Chicken Bone – A Case Report

Introduction: Ingesting a foreign body is not an uncommon occurrence and most foreign objects pass uninterrupted through the gastrointestinal tract without any complications. Bowel perforation leading to acute abdomen requiring surgical treatment is seen in very few cases. Case presentation: We are presenting a case with acute abdomen caused by accidentally ingesting a part of chicken bone. A 61-year-old male was presented in the surgical emergency clinic with abdominal pain, nausea, and anorexia. Upon physical examination, a distended and diffusely tender abdomen with right lower abdomen rebound was revealed. Laparotomy was performed in general anesthesia on the day the patient was admitted. Intra-operative findings revealed diffuse purulent peritonitis.Discussion: Foreign bodies accidentally ingested mostly pass through the gastrointestinal tract without any consequences. The most common objects are dentures, fish bones, chicken bones, toothpicks, and cocktail sticks. A definitive preoperative history of foreign body ingestion is uncertain. During laparotomy we found diffuse purulent peritonitis. A tiny sharppointed object was found penetrating the inflamed portion of the distal ileum. We decided to do resection of the distal ileum with primary anastomosis. The postoperative treatment went well. Conclusion: Intestinal perforation by a chicken bone is rare and most often affects the left colon or distal ileum. The lack of history of ingestion and of detection of chicken bones preoperatively is of interest to be considered in the differential diagnosis of acute abdomen, which in this case was treated surgically.

Torsion of an accessory spleen with situs inversus in a child

We present an unusual case of acute abdomen caused by torsion of an accessory spleen with situs inversus in a child. A three-year-old girl was admitted to our hospital with an 11-day history of right flank pain with fever. Her medical history revealed an operation of coarctation of the aorta with situs inversus at one month of age. Physical examination revealed a right flank mass and tenderness. A contrast-enhanced CT scan showed a normally enhanced small spleen in the right upper quadrant and a 7.0×6.0×3.5 cm, hypodense, marginal enhancing mass in the right midabdomen adjacent to the intestine. An emergency laparotomy was decided upon with a preoperative diagnosis as an acute abdomen. During surgery, a mass was found under the greater omentum and two accessory spleens of 1.5 cm in diameter were found surrounding the main spleen. Several loops of bowel were adherent to the mass. The loops of bowel were dissected away. A pediculated congested mass was observed as an accessory spleen emerging from the greater omentum. The mass was twisted on its vascular pedicle and strangulated. The necrotic mass was removed and the postoperative recovery was uneventful. Though torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in childhood.

Total colorectal and terminal ileal duplication presenting as intussusception and intestinal obstruction

Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a diagnostic challenge. A computed tomography (CT) scan is recommended in adult cases as the most sensitive diagnostic tool and the pathognomonic finding of outer intussuscepiens and central intussusceptum is diagnostic. A septum of a duplicated colon in a non-intussuscepted segment has been rarely reported in the literature. With advancements in radiological imaging technology and the increased availability of CT scanners, the capacity for a correct pre-operative diagnosis has been significantly enhanced. Our current case report illustrates the importance of considering an uncommon etiology for enteric intussusception and duplication as a differential diagnosis of acute abdomen in an adult patient. Our analyses of this patient also highlight the successful use of CT scanning to make this diagnosis.

A case of spontaneous splenic rupture during chemotherapy for B-cell chronic lymphoid leukemia.

Spontaneous splenic rupture is a life-threatening disease and an important differential diagnosis of acute abdomen. Early clinical diagnosis and rapid intervention is required to ensure patient survival. Spontaneous splenic rupture may be induced by hematological, inflammatory or infiltrative diseases affecting the spleen. Splenomegaly may also significantly increase the risk of rupture. Other contributory factors include male, adulthood, rapid growth of the spleen and splenic abscess. Here, we present the case of a 69-year-old man who was undergoing chemotherapy for B-cell chronic lymphoid leukemia. He was admitted to our hospital after he suddenly developed persistent upper abdominal pain. Computed tomography and ultrasonography revealed accumulation of free fluid in and around the spleen. He was diagnosed as having spontaneous splenic rupture and an emergency operation was performed. During the operation, we found a massively enlarged spleen with several capsular tears, and performed a splenectomy. The patient made a good recovery. Pathological examination revealed that the spleen was infiltrated by CD20-, CD5- and CD23-positive lymphoid blasts. We encountered a case of spontaneous splenic rupture in a patient receiving chemotherapy for exacerbating B-cell chronic lymphoid leukemia. In a case of abdominal pain of acute onset in patients with hematological disease, spontaneous splenic rupture should be suspected.

Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum

IntroductionTorsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation. Presentation of caseWe present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia. DiscussionOmental torsion should always be included in the differential diagnosis of acute abdomen. ConclusionCT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.

Diagnosis of Acute Abdomen

Diagnosis of Acute Abdomen