Diagnosis Of Lower Abdominal Pain Research Articles

Symptomatic Preperitoneal Lipoma Resected via Preperitoneal Approach: A Case Report and Review of the Literature

Introduction: Lipomas are benign adipose tissue tumors that can vary in size and location. Magnetic resonance images should be obtained for all soft-tissue masses that are deep to fascia or those >5 cm in subcutaneous tissue. In this case report, we present a minimal invasive technique to resect a large preperitoneal lipoma. Case Presentation: A 36-year-old woman presenting with left fossa pain caused by a large mass. MRI-imaging shows a large preperitoneal lipomatous lesion (61 × 58 × 40 mm) which compresses the bladder, tuba and surrounding vessels. We did a minimally invasive preperitoneal laparoscopic surgical resection. Postoperative follow-up was uneventful. The pathology report confirmed benign lipoma without signs of malignancy. Discussion: Preperitoneal lipomas should be considered in the diagnosis of lower abdominal pain and can be minimally invasive resected via preperitoneal laparoscopic approach in day clinic.

Haematocolpos and Secondary Hematometra Due to Imperforate Hymen: Diagnosis and Treatment

BackgroundImperforate hymen is an uncommon congenital anomaly of the female genital tract and is rarely diagnosed in newborns. An imperforate hymen is a cause of primary amenorrhea. Case DescriptionA 12-year-old girl was admitted to the pediatric outpatient clinic with cyclic abdominal pain for eight days. She had lower abdominal pain with dysuria and constipation for the previous six weeks. There is a bulging mass on the perineal that appears when straining. Fever, nausea, vomitus, abdominal enlargement, and leucorrhea were denied; breast enlargement since 12 years old with no history of menarche. The patient vital signs were normal. On physical examination obtained, lower abdominal pain and tender suprapubic mass were palpable. The pubertal status was normally secondary sexual characteristics. An interlabial mass was found protruding from the introitus vagina and the hymen intact on inspection of the external genitalia. Laboratory and urinalyses revealed normal. Hematometra and hematocolpos were found on abdominal ultrasonography, which led to the diagnosis of imperforate hymen. Therefore, a hymenectomy was performed and evacuated 520 ml of dark red blood. The patient’s condition was good, and she had regular menstruation. ConclusionsImperforate hymen is an easy diagnosis, but sometimes clinicians are oblivious to including this in the differential diagnosis of lower abdominal pain in pubescent girls with primary amenorrhea. Also, a lack of awareness about the importance of external genitalia examination as part of routine physical examination in children and adolescents makes this diagnosis easily missed or delayed.

Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report.

IntroductionRuptured ectopic pregnancy is one of the leading causes of maternal death. Point-of-care ultrasound (POCUS) has been shown to be highly sensitive for excluding ectopic pregnancy. Ectopic pregnancy after a hysterectomy is a rare but life-threatening occurrence. We present a case where POCUS helped to diagnose a post-hysterectomy ectopic pregnancy.Case reportA 36-year-old female with a prior surgical history of hysterectomy without oophorectomy presented to the emergency department with lower abdominal pain. A POCUS revealed free fluid in the right upper quadrant with an unremarkable gallbladder. Subsequently, the pelvic POCUS noted free fluid as well as a heterogeneous structure in the right adnexa. The clinician ordered a serum beta human chorionic gonadotropin level, which was 173.2 international units per milliliter (lU/mL) (negative: < 5m IU/ml). Transvaginal ultrasound revealed a right adnexal echogenic structure with surrounding vascularity and moderate, complex free fluid suggestive of hemorrhage. Given the concern for possible ectopic pregnancy, obstetrics took the patient to the operating room where a right tubal ectopic pregnancy was confirmed.ConclusionA ruptured ectopic pregnancy is a life-threatening condition that requires rapid diagnosis. Ectopic pregnancy post hysterectomy is an uncommon occurrence infrequently considered in the differential diagnosis of lower abdominal pain, leading to considerable delays in diagnosis. Although uncommon, emergency clinicians must consider this diagnosis in female patients with lower abdominal pain.

Arare differential diagnosis of lower abdominal pain in pediatrics

Arare differential diagnosis of lower abdominal pain in pediatrics

Atypical Presentation of Complicated Dermoid Cyst of Ovary Mimicking Diverticular Abscess

Background: Cystic teratomas comprises 20% overall among all ovarian neoplasia. They are made of derivatives of at least two of three germ layers. Histologically different dermoid cyst contains only well differentiated embryological elements of ectodermal layer. Diverticulitis of colon mainly affects elderly population having abscess formation causing lower abdominal pain. Case presentation: We report a case of 50 yr old woman presenting with lower abdominal pain. From barium enema, ultrasound and CT we suggested the probability of diverticular abscess. Patient was undergone left salpingo-oophorectomy with repair of adhered part of sigmoid colon. Post op biopsy shows typical features of dermoid cyst. Conclusions: We illustrate how a dermoid cyst may be diagnosed as diverticular abscess by imaging. We also showed the rupture of dermoid cyst into sigmoid colon with communication formation. So we the radiologists must be aware of all possible differential diagnosis of lower abdominal pain in elderly female, so that we can help our fellow surgeons to treat properly. Keywords: Cystic teratoma, Diverticulitis, Post menopausal, Sigmoid Colon.

Acute abdominal pain in a 13-year-old female adolescent

Introduction: Ovarian torsion can occur at any pediatric age, mainly between the ages of 9 and 14 years. Diagnosis is challenging, as symptoms are nonspecific, misleading to other more common diagnoses, as genitourinary and gastrointestinal disorders. In children, ovarian lesions leading to torsion are typically benign and cystic. Surgical approach is safe, as most cases of early torsed ovary untwisting exhibit later normal ovarian function.Case report: A 13-year-old female adolescent was referred to the Emergency Department for vomiting, left low back pain, and diffuse abdominal pain with irradiation to the hypogastric area, associated with urinary symptoms. Abdomen was tender in the right iliac fossa and hypogastric area. Analytical study revealed increased inflammatory parameters, urinary test strip was negative, and pelvic computed tomography showed a cystic lesion of ovarian origin. Due to suspicion of cyst torsion, laparoscopic surgery was performed, revealing a necrotic adnexal torsion requiring adnexectomy. Discussion: Although often suspected, adnexal torsion is rarely confirmed. Although ovarian torsion accounts for a small number of all gynecological emergencies, it represents a common diagnostic challenge in the emergency setting. Conclusion: As ovary viability depends on early diagnosis, a high index of suspicion is required. This clinical case raises awareness of this entity in the differential diagnosis of lower abdominal pain in female children and adolescents.

Acute intermittent porphyria exacerbation following in vitro fertilization treatment

ObjectivesAssisted reproductive technology is commonly used for women with infertility. We report a case of acute intermittent porphyria associated with in vitro fertilization treatment. Case ReportA 35-year-old woman with tubal factor infertility presented to our clinic with persistent low abdominal pain and hyponatremia after transvaginal oocyte retrieval. During admission, she experienced a generalized tonic–clonic seizure attacked following by dark brown color urine. Urinary tests showed elevated porphobilinogen, 5-aminolevulinic acid, uroporphyrin, and coproporphyrin, confirming the diagnosis of acute intermittent porphyria. The patient's condition continued to improve after hemin treatment and rehabilitation. ConclusionNewly onset acute intermittent porphyria during the course of controlled ovarian hyperstimulation for in vitro fertilization is a rare but possible complication. Acute intermittent porphyria should be taken into consideration for persisted unexplained abdominal pain and seriously alerted if accompanied with neurological symptoms. Special tests for acute intermittent porphyria should be taken into consideration for the differential diagnosis of lower abdominal pain after oocyte retrieval.

Double Appendix.

The incidence of duplication of the vermiform appendix is reported as 0.004%. Most anomalies of the appendix have been observed in adults and were noticed incidentally during surgery not primarily involving the appendix. Picoli in 1892 reported the first case of appendiceal duplication. Malformations of the appendix may be associated with other visceral anomalies. Several theories have been put forth to explain the developmental anomaly. Duplication of the appendix should be considered in the differential diagnosis of lower abdominal pain, even if the patient reports a previous appendicectomy. Surgeons should be aware of the potential anatomical variations of the vermiform appendix, and careful inspection of the caecum should be performed during laparotomy. Misdiagnosis can cause serious life-threatening complications for the patient and lead to medicolegal problems. This is a case report of a 24-year appendiceal duplication revealed on old female with appendicitis who had laparotomy.

Adnexal torsion in a first-trimester pregnant patient without any predisposing factor: A case report

SummArY Adnexal torsion is an uncommon case during pregnancy. Torsion usually occurs in ovaries with previously diagnosed cysts or tumors. It is rare for a previously normal ovary to undergo torsion in advanced gestation. Here, we report a case of adnexal torsion during the 9th week of pregnancy without any predisposing factors. The patient was admitted to emergency department with mild lower abdominal pain and nausea. With the worsening of clinical and ultrasonographic signs, a right salpingo-ovariectomy was performed. After surgery, the pregnant patient was treated with fluid and appropriate drug supplementations and continuation of the pregnancy was achieved. Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation.

Torsion of a fallopian tube: a rare cause of lower abdominal pain in a female of reproductive age

Isolated unilateral torsion of a fallopian tube is an infrequent but significant cause of acute lower abdominal pain in a female of reproductive age. We present a literature review and the case of a 41-year old lady who presented with sudden onset right-sided lower abdominal pain radiating to right thigh. Clinical examination revealed tenderness in the right lower quadrant of the abdomen and a tender right adnexal mass was noted on vaginal examination. Transvaginal scan revealed an elongated, multiloculated right adnexal mass and a normal left ovary. No free fluid or ascites were noted. Torsion of a right hydrosalpinx was suspected and an emergency laparoscopy was performed which confirmed the diagnosis and a right salpingectomy was carried out. Isolated torsion of a fallopian tube should be considered in the differential diagnosis of lower abdominal pain in any female of reproductive age, particularly when she has a history of tubal sterilisation, oophorectomy and/or pelvic adhesive disease. <strong>Key words: </strong>torsion; fallopian tube; hydrosalpinx; adnexal mass; salpingectomy. DOI: <a href="http://dx.doi.org/10.4038/sljog.v33i2.4009">http://dx.doi.org/10.4038/sljog.v33i2.4009</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2011; <strong>33</strong>: 63-64

Pediatric Ovarian Torsion in a Medical Center in Taiwan: Case Analysis

Abdominal pain is one of the most common complaints made by patients visiting emergency departments; however, ovarian torsion is an uncommon cause of abdominal pain, especially in young children. Early diagnosis is essential in order to salvage the ovaries. We performed a retrospective analysis of patients under 18 years of age who visited Changhua Christian Hospital with adnexal torsion between June 2003 and June 2010. Medical records were reviewed for age, associated symptoms, past and present medical histories, physical findings, diagnostic tests performed, clinical course, pathological findings, and diagnoses. A total of 21 patients were identified and included in the analysis; their mean (SD) age was 13.62 (3.75) years. Abdominal pain was the universal symptom. Vomiting or nausea was the second most common symptom (33.3%). The average period between symptom onset and diagnosis was 3.29 (6.39) days. Right-side adnexal torsion occurred in 14 patients, and left-side torsion in seven patients. Ovarian cysts, most often dermoid cysts (e.g., teratomas), were found in 16 patients (76%). Except for one conservatively treated case and one malignant case (adult granulose cell tumor), the other results of the pathological examination were as follows: eight dermoid cysts, two cystadenomas, one follicular cyst, and eight simple cysts. Although it is uncommon, adnexal torsion should be included in the differential diagnosis of lower abdominal pain in all girls, regardless of age. Sonography is helpful for making such a diagnosis. Time is a critical factor, and early laparoscopy or laparotomy may save a viable ovary.

Adult intussusception by tumor in ileum: a diagnostic dilemma

Intussusception in adults is an infrequent cause of intestinal obstruction; preoperative diagnosis is difficult as symptoms can be intermittent and long standing. This relatively rare entity differs from the childhood form in its etiology, presentation and treatment. We present two cases of ileo-colic intussusception in adults, with a clinical presentation that mimicked complicated appendicitis. These cases remind us that both ileal tumors and intussusception must be included in the diagnosis of lower abdominal pain.

Isolated torsion of the fallopian tube: a case report and review of the literature

Isolated torsion of the fallopian tube is a rare medical emergency, especially in premenarchal girls. We present a 9-year-old girl with right-sided lower abdominal pain. Isolated torsion of the fallopian tube was suspected preoperatively because of the clinical presentation combined with the results of ultrasound and magnetic resonance imaging (MRI). At emergency laparoscopy, the isolated torsion of the fallopian tube could be reduced, and the tube could be salvaged. This case report shows that the use of ultrasonography and MRI or CT is a helpful diagnostic tool to recognize this condition at an early stage. Especially in young girls presenting with abdominal pain, this should be kept in mind, as digital vaginal examination and vaginal ultrasound most often cannot be used in the diagnostic process. In conclusion, because prompt surgical intervention is required to preserve the tube and prevent progression to peritonitis and possible detrimental effects on future fertility, isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain in all female patients regardless of age.

NEUROENDOCRINE TUMOR OF THE CECUM IN A YOUNG BOY DIAGNOSED BY COLONOSCOPIC EXAMINATION

Cecal NETs are very uncommon and can be easily misdiagnosed, resulting in advanced-stage disease at initial diagnosis. For that reason, a high level of vigilance and awareness of NETs in the differential diagnosis of lower abdominal pain is crucial even when the patient has no symptoms from hormone secretions.

Isolated Torsion Of The Fallopion Tube With Hydrosalpinx: A Rare Presentation

Isolated torsion of fallopian tube is a rare event, which generally occurs in the reproductive age group. It is often difficult to diagnose it clinically or on imaging and for diagnosis laparoscopy remains the gold standard. This report describes such a condition in a patient who presented with pain lower abdomen and clinicosonographic evaluation revealed an adnexal mass. Diagnostic laparoscopy revealed dilated tube and diagnosis of hydrosalphinx with torsion of the tube was established. Torsion of fallopian tube is a rare event. It should however be kept in mind in the differential diagnosis of lower abdominal pain in women of all ages.

Torsion of a normal ovary in the third trimester of pregnancy: a case report

IntroductionAdnexal torsion in advanced pregnancy is an uncommon emergency. Torsion usually occurs in ovaries with functional cysts or tumors. It is uncommon for a normal-sized ovary to undergo torsion in advanced gestation. We report torsion of a normal-sized ovary in the third trimester of pregnancy, most probably the first case report of its kind in the English-language literature.Case presentationA 32-year-old Omani woman at 32-weeks gestation (gravida 2 para 1) was admitted with right iliac fossa pain, nausea and vomiting of 2 days duration, as well as a history of a similar episode one month earlier. On examination, a provisional diagnosis of appendicitis was made. Laparotomy revealed, however, that the right ovary was gangrenous and had undergone torsion.ConclusionAdnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation. Although in our patient, the affected ovary could not be saved, an early diagnosis using imaging like Doppler of the adnexae will enable early intervention to save the ovaries of the patient, especially in young women.

An Uncommon Cause of Abdominal Pain in an Adolescent

Imperforate hymen is a rare congenital anomaly which emergency physicians often forget to include in the differential diagnosis of lower abdominal pain in a pubescent girl. These patients often remain asymptomatic until puberty and present in early adolescence with cyclic abdominal pain. This case report reviews the presentation and treatment of an 11-year-old girl with imperforate hymen.

Útero didelfo y hemivagina ciega. Una causa de dolor abdominal en la adolescencia

Objective To evaluate didelphic uterus as a cause of abdominal pain. Material and method We reviewed 2 cases in adolescents managed by our service from 2002 to 2006. Results In both patients, we confirmed the existence of didelphic uterus and septate vagina associated with renal agenesis. Outcome was favorable in both patients after surgery. Conclusions The 2 cases described illustrate the need to include congenital abnormalities in the differential diagnosis of lower abdominal pain and vaginal mass in adolescents.

Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL)

OPEN ACCESSMarch 12, 2007Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL) Maurice Clifton, MD, MSEd Maurice Clifton, MD, MSEd University of Pittsburgh School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.264 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Understanding the differential diagnosis of lower abdominal pain is complex, especially with an adolescent patient. We created this problem-based learning (PBL) exercise to facilitate teaching about pelvic inflammatory disease (PID) in an adolescent during a 1-hour rounds-type format within a clinical curriculum. Methods: This resource contains a facilitator guide that outlines the case and provides question prompts which may be used to guide the students’ experience of the case. A learner version of the case and a handout containing useful reference information are also provided. This group works through each page followed by a very short summary of the learning points that are on the facilitator copy. It is important that the facilitator has a basic understanding of talking with adolescents and is comfortable with the PBL format. The diagnosis and treatment for PID is based on 2006 CDC Guidelines. Results: This case has been used multiple times. No formal studies have been done, but it has been used multiple times with a pediatric inpatient team made up of multiple levels of learners. Informal feedback has been uniformly positive supporting that the case is realistic, useful, and practical. Discussion: This case is appropriate for both undergraduate and graduate medical education settings and has been successful when utilized with a pediatric inpatient team made up of multiple levels of learners. While used in a rounds-type format it can be adapted to other PBL or case-based formats. Educational Objectives By the end of this session, learners will be able to: Demonstrate understanding of differential diagnosis of lower abdominal pain.Describe how to diagnose pelvic inflammatory disease (PID).Formulate a plan to treat a patient with PID. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Adolescent PID Facilitator's Guide.doc Adolescent PID Handout.doc Adolescent PID Learner Sheets.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Teen Substance Abuse Problem Based Learning (PBL) Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL) Copyright & Permissions© 2007 Clifton. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsSTDsPelvic Inflammatory DiseaseLower Abdominal PainSexually Transmitted InfectionsSTIsPIDAdolescence Disclosures None to report. Funding/Support None to report. Loading ...

Women presenting with lower abdominal pain: A missed opportunity for chlamydia screening?

Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Officer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a significant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis.