Differential Diagnosis Of Acute Abdomen Research Articles

Perforated Acute Appendicitis in a Pre-Term Neonate

Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion.

Lassa fever presenting as acute abdomen: a case series

Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff.We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin.Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

Spontaneously Ruptured Hydatid Liver Cyst with a Presumptive Diagnosis of Acute Appendicitis

A 14-year-old female patient with abdominal pain diagnosed as acute abdomen was operated on; a perforated hydatid cyst was found. Hydatid cysts are endemic in Turkey, especially in the eastern and southeastern regions. The liver is the most common location. Ultrasonography and computed tomography can be used in the diagnosis hydatid cysts. Spontaneous intraperitoneal rupture of a hydatid cyst is rare, but it can cause severe anaphylactic reactions and biliary peritonitis. Very few cases have been reported. Though rare, a ruptured hydatid cyst should be considered in the differential diagnosis of acute abdomen in a patient residing in the endemic zone.

Intestinal hydatidosis in unusual location: A case report

Introduction: Hydatid cyst in the small intestine is extremely rare and only a few cases have been reported in literature. Case Report: A 60­year­ old male presented with abdominal pain in the periumbilical region, nausea and fever. Hematological investigations revealed neutrophilic leukocytosis with eosinophilia. Ultrasound scan revealed multiple hypoechoic cysts in the small intestine. Serological tests were positive for hydatid disease. Surgical laparotomy was done and patient was treated with antihelminthic drugs. Histological diagnosis of hydatidosis was made. Conclusion: Intestinal hydatidosis is a rare entity and can be considered as one of the differential diagnosis of acute abdomen or abdominal mass.

Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen

Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient's hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma.

Polyarteritis nodosa diagnosed by surgically resected jejunal necrosis following acute abdomen

The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.

Perforated duodenal ulcer: A rare complication of deferasirox in children

Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

Spontaneous Bladder Perforation in an Infant Neurogenic Bladder: Laparoscopic Management

Spontaneous bladder perforation is an uncommon event in childhood. It is usually associated with bladder augmentation. We are presenting a case of bladder rupture in an infant with neurogenic bladder without prior bladder surgery. Three days after lipomyelomeningocele excision the patient showed signs and symptoms of acute abdomen. The ultrasound exploration revealed significant amount of intraperitoneal free fluid and therefore a laparoscopic exploration was performed. A posterior bladder rupture was diagnosed and repaired laparoscopically. Currently, being 3 years old, she keeps successfully dry with clean intermittent catheterization. Neurogenic bladder voiding function can change at any time of its evolution and lead to complications. Early diagnosis of spontaneous bladder rupture is of paramount importance, so it is essential to think about it in the differential diagnosis of acute abdomen.

Torsion of preterm gravid uterus: A case report

Introduction: Rotation of the gravid uterus is a normal occurrence in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees i.e, torsion of the entire uterus­is rarely encountered. We report here a case of uterine torsion from our obstetrical practice. Case Report: A young 25­ year­old second gravida, para one presented with features of antepartum hemorrhage (Abruptio placentae) with intrauterine fetal demise at 25 weeks of pregnancy. During laparotomy uterine torsion of 180 degrees was diagnosed. As all attempts at detorsion failed, a deliberate posterior lower segment incision was made to deliver the baby. Subtotal hysterectomy had to be done as conservative procedures (utertonics, uterine artery ligation, B­Lynch suture) to control postpartum hemorrhage failed. The patient was recovering in the postoperative period, when she died unfortunately of a suspected pulmonary embolism. Conclusion: Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences. Aetiopathogenesis of this condition is still unclear. The diagnosis is usually made at laparotomy. Often posterior lower segment incision is used for delivering the baby. It merits consideration as a differential diagnosis of acute abdomen in pregnancy.

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.

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.

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.

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)

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.