Important Cause Of Abdominal Pain Research Articles

Mesenteric vein thrombosis: a rare but important cause of abdominal pain.

Mesenteric vein thrombosis: a rare but important cause of abdominal pain.

Detecting isolated superior mesenteric artery dissection with computed tomography

Aim: Isolated superior mesenteric artery (SMA) dissection without associated aortic dissection is a rare entity. The aim of the study is to evaluate its incidence, and multidetector computed tomography (MDCT) and computed tomography angiography (CTA) findings, as well as show the clinical importance of this condition, which should be diagnosed and treated urgently. Methods: Images of all patients who underwent contrast enhanced CTA or MDCT scan from July 2017 to July 2020 at our radiology department were examined retrospectively. A total of 600 CTA and 14000 contrast enhanced MDCT scans (14600 CT) were evaluated. Only the cases with isolated SMA dissections without aortic involvement, who had arterial phases on contrast enhanced MDCT images, were included. Aortic dissection cases with SMA involvement, and non-contrast MDCT images were excluded. Age, gender, symptoms, presence of thrombosis or bowel ischemia were noted. Average extension of dissection and distance from origin were measured. Results: Ten patients (7 M, 3 F), aged between 48-66 years (mean: 57 years), had isolated SMA dissection. The mean distance of dissection from origin and mean extension were 1.9 cm and 3.4 cm, respectively. Patients were treated with conservative anticoagulation therapy. Follow-up CTA or MDCT showed normal SMA without evidence of dissection in 5 patients, decreased extension and length of dissection in 3 patients and no significant difference in 2 patients. Conclusion: Isolated SMA dissection is a rare but important cause of abdominal pain. Early diagnosis allows correct treatment. CT is a useful noninvasive method for diagnosis and anticoagulation therapy is successful.

Mas-related G protein-coupled receptor C11 (Mrgprc11) induces visceral hypersensitivity in the mouse colon: A novel target in gut nociception?

Visceral hypersensitivity, an important cause of abdominal pain in disorders such as IBD and IBS, presents with a poorly understood pathophysiology and limited treatment options. Several members of the Mas-related G protein-coupled receptor family (Mrgprs) have become promising targets in pain research. The potential link between the murine Mrgpr C11 (Mrgprc11) and gut nociception is currently uninvestigated. Therefore, we explored the expression and functional role of Mrgprc11 in the gut nociceptive innervation. Mrgprc11 expression was evaluated in DRG neurons innervating the mouse colon using in situ hybridization and immunohistochemistry. Visceromotor responses to colorectal distension (CRD) assessed the effect of the Mrgprc11 agonist, BAM(8-22), on colonic pain sensitivity in healthy mice. Moreover, we determined pERK1/2-immunoreactivity in the thoracolumbar spinal cord after noxious CRD. Finally, from a translational point of view, we looked for expression of the human counterpart of Mrgprc11, MRGPRX1, in human thoracolumbar DRGs. In situ hybridization and immunohistochemistry revealed Mrgprc11 expression in colonic DRG neurons. Intracolonic administration of BAM(8-22) significantly increased colonic pain sensitivity in an Mrgprc11-dependent manner, and led to a significantly increased degree of neuronal activation in the splanchnic spinal cord upon noxious stimulation. Furthermore, MRGPRX1 expression was also detected in human thoracolumbar DRG neurons. CONCLUSIONS& INFERENCES: Our findings established a novel function for Mrgprc11 in the gut nociceptive innervation and propose the receptor as a new player in visceral hypersensitivity. Given the presence of MRGPRX1 in human DRG neurons, our study warrants future research on its therapeutic potential in abdominal pain disorders.

Types and Management of Chronic Intestinal Ischemia

Background:chronic intestinal ischemia is unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences Aim of the Work: the objective of this systematic review was to assess the value of different types of management of chronic intestinal ischemia (Open surgery versus endovascular interventions). PubMed and EBSCOHost electronic databases were methodically searched for English-language articles published be­tween 1996 and 2015. Conclusion: chronic mesenteric ischemia is a condition characterized by postprandial abdominal pain, which is ascribed to intestinal hypoper­fusion. Patients were frequently malnourished and develop significant weight loss due to sitophobia. Traditionally, open surgery has been the treatment of choice; however, endovascular surgery was gaining wider accep­tance. Based on the data, open surgeries surpass endovascular procedures in terms of symptom amelioration and long-term vessel patency, along with less significant symptomatic recurrence. Patients undergoing open procedures do, however, have a higher rate of complications. Nonetheless, there was no statistically significant difference in mor­tality rates between the two approaches.

Successful surgical bypass of superior mesenteric and inferior mesenteric artery

Chronic mesenteric ischemia is a rare but important cause of abdominal pain with high mortality and morbidity rates. The main goal of the treatment is to relieve patient’s symptoms by restoration of intestinal perfusion and to prevent intestinal necrosis. A 40-year-old male was referred to us with complaints of post prandial abdominal pain and weight loss for last 2 years. Computed tomography angiography of abdominal aorta revealed complete occlusion of proximal part of superior mesenteric artery and inferior mesenteric artery. Surgical bypass of superior mesenteric artery was done by retrograde technique from right common iliac artery to ileocolic artery using great saphenous vein. Inferior mesenteric artery bypass was done with great saphenous vein from infrarenal abdominal aorta to inferior mesenteric artery. Postoperative recovery was uneventful and patient was asymptomatic after follow-up period of 6 months.

ABSTRACT 853

Background and aims: Acute appendicitis is the most important cause of abdominal pain in children and the commonest that requires emergency surgery. Aims: We aim to evaluate and compare the ultrasonographic findings and pediatric appendicitis scoring (PAS) in diagnosis of acute appendicitis. Methods: Twentyfive patients between 2-18 ages who were admitted to emergency department with acute abdominal pain and thought to have acute appendicitis by history and physical examination were included in the study prospectively. Abdominal ultrasonography was performed for all patients. Pediatric appendicitis scoring was evaluated by one physician. Fifty two percent of patients (n=13) underwent surgery. Definitive diagnosis of acute appendicitis was made according to histopathological findings. Permission was received from the local ethics committee. Results: Fifty two percent of twenty-five patients underwent surgery with preliminary diagnosis of acute appendicitis. Intussusception was found in one patient surgically and 12 patients (48%) had acute appendicitis according to histopathological findings. Pediatric appendicitis scoring mean score was 5.5 (range 2-10) for all 25 patients and it was 8.0 (range 6-10) for the 12 patients who were diagnosed by histopathological study. In non-surgical group of patients the PAS mean score was 3.2 (range 2-5) and this results were statistically significant (p<0.05). Conclusions: Pediatric appendicitis scoring is a safety complementary method for evaluation of patients who have preliminary diagnosis of acute appendicitis in childhood but we need comprehensive studies that contain large number of patients.

A Rare Cause of Acute Abdomen

Introduction: Superior mesenteric venous thrombosis is a rare but important cause of mesenteric ischemia. Mesenteric ischemia, if untreated, can lead to bowel gangrene, septic shock, and death. 75% of patients with isolated mesenteric venous thrombosis have an inherited thrombotic disorder. Case presentation: A 62-year-old HIV-positive Caucasian male presented with a four-day history of sudden onset, severe abdominal pain. The patient also had decreased appetite and nausea. He was passing flatus. His last CD4 count was 612, a month ago. On abdominal examination, there was tenderness around the umbilicus. Abdominal and pelvic CAT scan with contrast showed superior mesenteric venous thrombosis with patent portal and splenic veins. Patient was made nil per oral and started on heparin drip. A complete hypercoagulability panel was sent. The patient was diagnosed with heterozygous mutation of MTHFR (Methyl-tetra-hydro-folate-reductase), heterozygous mutation of prothrombin gene, and hyper-homocysteinemia. The patient was started on warfarin to overlap with heparin for long-term anticoagulation. The patient recovered uneventfully, and was started on an oral diet and discharged home. Discussion: In patients presenting with superior mesenteric vein thrombosis hypercoagulability, work-up is necessary, as 75% of the patients have underlying coagulation defects. The patient needs to be on long-term anti-coagulation to prevent re-occurrence. Superior mesenteric vein thrombosis, although a rare but important cause of abdominal pain, should be considered in a patient presenting with acute abdomen. If diagnosed early, it can be treated successfully and prevent devastating consequences like bowel gangrene, perforation, and sepsis.

Surgical treatment of chronic mesenteric ischemia with splenic artery-to-superior mesenteric artery bypass: a case report

Chronic mesenteric ischemia is a rare, but important cause of abdominal pain with high mortality and morbidity rates. Postprandial abdominal pain, sitophobia and weight loss are the important clinical signs and symptoms. The main goal of the treatment is to relieve patient&#8217;s symptoms by restoration of intestinal perfusion and to prevent intestinal necrosis. Doppler ultrasound, computed tomography angiography, magnetic resonance angiography and conventional angiography are used in the diagnosis of chronic mesenteric ischemia. Surgical or endovascular interventions as well as medical therapy may be used in the treatment of chronic mesenteric ischemia. In this article, we present a 60-year-old female case of chronic mesenteric ischemia with inferior and superior mesenteric artery occlusion, who was successfully treated with splenic arteryto- superior mesenteric artery bypass surgery.

Ovarian torsion—A course for severe abdominal pain in children

Ovarian torsion is a rare, albeit important cause of abdominal pain as it may lead to ovarian necrosis if not resolved. Although it has been described in all ages, it is very rare in young children. The primary symptom is abdominal pain, and due to the abundance hereof in a pediatric setting and the significant overlap in the clinical manifestations between ovarian torsion and more common entities such as appendicitis, a high level of suspicion needs to be maintained. We report the case of a young girl with a history of severe abdominal pain. A primary hospitalization at the age of 1? years resolved quickly and spontaneously without any imaging. At the age of 2 years and 10 months, she was once again hospitalized for severe abdominal pain. A CT scan shoved a large dermoid cyst and possible torsion of the ovary. An exploratory laparotomy confirmed the diagnosis and oophorectomy was performed. Histopathological examination of the cyst demonstrated a 5 × 5 × 6 cm mature cystic teratoma without malignancy. This case illustrates how a high level of suspicion for ovarian torsion needs to be maintained, even in otherwise healthy children.

Ovarian torsion among girls presenting with abdominal pain: a retrospective cohort study

BackgroundOvarian torsion (OT) is an important cause of abdominal pain in girls. Prompt recognition of OT may lead to higher rates of ovarian salvage.ObjectiveTo identify clinical and laboratory findings that...

Management of suspected appendicitis in children

Acute appendicitis is the most important cause of abdominal pain in children and is the commonest that requires emergency surgery. Prompt diagnosis, immediate referral and expeditious surgery should be undertaken...

Ovarian torsion in a prepubertal girl

A previously healthy 4-year-old female presented to the Emergency Department complaining of sudden-onset right-lower-quadrant abdominal pain that awoke her from sleep. The pain was constant, non-radiating and severe. She denied trauma, dysuria, hematuria, nausea, vomiting, diarrhea, constipation or hematochezia. Her vitals were HR: 92, RR: 16, BP: 116/76 and T: 37.0 °C. Physical exam revealed tenderness at McBurney’s point, but no rebound, rigidity or guarding. CBC with differential, basic metabolic panel and urinalysis were all unremarkable. A CT abdomen with contrast and ultrasound revealed a 5.0 × 4.2 × 4.8-cm non-communicating cystic mass abutting the left dome of the bladder. The differential diagnosis included mesenteric cyst, enteric duplication cyst, urachal cyst and ovarian cyst. Surgical exploration confirmed the diagnosis of right ovarian cyst with torsion. Kokoska et al. reviewed 51 cases of ovarian torsion between 1983 and 1999 and reported the mean age to be 12.5 ± 1.3 years [1]. A similar study by Anders et al. reviewed 22 cases and calculated the mean age to be 10.2 years with a range of 3–15 years [2]. Ovarian torsion is a rare, but important cause of abdominal pain in younger children that requires a high index of suspicion (Figs. ​(Figs.1,1, ​,22 and ​and33). Fig. 1 Transverse CT image Fig. 2 Coronal CT image Fig. 3 Abdominal US image

Splenic infarction complicating percutaneous transluminal coeliac artery stenting for chronic mesenteric ischaemia: a case report

IntroductionChronic mesenteric ischaemia is an important cause of abdominal pain, especially in older patients with risk factors for vascular disease. Until recently, surgical revascularization procedures such as endarterectomy and aorto-coeliac or aorto-mesenteric bypass grafting were the only available treatment options for patients with chronic mesenteric ischaemia. Percutaneous angioplasty and stenting have recently been shown to be effective and safe alternatives to surgical revascularization in high-risk patients with chronic mesenteric ischaemia.Case PresentationWe report an 84-year-old woman with symptoms of chronic mesenteric ischaemia, including post-prandial abdominal pain and weight loss. Investigations demonstrated calcific stenoses at the origins of the celiac, superior mesenteric and inferior mesenteric arteries, along with nonocclusive calcification in the mid-splenic artery. Coeliac artery angioplasty and stenting was performed, resulting in excellent arterial dilatation at the stenotic point and distal filling of the coeliac and superior mesenteric arteries and their branches. Within hours of successful stenting of the coeliac artery, the patient developed severe left upper quadrant pain. Progress imaging demonstrated splenic infarction, likely as a result of calcific emboli dislodged from the calcified plaque at the origin of the celiac artery at the time of angioplasty and stenting. The left upper quadrant pain resolved after 8 days and the patient remains asymptomatic 2 years post-procedure.ConclusionThis is the first reported case of splenic infarction complicating otherwise successful coeliac artery stenting, presumably as a consequence of distal embolization of disrupted calcific plaque. This complication, occurring on a background of non-occlusive splenic arterial calcification, represents a novel cause of abdominal pain post-procedure.

Gastric outlet obstruction due to gastroduodenal eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare but important cause of abdominal pain of unknown etiology [1]. It can sometimes be recognized on the basis of macroscopic abnormalities, such as erythema, focal erosions, ulcerations, and thickening of mucosal folds [2]. Small-bowel obstruction can occur in eosinophilic gastroenteritis involving the muscularis layer [3], but gastric outlet obstruction is extremely rare [4].

Surgical management of intestinal malrotation in adults

The aim of this study was to review our experience with diagnosis and surgical management of intestinal malrotation in adult patients. A retrospective review of the surgical outcome of adults with intestinal malrotation was performed. Twelve patients were observed and treated between July 1996 and July 2006 (4 women and 8 men; the mean age of the patients was 28.5 years). Surgical outcomes, including postoperative complications, deaths, and resolution of preoperative symptoms, were measured. A diagnosis of malrotation was made preoperatively in five patients by upper gastrointestinal contrast study, barium enema, or computed tomography scan. The anomaly was discovered incidentally at laparotomy in seven patients. All cases were proved to be malrotation intraoperatively. Nine patients underwent laparotomy and three underwent laparoscopic surgery (one converted to an open procedure). Follow-up ranged from 2 months to 118 months. Three patients had complications: one had wound infection, one had delayed gastric emptying, and one developed adhesive ileus. There were only two recurrences detected and one patient with recurrence required reoperation. No one died. Intestinal malrotation is a rare but important cause of abdominal pain in adults. It may present with chronic or acute symptoms. Laparotomy and laparoscopy are alternative and feasible techniques with low rates of complications for the treatment of intestinal malrotation in adults.

Trends in the incidence and significance of presentations to the emergency department due to acute pancreatitis

Acute pancreatitis is an important cause of abdominal pain that may be associated with significant morbidity for the patient and considerable workload for the hospital. Our impression has been that it is becoming increasingly common, perhaps in tandem with increased rates of other alcohol-related disease. The medical records of all patients attending our emergency department with acute pancreatitis by Hospital Inpatient Enquiry coding over a 9-year period were examined to determine its incidence, aetiology and significance (Imrie severity of pancreatitis scoring, length of hospital stay and interventional workload). The incidence of acute pancreatitis (n=97, 40 male patients) increased approximately threefold over the study period (especially in the lattermost triennial period with 75 patients) in a fashion disproportionate to changes in our locality's population. Gallstone-related disease continues to be most prevalent although alcohol-related disease also became more common. Disease severity (length of hospital stay and Imrie score) was similar throughout with a mean length of hospital stay exceeding that of the majority of accident and emergency admissions. Seven acute complications of acute pancreatitis were noted while 34 chronic sequelae developed. Requirement for invasive intervention doubled (n=19 in first triennial period in the study vs 39 in the latter triennial period), although the relative need for endoscopic retrograde cholangiopancreaticography diminished with increased availability of magnetic resonance cholangiography imaging. Nine patients with gallstone-related acute pancreatitis suffered recurrent attacks while awaiting cholecystectomy. Acute pancreatitis is an increasingly frequent cause of hospital admission while the clinical significance of each incident remains high. The presentation of acute pancreatitis to the emergency department as an early declaration of symptomatic cholelithiasis is especially worrisome as it suggests a failing of recognition and/or effective referral of premonitory biliary complaints.

Acute mesenteric infarction: an important cause of abdominal pain in ulcerative colitis

We present four cases of acute mesenteric infarction in patients with active ulcerative colitis: one presenting prior to the diagnosis of ulcerative colitis, two at the time of diagnosis, and one many years after the diagnosis had been made. Intestinal ischaemia is an important part of the differential diagnosis in patients with ulcerative colitis presenting with abdominal pain. Conversely, in patients presenting with bloody diarrhoea after mesenteric ischaemia, ulcerative colitis should be considered.

Gynaecological causes of abdominal pain

Gynaecological causes of abdominal pain may arise from conditions associated with pregnancy and the non-pregnant state. In the former, the presentation is usually as an emergency and the most important diagnosis is ectopic pregnancy. In women who are not pregnant, the most common emergencies associated with abdominal pain are acute pelvic inflammatory disease and complications of ovarian cysts. Less acute causes of abdominal pain include endometriosis, fibroids and chronic pelvic inflammatory disease. Women with acute abdominal pain due to gynaecological disease may present to surgeons, and the most useful investigations for possible gynecological problems are sensitive pregnancy tests and pelvic ultrasonography. A negative pregnancy test effectively excludes an ongoing pregnancy. Gynaecological conditions may be encountered during surgery (particularly diagnostic laparoscopy) and gynaecologists must be involved in management decisions when a gynaecological abnormality is suspected preoperatively or if it is encountered intraoperatively. The most important cause of abdominal pain due to a gynaecological problem is ovarian cancer. This rarely presents acutely, but often gives rise to vague abdominal symptoms. The cancer has usually spread by the time of diagnosis, and clinicians should be particularly vigilant in postmenopausal women with vague abdominal symptoms.

Unusual colitides

Colitis is an important cause of abdominal pain and diarrhoea and is the main cause of blood and mucus in the stool. The inflammation can be due to infectious or to non-infectious causes, most commonly ulcerative colitis and Crohn's disease. However, a wide variety of rarer causes of colitis also present in childhood. These include colitis or enterocolitis secondary to Hirschsprung's disease and metabolic disorders (which include Hermansky-Pudlak syndrome, glycogen storage disease type 1b and pellagra). Primary inflammation of the colon is seen in microscopic and collagenous colitis, ulcerating enterocolitis of infancy, allergic colitis and autoimmune enteropathy. The histological pattern of each of these diseases has a characteristic picture and separates them from each other from ulcerative colitis and Crohn's disease. The pathophysiology of these rare forms of colitis in childhood is not clear; but in the future they may give us an insight into the pathogenesis of large bowel inflammation, particularly when the colitis occurs secondary to an established disease.