Mild Abdominal Pain Research Articles

Irritable Bowel Syndrome in a Population of a Developing Country: Prevalence and Association.

Introduction: Irritable bowel syndrome (IBS) is included as one of the functional gastrointestinal (GI) related disorders presenting with pain in abdomen of chronic duration in the absence of any identifiable organic cause. Bloating, distension of abdomen, and defecation in disordered manner are other features commonly associated with IBS. It is a complex disorder with mixed physiological, psychological, and social interactions. The present study was carried out with the aim to determine the frequency of IBS in patients presenting with abdominal pain in a population of a developing country.Materials and methods: A descriptive cross-sectional study was undertaken at the outpatient department of a large tertiary care hospital. Patients of either gender aged between 20 and 50 years presenting with abdominal pain were included. The diagnosis of IBS was established using Rome III criteria. Prevalence of IBS was calculated and confounding factors such as age, gender, marital status, duration of abdominal pain, and economic status were stratified to see their effect on outcome variable by applying chi-square test and taking p-value of <0.05 as significant.Results: A total of 186 patients were included in this study. Some 100 (53.76%) were male and 86 (46.24%) were female. Mean age of the patients was 33.67 ± 7.08 years. Some 58.6% were married and 41.4% were single. Some 61.83% had mild abdominal pain and 38.17% had moderate pain. Out of the total 186 patients, the frequency of IBS was found to be 35.48%. There was no significant effect of confounding variables such as age, gender, duration of abdominal pain, marital status, and economic status on IBS.Conclusion: In our study the frequency of IBS in patients with abdominal pain is high with no significant effect of gender, marital status, economic status, and duration of abdominal pain on IBS.

Unusual metastasis of papillary thyroid cancer to the pancreas, liver, and diaphragm: a case report with review of literature

BackgroundPapillary thyroid cancer (PTC) is the most common form of well-differentiated endocrine malignancy. Distant metastases of PTC are rare and usually occur in the bones, lungs, and thoracic lymph nodes despite the common locoregional metastases to the lymph nodes of the neck. The metastasis of PTC to the pancreas is extremely rare. Here, we present a patient with PTC that had simultaneously metastasized to the pancreas, liver, and diaphragm.Case presentationA 47-year-old male patient suffering from mild abdominal pain for 2 months was admitted to our hospital. The ultrasound (US) and computed tomography (CT) scan of the abdomen revealed a pancreatic space-occupying lesion and pancreatic duct dilatation, and the patient underwent exploratory laparotomy. Intraoperative examination identified a hard mass (approximately 4.0 cm × 3.0 cm) in the body and tail of the pancreas and a mass (1.5 cm in diameter) in the diaphragm. Three light masses were also noted on the surface of his liver. The patient underwent radical distal pancreatectomy, splenectomy, diaphragm, and liver mass resection. After surgery, the pathological report revealed that the masses resected from the pancreas, liver, and diaphragm were PTC metastases. Then, the patient had a thyroid US and an endoscopic US-guided fine needle aspiration biopsy of the thyroid mass. Pathology showed papillary cancer. Subsequently, the patient received a complete thyroidectomy, a cervical lymphadenectomy, bilateral parotidectomy, and bilateral submandibular gland resection.ConclusionsAggressive surgeries, such as pancreaticoduodenectomy (PD), should be considered for selected patients with metastatic diseases from PTC to alleviate the symptoms and prolong their survival.

Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video)

We previously reported safety and effectiveness of EUS-guided hepaticogastrostomy (EUS-HGS) using a long, partially covered metal stent (LP-CMS) for malignant biliary obstruction (MBO). In this study, we aimed to evaluate long-term outcomes of EUS-HGS in an expanded cohort. One hundred ten patients undergoing EUS-HGS using an LP-CMS in 2 centers were retrospectively studied. Technical and functional success, adverse events, recurrent biliary obstruction (RBO), and reinterventions were evaluated. The cause of MBO was pancreatic cancer in 50%, and the location of MBO was distal in 68%. The stent length was 8 cm in 2%, 10 cm in 84%, and 12 cm in 15%, with a median intragastric stent length of 54mm. Technical and functional success rates were 100% and 94%, respectively. The adverse event rate was 25% (mild 15%, moderate 7%, severe 3%), but about one-half of adverse events were mild transient fever and abdominal pain. RBO developed in 33%, with a median cumulative time to RBO of 6.3 months. The major cause of RBO was hyperplasia at an uncovered portion. The presence of prior biliary drainage and short intragastric stent length were significantly associated with RBO. Reintervention for RBO was successfully achieved through the EUS-HGS route in 92%. The remaining reintervention procedures were 1 EUS-HGS and 2 percutaneous transhepatic biliary drainage all in cases with hilar MBO. EUS-HGS using an LP-CMS for unresectable MBO was safe and effective. RBO was not uncommon, butreintervention through the EUS-HGS route was technically possible in most cases.

Bilateral Morgagni hernia in a donkey

SummaryThis case report describes the clinical presentation and management of a donkey admitted with acute signs of abdominal pain that was diagnosed with a bilateral Morgagni hernia, a rare type of congenital diaphragmatic hernia. For more than 8 months before presentation, the donkey had been showing signs of recurrent mild abdominal pain that responded favourably to medical treatment. On admission, the donkey had mild tachycardia and tachypnoea. Radiography and ultrasound of the thorax and abdomen showed thoracic herniation of the large colon. Exploratory laparotomy was performed, and the sternal and diaphragmatic flexures of the large colon, as well as the left hepatic lobe, were found incarcerated in a bilateral Morgagni hernia. Intestine and liver were removed from the hernia, and the large colon was exteriorised. The defect in the diaphragm was repaired by stapling a polyester mesh circumferentially around the hernia ring and covering the mesh with an excised section of the greater omentum. No further complications and no recurrence of colic were observed during an 8‐month follow‐up period.

Meckel's diverticulum penetrating the mesentery causing hemoperitoneum

Meckel's diverticula are common congenital gastrointestinal malformations that most often present with bloody stool or bowel obstruction in children. Herein, we report a rare case of a 5-year old boy who presented hemoperitoneum with mild abdominal pain and without bloody stool. Upon performing an exploratory laparotomy, Meckel's diverticulum penetrating to mesentery and caused hemoperitoneum bleeding from branch of mesenteric artery.

Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series

The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients. A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus. The surgeries were performed in a single institution between January 2015 and June 2019. The patients were selected if a laparoscopic intervention was indicated. The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision wasrepaired with a permanent suture. Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before andafter surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up. LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.

Magnetic Resonance Cholangiopancreatography Detection of Multiple Biliary Dilatations With Cysts

A 47-year-old woman presented with a 6-month history of mild intermittent but recurrent abdominal pain. On physical examination, there was mild tenderness in the right upper quadrant. Laboratory results showed all tumor markers were normal, including α-fetoprotein levels and serum carbohydrate antigen 19-9. Ultrasonography showed multiple small hypoechoic and hyperechoic hepatic lesions. An abdominal magnetic resonance cholangiopancreatography was performed, and thousands of subcentimeter liver foci, with T1-weighted hypointense (dark image) and T2-weighted hyperintense (bright image), were shown.

Methodology, safety and applications of colonic transendoscopic enteral tubing (with video)

Objective To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. Methods This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. Results A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases. Key words: Colonoscopy; Fecal microbiota transplantation; Enema; Transendoscopic enteral tubing

Formalin induced Corrosive Mucosal Injury: A Rare Case Report

Formalin is an aqueous solution of formaldehyde (37%), which is a pungent and highly reactive gas. Ingestion of formalin is infrequent due to its strong odour and irritant effects. Here, we report a case of accidental ingestion of formalin in a five-year-old child. This child was referred to our hospital with a history of accidental ingestion of 30 mL of formalin at home. Following the intake she developed vomiting and mild abdominal pain. Arterial blood gases at admission were as follows: pH: 7.39, pCO2: 30.4 mm Hg, pO2: 102 mm Hg, bicarbonate: 19.8 mmol/L, lactate: 1.2 mmol/L. Routine haematological, liver and kidney investigations revealed no significant abnormality. Oesophago-gastro duodenoscopy indicated corrosive injury to stomach and oesophagus. Supportive care treatment was provided with broad spectrum antibiotics, intravenous fluids, antiemetics, proton pump inhibitors and gastrointestinal mucosal protectant like sucralfate. She showed improvement with the treatment and was later started on a clear liquid diet which gradually advanced to soft diet. Thus, the gastrointestinal system appears to be primarily affected due to formalin intoxication. In the absence of a specific antidote, such poisoning cases need to be treated symptomatically. Prompt supportive treatment can avoid fatal consequences.

The causes of visits of non-urgent patients to an emergency department in King Fahad Hospital-Albaha-Kingdom of Saudi Arabia

OBJECTIVE: The use of the emergency department by patients presenting with non-urgent conditions has become an important problem that is faced by all local and global health systems. The main objective of this article is to determine the causes of non-urgent emergency department visits by patients. METHOD This is a retrospective, descriptive study, conducted in the emergency department from January to April 2020. All patients triaged according to the Canadian Triage and Acuity Scale (CTAS) as CTAS -5 (non-urgent conditions) were included during the study period and their data such as demographics and presenting complaints were extracted from the hospital electronic files. Ethical approval was taken from the hospital's ethical review board. RESULTS Out of 1308 patients that visited the emergency department (ED), 327 (25%) patients were categorized as non-urgent visits (CTAS-5) according to the triage system. There was a slight female predominance of 165(50.5%) as compared to males 162(49.5%). 71% of patients were between 20-40 years of age. It was identified that 92% of the selected patients had non-urgent conditions, did not need any treatment in ED, and could be treated and followed up in primary health clinics or hospital polyclinics. 32.7% of patients had no chronic illness and 32.1 % of the patients had visited the ED before at least one time for the same complaint. The most common complaints at presentation for non-urgent visits were musculoskeletal system pain (30.5%), mild non-surgical abdominal pain (17.7%), Upper respiratory tract infection (9.5%), and fever (3.7%). It was found that 5.8% needs to be upgraded to CTAS 3-4 zone for further assessment and management. CONCLUSION The majority of non-urgent visits at the emergency department could be treated in other facilities like primary health care and hospital polyclinics. Proper, safe application of triage system and necessary education to the patients can reduce the emergency department overcrowdedness which will ensure patients safety and improve patients' clinical outcome.

Peripheral Neuropathy: A Rare Side Effect of Metronidazole

Metronidazole (MTZ) is a potent drug used against protozoa such as Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis, and Balantidium coli, anaerobic bacteria, amebic liver abscess, bacterial meningitis, infection of the bone, and infectious disorder of the joint. Common side effects of MTZ include mild abdominal pain, headache, nausea, and persistent metallic taste, while other serious and rare side effects include pseudomembranous colitis, seizures, encephalopathy, and peripheral neuropathy. A case of MTZ-induced peripheral neuropathy has been included in this article. A patient was prescribed MTZ for liver abscess for 4 weeks; the patient developed peripheral neuropathy in 15 days; immediately, he reached the hospital and MTZ was withdrawn. He has then been prescribed pregabalin to treat peripheral neuropathy. The patient improved in 4 days on this treatment and was discharged from the hospital. This study concludes that MTZ has a rare side effect of peripheral neuropathy.

Primary Ovarian Lymphoma: A Rare Entity

Primary ovarian lymphoma (POL) refers to involvement of the ovary with lymphoma but without the involvement of any other site. It is an extremely rare yet well-recognized condition. We present to you a case of 25 year old female who presented with abdominal distension and mild lower abdominal pain for 4 weeks diagnosed radiologically and pathologically as primary ovarian lymphoma.

Efficacy of Fecal Microbiota Transplant in Hematological Cancers Patients with Recurrent Clostridioides Difficile Infection: A Systemic Review and Meta-Analysis

Introduction: Fecal microbiota transplant (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infection (CDI). Immunosuppression is one of the risk factors for CDI. However, most of the trials evaluating efficacy of FMT have excluded immunocompromised patients. Patients with hematological cancers represent a major class of immunocompromised patients. Hence, we performed a meta-analysis to evaluate the efficacy of FMT in patients with hematological cancer for the treatment of recurrent CDI. Methods: A systematic search of Medline, Embase, and Web of Science was performed from January 2000 up to December 2018. Articles included for meta-analysis were case series and case reports that assessed efficacy of FMT in hematological cancer patients were included. Study quality was assessed using the Newcastle-Ottawa scale. The main outcomes were pooled proportions of patients achieving cure after first FMT. The cure rate was defined as resolution of diarrhea without any recurrence. Results: 10 studies (5 case series and 5 case reports) were included in the analysis, making up 29 patients who underwent 38 total FMT procedures. The follow up period ranged from 1- 14 months. Of the included patients, 17 had leukemia, 10 had lymphoma and 2 patients had multiple myeloma and myelodysplastic syndrome each. 7 of these patients had undergone hematopoietic stem cell transplant. The pooled cure rate was 82% [confidence interval (CI) 67-94%] after 1 FMT with no heterogeneity (I2=0%). Minor publication bias was seen on visual inspection of funnel plot. FMT was generally well tolerated by these patients. No serious side effects were reported in any study. One of the studies reported death due to cardiac arrest 5 days after FMT which was thought to be unrelated to the procedure. Mild side effects including mild abdominal pain, transient diarrhea, fecal urgency, constipation and nausea were reported in 5 patients. Conclusion: Based on limited observational data, FMT seems to be an effective and safe modality for management of recurrent CDI in patients with hematological cancers. However, further prospective clinical trials are needed to establish its safety as a first line therapy for recurrent CDI in this population. Figure Disclosures Jamshed: Takeda Pharmaceutical: Honoraria. Khanna:Rebiotix, Inc: Research Funding; Probio Tech, LLC: Consultancy; Facile Therapeutics: Consultancy; Shire, Plc: Consultancy.

A Rare Case of Mucinous Borderline Tumor in Adolescent Age Accompanied by Complete Vaginal Obstruction

Abstract- Ovarian tumors are rare in childhood and adolescent age. A 14-year-old girl presented with abdominal distention and mild cyclical abdominal pain since 3 months ago. There was an abdominal distention, and huge firm mass was palpated from pelvis to epigastric region. Abdominal ultrasonography revealed normal uterus and large multiloculated adnexal mass with multiple fine septations. Laparotomy was performed, and the ovarian mucinous borderline tumor was reported in frozen section biopsy. Exploration of other abdominopelvic organs revealed no other pathological signs. The final pathological report showed the right ovarian mucinous borderline tumor. Although the mucinous ovarian borderline tumor is a rare condition in adolescent age, pelvic mass, especially with solid or nodular component, must arise this diagnosis, and exploratory laparotomy with comprehensive surgical staging with regard to fertility preservation is warranted.

Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal

Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

Case Report on Tuberculosis of Cervix: Rare Entity

This is the case report of a rare form of genital TB, cervical tuberculosis, which accounts for only 5-15 % ofgenitourinary tuberculosis (GUTB). Although pulmonary tuberculosis remains the commonest and the mostinfectious type of tuberculosis, extra pulmonary tuberculosis is becoming more prevalent in reproductive age womenof developing countries. We report a case of 24 years old married nullparous lady presented with vaginal dischargeand mild lower abdominal pain despite repeated treatment with antibiotics. She became amenorrhea and failed toconceive for the last 5 years despite regular, unprotected sexual activity. She visited different health facilities beforeher referral to Jimma University Medical Centre where genital tuberculosis was confirmed histologically by thepresence of caseous necrosis and epithloid granuloma on cervical biopsyKEYWORDS: Cervical tuberculosis, amenorrhea, infertility(

Recurrent abdominal pain in school children in a rural tertiary hospital

Background: Recurrent abdominal pain is one of the most common presenting complaints among school going children, with a prevalence of 10-12%. Most of the children with recurrent abdominal pain are not evaluated further, either due to the mild abdominal pain or transient nature of the symptoms. Recurrent abdominal pain requires complete evaluation to look for organic causes. However, in many cases, where no specific organic cause can be identified, a psychosomatic component has been shown to play a role. The aim of the study is to evaluate children with recurrent abdominal pain in the age group 2-12 years for a cause at a tertiary rural hospital, in an attempt to better understand this syndrome. Methods: Retrospectively collected data from 210 consecutive patients aged between 2-12 years from January 2015 to January 2017, who presented to Department of Surgery and Emergency department in MOSC Medical College with recurrent abdominal pain were studied. Data collection included demographic details, symptomatology and clinical details, and response to treatment. Each patient was thoroughly evaluated to identify an organic cause for the pain. All the patients were evaluated by the paediatrician for any underlying medical cause. Results: During the two-year period, 210 patients were evaluated and investigated, and an organic cause was detected in 44 patients, while 166 patients were diagnosed to have RAP. The 44 patients with an organic cause were treated for the primary condition and were asymptomatic on follow up. Investigations revealed that 20 patients suffered from acute appendicitis, 20 patients were diagnosed with habitual constipation Patients without an organic cause were reassured, counselled and treated symptomatically. All the patients were on follow up for the entire period of the study. Of the 166 patients diagnosed with RAP, 110 patients responded to symptomatic measures, while 21 patients were referred to child psychiatry and are on long term follow up. Conclusion: Recurrent abdominal pain is a significant cause of functional impairment in the life of a child. Thorough evaluation of the patient to rule out organic causes is vital. Majority of the children diagnosed with recurrent abdominal pain respond to counselling. Acknowledging the existence of the symptoms instead of dismissing it, and empathising with the child is often all that is required in the management of these patients

Abortion Induced by Peganum Harmala Ingestion in a Pregnant Woman: A Case Report and Literature Review

Background : Peganum harmala is a medicinal plant used in Iran and other countries. Many therapeutic effects have been described for this plant; it is insect repellant, disinfectant, antimicrobial, sedative, analgesic, anti-inflammatory, emetic, and abortifacient. Roots and seeds are medicinally-active parts of the plant containing some β-carboline and quinazoline alkaloids, which are responsible for its pharmacological and toxicological effects. Poisoning with high doses of Peganum harmala can be life-threatening. Case Report : We reported a 31-year old woman with an unwanted pregnancy, who ingested 1 glass of Peganum harmala seeds to induce abortion. On admission, she had severe nausea and vomiting, mild abdominal pain, and stable vital signs. Physical examination was unremarkable, and the leukocytosis was the only abnormal laboratory finding. The patient underwent nasogastric tube insertion, gastric lavage, as well as the administration of activated charcoal. Although she left the hospital on self-consent, further follow-up revealed that she had a spontaneous abortion without any complications. Conclusion : Although most cases of Peganum harmala intoxication can be managed successfully, this poisoning led to abortion in our case. Physicians working in Iran and other regions, where Peganum harmala is used as traditional medicine, must be aware of its toxicity for the early diagnosis and management.

Interventions for pityriasis rosea.

Interventions for pityriasis rosea.

Propranolol Alleviating the Challenging Clinical Course of Birth Onset Generalized Lymphangiomatosis. A Case Report

Background: Cystic hygromas, interchangeably named Lymphangiomas, are rare, congenital, benign lesions due to an abnormal lymphatic system development that tend to occur mostly in the head, neck, and oral cavity. Case Presentation: This is a case of 18 year old male patient Syrian, smoker, with a history of multiple cystic hygromas since birth along with a generous surgical history of multiple laparotomies for intrabadominal cystic excisions, splenectomy herniorrhaphies (bilateral inguinal hernias and 2 incisional hernias due to laparotomies) left orchieopexy then testiculectomy, scrotal skin graft , multiple abdominal radioguided cystic drainage and sclerotherapy; presented to our care center for fever, dry cough, pleuretic chest pain, and mild abdominal pain with watery diarrhea. Conclusion: Cystic Hygroma is still being considered as a rare entity and can virtually occur in the whole body sites mostly at head and neck regions as explained above. Challenges in this disease is by finding cases where the presence of such cystic lesions is in extremely rare and unusual sites as well as different treatment modalities and prognostics depending on the site and size of the detected cystic formations.