Nonspecific Abdominal Pain Research Articles

Nonfunctional pancreatic neuroendocrine tumours misdiagnosed as autoimmune pancreatitis: A case report and review of literature

BACKGROUNDNonfunctional pancreatic neuroendocrine tumours are difficult to diagnose in the early stage of disease due to a lack of clinical symptoms, but they can rarely manifest as autoimmune pancreatitis. Autoimmune pancreatitis is an uncommon disease that may cause recurrent acute pancreatitis and is therefore often regarded as a special type of chronic pancreatitis.CASE SUMMARYWe report a case of a 42-year-old female who had nonspecific upper abdominal pain for 4 years and radiological abnormalities of the pancreas that mimicked autoimmune pancreatitis. The symptoms and pancreatic imaging did not improve following 1 year of steroid therapy. Finally, pancreatic biopsy was performed through endoscopic ultrasonography-guided fine-needle aspiration biopsy, and nonfunctional pancreatic neuroendocrine tumours were ultimately diagnosed. Pancreatectomy has resolved her symptoms.CONCLUSIONTherefore, the differentiation of nonfunctional pancreatic neuroendocrine tumours from autoimmune pancreatitis is very important, although it is rare. We propose that endoscopic ultrasonography-guided fine-needle aspiration biopsy should be performed if imaging characteristics are equivocal or the diagnosis is in question.

Quantitative Assessment of Secondary Healthcare Utilisation by Patients With Functional Abdominal Pain.

There is increasing awareness of the impact functional conditions have on the National Health Service (NHS). Less is known about the resources used to manage these conditions. This retrospective quantitative audit aims to determine the demographic and healthcare utilisation of functional abdominal pain patients presenting to the hospital.The most frequent hospital attenders with non-specific abdominal pain in NHS Grampian, 2018-2019, were assessed (n=144). Adult patients meeting the ROME II diagnostic criteria for functional abdominal pain diagnosis were included (n=33). Data were retrospectively collected manually from electronic medical records.Of 33 patients, 93.9% were female, with a mean age of 31.2 years. Each had accessed a mean of 11.5 specialist services, with 69.7% being referred to mental health services; 9.1% had completed treatment. Each patient had a median 4 (range 1-26) emergency/unscheduled presentations to hospital and median 2 (range 0-13) admissions for functional abdominal pain during the study period, with a total of 247 nights spent in hospital by this patient cohort for functional abdominal pain alone. The estimated total cost for these hospital admissions was £593,786.00.Extensive secondary-care input is currently required for patients with functional abdominal pain at a significant cost. Patients are re-presenting to the hospital frequently, which suggests that current management is not effective.

Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project.

PurposeThere is a paucity of data on pain diagnoses and analgesic utilization in medically underserved areas (MUAs). This study compared the prevalence of pain diagnoses and analgesic medication use between MUAs and non-medically underserved areas (N-MUAs) in Southern Minnesota and Western Wisconsin using the Rochester Epidemiology Project (REP) database.MethodsFive-year prevalence per 100 people (January 1, 2011 to January 1, 2016) was extracted from the REP database for multiple pain diagnosis variables and analgesic medications. Primary outcomes included comparison of five-year prevalence of each pain diagnosis and analgesic between MUA and N-MUA; and association between index of medical underservice (IMU) score and five-year prevalence for each pain diagnosis and analgesic. Linear regression models were performed to assess associations and significance thresholds were adjusted per the Bonferroni approach to account for multiplicity.ResultsThe prevalence per 100 people for a diagnosis of chronic pain was similar between MUAs and N-MUAs (13.8 ± 2.5 vs 14.6 ± 2.0, P = 0.543). Similarly, prevalence per 100 people for other specific pain diagnoses including nonspecific chest pain, abdominal pain, lumbago, somatoform disorder, and painful respiration did not differ based on MUA status. In terms of analgesic use, prevalence per 100 people for use of opioids, non-opioid analgesics, salicylates, and NSAIDs did not differ based on MUA status. An association between higher IMU scores and lower prevalence of painful respiration was identified, although this was not significant after significance threshold adjustment per the Bonferroni method.ConclusionOur data suggest that there are no differences in several pain diagnoses and analgesic utilization between MUAs versus N-MUAs, and that the IMU score did not predict changes in prevalence of pain diagnoses or analgesic utilization. Future powered and national database studies are warranted to increase validity of findings to other populations outside of Southern Minnesota and Western Wisconsin.

Surgical Treatment for Advanced Thoracic Spinal Tuberculosis in Infants: Case Series and Literature Review.

Spinal tuberculosis (TB), or Pott's disease, is the most common form of osteoarticular TB. Early diagnosis and anti-TB drug therapy are the mainstays of treatment. However, in advanced stages, surgery is essential to correct spinal deformities and avoid neurological damage. Very few cases in young children requiring surgical treatment have been described. We present 2 cases of surgically treated thoracic spinal TB in patients under 2 years of age and review the literature on this entity in young children. Two male toddlers, aged 21 (patient 1) and 23 (patient 2) months, were admitted due to insidious systemic deterioration associated with neck stiffness and nonspecific abdominal pain in patient 1 and limping in patient 2. The findings of laboratory tests were unremarkable despite an increase in acute-phase reactants. After an extensive workup, results of a magnetic resonance imaging were consistent with spinal TB in both patients. Patient 1 underwent costotransversectomy of the left third and fourth ribs, debridement, T3-T4 corpectomy, and T2-T6 posterior fusion, to which an anterior rib autograft was added. Patient 2 had a right-sided thoracotomy performed at the apex in addition to debridement and T8 corpectomy; the resected rib was used as anterior structural autograft. Several samples of purulent, caseous material were sent for study. On follow-up, progression of proximal junctional kyphosis was evidenced in patient 1, requiring revision surgery to restore sagittal alignment; the patient was asymptomatic at 2-year follow-up. Patient 2 evolved satisfactorily without neurological sequelae and was asymptomatic at 4-year follow-up. Spinal TB in young children requires appropriate surgical treatment when presenting at advanced stages or having severe deformity or neurological compromise. Despite the challenges associated with young age and ongoing growth, surgery can be performed safely provided proper surgical expertise. After extensive debridement and decompression, priority should be given to restoring sagittal alignment and balance with stable and durable spinal reconstructions.

English

Giant ovarian cysts are tumours of the ovary presenting with diameters greater than 10 cm. They have become rare in recent days as they are diagnosed and managed early due to the modern imaging modalities. An 18-year-old female patient was admitted with abdominal distension and was detected to have a serous cystadenoma measuring 33 cm arising from the right ovary, which is presented in this report. Our aim is to show how a huge cystic ovarian mass can mislead the diagnosis of ascites or mesenteric/omental cysts in an adolescent woman. Cystic abdominopelvic tumours are common and are diagnosed early due to the availability of modern imaging modalities. The differential diagnosis is extensive and includes paraovarian cyst, peritoneal/mesenteric cyst, appendiceal mucocele, cystic adenomyosis etc.1 Ovarian cysts rarely reach a large size and are generally asymptomatic at early stages and causing symptoms only after reaching enormous dimensions. The symptoms include progressive abdominal distension, nonspecific abdominal pain, constipation, early satiety, vomiting and frequent micturition. Only a few cases of giant ovarian cysts have been sporadically reported in the literature.2,3,4 Serous tumours are the most common cystic neoplasms of the ovary, 60 % of which are benign. Surgical management is the preferred treatment. We present a case of a giant ovarian cyst (GOC) in an 18-year-old female that turned out to be a benign serous cystadenoma of the ovary on histopathological examination. Very few cases of GOCs masquerading as ascites or mesenteric cysts have been reported.5 This case is reported to increase the suspicion index of serous cystadenoma in the case of giant intra-abdominal cysts in young women.

Greater omental infarction.

Greater omental infarction.

Confluent Small Bowel Lipomatosis: A Rare Cause of Recurrent Abdominal Pain

Small intestine lipomatosis is rare but may be associated with pain, intussusception, and gastrointestinal bleeding. In this report, we examine the case of a 41-year-old man who had recurrent presentations to the emergency department with non-specific abdominal pain. Preoperative imaging suggested extensive infiltration of small intestine with macroscopic fat. At surgery, extensive and confluent small bowel lipomatosis were seen. The affected ileal segment was resected, and the patient remained symptom-free after surgery. Abdominal lipomatosis is a rare condition which can be completely treated by resection of the affected gut segment but is often unsuspected and difficult to diagnose. In this report, we describe a case with the most extensive lipomatosis on record with more than 70 cm of gut with confluent lipomatosis. Magnetic resonance Enterography (MRE) is a useful non-invasive diagnostic modality, although laparoscopy/laparotomy may be necessary for assessment of the extent of disease. Symptomatic cases should be treated with segmental small bowel resection, which is curative.

A Case of Erdheim-Chester Disease with Omental Caking Initially Mistaken for a Malignancy

Introduction: Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis. Bilateral symmetric sclerosis of the long bones and possible multiorgan involvement are the main presentations of this disease. Histologically, lipid-laden foamy histiocytes are positive immunochemically for CD68 (occasionally for PS100) and negative for S100 and CD1a in ECD. Case Presentation: We describe the case of a 35-year-old man diagnosed with ECD with peritoneal and retroperitoneal infiltrations and bone involvement. The diagnosis of ECD was only confirmed after two years of non-specific abdominal pain, nausea, and weight loss. Primarily, the patient’s clinical symptoms and abdominal computed tomography (CT) findings, which indicated omental caking, peritoneal thickening, and perinephric soft tissue density, suggested an intra-abdominal malignancy. Finally, a peritoneal biopsy was carried out, which demonstrated xanthogranulomatous infiltrations from ECD. Further radiographic skeletal survey based on histopathological results showed symmetric osteosclerosis of the long bones. Conclusion: Although ECD, associated with peritoneal and retroperitoneal infiltrations, is an uncommon finding, it should be included in the differential diagnosis of patients with non-specific gastrointestinal manifestations, along with multiorgan involvement and typical radiological findings.

Inflammatory myofibroblastic tumour: case report of a rare form of bladder tumour.

Introduction and importanceInflammatory myofibroblastic tumour (IMT) is a rare tumour with malignant potential and has been described in many major organs with the most frequent site being the lungs. However, bladder is an extremely rare location. IMT presents a unique diagnostic challenge because of the characteristics it shares with malignant neoplasms.Case presentationHere we report the case of a 47-yearold male who presented with storage lower urinary tract symptoms associated with non-specific lower abdominal pain for one month duration. Contrast-enhanced computed tomography of abdomen and pelvis revealed a 6 cm tumour at the dome and left side anterior wall of the bladder. He underwent laparotomy and partial cystectomy. Histopathology results were consistent with an IMT.Clinical discussionEven though bladder IMT is indolent in course, typical IMTs can be locally aggressive. Due to the lack of specificity in clinical symptoms, it is not easy to arrive at a precise diagnosis before surgery. Hence, the final diagnosis depends on histomorphological features and the immune histochemical profile.ConclusionIt can be challenging to distinguish IMT from malignant neoplasms both clinically and histologically. As such, local surgical resection with close follow-up remains the mainstay of treatment for urinary tract IMT.

Leiomiossarcoma de veia cava inferior como etiologia para dor abdominal crônica – um relato de caso

Inferior vena cava leiomyosarcomas are rare tumors that account for less than 0.7% of all retroperitoneal leiomyosarcomas. They are more common in women and cause nonspecific chronic abdominal pain. In this report, we present the case of a 53-year-old female patient complaining of chronic nonspecific periumbilical abdominal pain with initial onset 8 months previously who was diagnosed with inferior vena cava leiomyosarcoma by computed tomography angiography. The patient was treated with complete resection of the tumor and reconstruction of the inferior vena cava with interposition of a Dacron prosthetic graft. The treatment considered the gold standard consists of complete surgical excision, because these tumors are resistant to chemotherapy and radiotherapy. The prognosis of these patients is closely related to early diagnosis. Therefore, it is very important that vascular and general surgeons know that this disease is a possible differential diagnosis of chronic abdominal pains.

Unusual finding of deodorant bottle in the rectum

A foreign body in the rectum is not an uncommon encounter in current medical practice. In most cases, rectal foreign bodies are a result of sexual eroticism, sexual abuse, assault, or rarely, accidental involuntary insertion. It poses diagnostic difficulties and management challenges among medical professionals. The diagnostic approach usually involves careful history and physical and radiological examination. Here, we present the case of a 22-year-old man with a retained rectal foreign body for a duration of 3 hours. He presented with impacted foreign body per rectum, non-specific abdominal pain, abdominal mass, and non-passage of stool and flatus. Successful removal of the rectal foreign body was done manually under local anesthesia in the lithotomy position in the operation theatre.

Gastrointestinal stromal tumours: A single institution study

Background and Objectives: Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract arising from the interstitial cells of Cajal with an increasing incidence. It can occur anywhere from the esophagus to the anus. It has a few works of literature to its credit in India. Hence we conducted the study to evaluate the epidemiology, clinical and histopathological findings, management and survival pattern of gastrointestinal stromal tumours treated in our surgical setup. Methods and Methodology: A retrospective cross-sectional study conducted at the department of general surgery/ surgical oncology between 2011 and 2016. Data were collected according to demographic characteristics, clinical pattern, investigations, treatment and therapeutic variable and was analysed and reviewed. Results: On analysing, we found that among 32 patients diagnosed with GIST had a median age of 56.5 years and a sex ratio of 1.4:1.Non-specific abdominal pain was the most common symptom.18 of the tumours was found in the stomach, 11 in the small bowel and 2 in the rectum and 1 in the colon. All were confirmed by the positivity of CD 117. All underwent surgical resection with adjuvant Imatinib. The overall survival was 71% in one year. Conclusion: The size of the tumour and the mitotic index were identified as the prognostic factors. GISTs managed by aiming to complete surgical resection combined with targeted chemotherapy had a good prognosis.

Idiopathic proximal small bowel intussusception in an adult

Rationale: Intussusception is fairly uncommon in adults accounting for 5% of all intussusception cases and is a cause in 1% of intestinal obstruction cases. The condition is usually associated with a pathological lead point. Idiopathic intussusception is comparatively rarer in adults. Patient Concerns: 24-year-old male with right lower abdominal pain and intermittent loose stools for fifteen days. Diagnosis: Proximal small bowel intussusception. Intervention: Resection of the involved segment with primary jejunojejunal anastomosis. Outcome: Uneventful postoperative course and full recovery. Lessons: Idiopathic intussusception, though rare in adults, should be suspected in all adults presenting with non-specific abdominal pain particularly in absence of distinct abdominal signs. Management is surgical and usually entails resection of the involved bowel.

An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015-2018.

Large-scale analyses stratifying bariatric surgery readmissions by urgency are lacking. Identify predictors of urgent/nonurgent readmission among "ideal" bariatric candidates, using a national registry. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database. We extracted an "ideal" patient cohort from the 2015-2018 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) registry, characterized by only typical weight-related comorbidities (hypertension [HTN], obstructive sleep apnea [OSA], gastroesophageal reflux disease [GERD], and diabetes (insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) undergoing primary bariatric surgery with an uneventful postoperative course. Readmissions were classified as "urgent" (UR; e.g., leak, obstruction, bleeding) or "nonurgent" (NUR; e.g., dehydration, nonspecific abdominal pain). χ2 or t test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission. The cohort (N = 292,547) comprised 38.5% of all MBSAQIP patients (mean age [standard deviation] = 43.2 [11.7]; body mass index [BMI] = 44.9 [6.6]; 81% female; 62% White, 17% Black, 14% Hispanic). Total readmission rates were 2.75% (n = 8046) and decreased from 2015-2018 (3.00%-2.63%; P < .001). Independent predictors of readmissions included Roux-en-Y gastric bypass (RYGB) (odds ratio [OR] = 1.97, p < .001), Black (OR = 1.46, P < .001) and Hispanic race (OR = 1.14, P < .001), GERD (OR = 1.27, P < .001), HTN (OR = 1.08, P = .003), and IDDM (OR = 1.39, P < .001). NUR and UR readmission rates were 1.27% (n = 3702) and 1.06% (n = 3090), respectively. NURs decreased over time (1.42%-1.16%, P < .001), with no change in Urs (1.01%-1.06%, P = .51); this trend persisted in multivariate analysis (2017: NUR OR = .85, P < .001; 2018: NUR OR = .82, p < .001). Independent predictors of both URs and NURs included Black (NUR OR = 1.71, p < .001; UR OR = 1.27, p < .001) and Hispanic (NUR OR = 1.15, P < .001; UR OR = 1.19, P < .001) race, RYGB (NUR OR = 1.84, P < .001; UR OR = 2.34, P < .001), and GERD (NUR OR = 1.39, p < .001; UR OR = 1.17, P < .001). Female sex (NUR OR = 1.64, P < .001), age (NUR OR = .98, P < .001), HTN (NUR OR = 1.22, P < .001), and IDDM (NUR OR = 1.41, P < .001) predicted NURs, while higher BMI (UR OR = 1.01, P<.001), and OSA (UR OR = 1.10, P = .02) predicted URs. Readmission rates for "ideal" bariatric patients improved over time, driven by reductions in non-urgent etiologies. Racial disparities persist for both urgent and non-urgent causes of readmission.

Nonspecific abdominal pain: Do I have to allocate a specific diagnosis for every patient?

Acute abdominal pain is one of the most common chief complaints in the acute setting all over the world. The definitive diagnoses of these patients vary depending on age, gender, geographical and sociodemographic characteristics etc. Apart from these, aging of the population, obesity, advanced diagnostic imaging modalities and changes in nutritional habits also have an impact on the rates of specific diagnoses. On the other hand, nonspecific abdominal pain constitutes almost half of all visits due to acute abdominal pain in the acute care setting. This phenomenon is the main differential diagnostic problem in the management of these patients because missing a life-threatening condition can cause enormous medicolegal problems for the caregivers. Certain diagnostic scoring systems have also been developed to facilitate recognition and management of these conditions. This article aims to review the entity and underline the challenges it can bring to the scene.

Causes of revisional surgery, reoperations, and readmissions after bariatric surgery

Introduction and objectivesBariatric surgery is the most effective treatment for weight loss, with comorbidity control. With low complication rates, the reasons for reoperation are major complications or weight loss failure/weight regain. Nonsurgical problems can also present, such as anemia, dehydration, chronic pain, and malnutrition, among others. Our aim was to analyze the main causes of revisional surgery, reoperation, and hospital readmission, at a specialized bariatric center. MethodsA retrospective study was conducted on patients that underwent bariatric surgery within the time frame of 2012 and 2019. The baseline analysis included demographic, anthropometric, and perioperative data, as well as a sub-analysis of the main readmission causes and complications. ResultsA total of 776 primary surgeries were performed (649 RYGBP, 127 SG, and 10 revisional surgeries), and 99 patients were identified for the study: 10 revisional surgeries, 44 reoperations, and 45 readmissions. The incidence of revisional surgery was 1.2%, reoperation was 5.6%, and readmission 5.8%. Fifty percent of the revisional surgeries were performed due to insufficient weight loss or weight regain; the most frequent causes of reoperation were cholecystitis (38.6%) and internal hernias (9.1%); and the most common causes of readmission were nonspecific abdominal pain (35.5%) and dehydration (24.4%). ConclusionThe most frequent causes of postoperative readmission were nonsurgical events, followed by non-bariatric reoperations, and finally revisional surgeries. There was a low incidence of early reoperations. Knowledge of the abovementioned data is important for identifying higher-risk patients, to prevent major complications.

P-BN05 Solitary jejunal diverticulum: a rare unexpected cause of chronic pneumoperitoneum

Abstract Background Jejunal diverticula are rare acquired herniation of the mucosa and submucosa through the muscularis propria. They are asymptomatic in the majority of cases, however, they can present with non-specific abdominal symptoms and rarely complicate leading to acute abdomen. Perforation usually results in symptoms and signs of acute peritonitis and it is not an identifiable aetiology of chronic pneumoperitoneum. Computed tomography scan may identify intestinal wall oedema, air bubbles travelling through the mesentery, free intra-abdominal air and/or fluid . Radiological diagnosis requires high index of suspicion of such pathology. We report a case of an isolated jejunal diverticulum as a cause for aseptic chronic pneumoperitoneum . Methods A 77-year-old female was referred to the ambulatory emergency surgical unit (AESU) with a 4-month history of nonspecific abdominal pain, considerable weight loss, diarrhea, nausea and a few episodes of vomiting.Physical examination revealed no constitutional signs of sepsis and her abdomen was mildly distended but soft and nontender to palpation. Laboratory investigations were unremarkable. CT scan of her abdomen and pelvis on her first visit showed pneumoperitoneum with associated low volume ascites, which raised the possibility of sealed gastrointestinal perforation. In the absence of any clear signs of sepsis, a strategy of ambulatory, conservative management and follow up was chosen. Four months after her initial presentation our patient presented with ongoing vague abdominal symptoms with weight loss and failure to thrive. A CT colonogram described pneumoperitoneum and larger volume of ascites is in comparison to the previous CT scan. There was an unusual pattern of mural gas in some loops of small bowel in the left side of the abdomen that suggested pneumatosis. MDT decided to proceed with diagnostic laparoscopy. Results Laparoscopy exploration revealed odorless pneumoperitoneum, moderate amount of non-turbid bile stained serous ascites and thin fibrinous covering. We identified a jejunal diverticulum associated with mesenteric air bubbles and moderately enlarged reactive feeling lymph nodes in the diverticular segment . A small bowel resection with a primary side-to-side anastomosis, washout of the abdomen and cholecystectomy were done through a Kocher’s subcostal incision. She made an uneventful post-operative recovery and was discharged home well on day 4. Histopathological examination of the resected specimens confirmed the presence of a ruptured isolated jejunal diverticulum with a breach in muscularis propria and chronic cholecystitis in the gallbladder. Conclusions In summary, our case report highlights the importance of being aware of the possibility of perforated jejunal diverticula as a possible source of chronic pneumoperitoneum causing chronic nonspecific abdominal pain, diarrhea and unexplained weight loss. The surgical option of segmental resection and primary anastomosis was beneficial in this patient. However, calculating the risk benefit ratio remains the mainstay of the management plan, which, as ever, should be tailored to each patient’s general condition and fitness with appropriate counselling and consent.

Causas de cirugía revisional, reoperaciones y readmisión posterior a cirugía bariátrica

Introduction and objectivesBariatric surgery is the most effective treatment for weight loss, with comorbidity control. With low complication rates, the reasons for reoperation are major complications or weight loss failure/weight regain. Nonsurgical problems can also present, such as anemia, dehydration, chronic pain, and malnutrition, among others. Our aim was to analyze the main causes of revisional surgery, reoperation, and hospital readmission, at a specialized bariatric center. MethodsA retrospective study was conducted on patients that underwent bariatric surgery within the time frame of 2012 and 2019. The baseline analysis included demographic, anthropometric, and perioperative data, as well as a sub-analysis of the main readmission causes and complications. ResultsA total of 776 primary surgeries were performed (649 RYGBP, 127 SG, and 10 revisional surgeries), and 99 patients were identified for the study: 10 revisional surgeries, 44 reoperations, and 45 readmissions. The incidence of revisional surgery was 1.2%, reoperation was 5.6%, and readmission 5.8%. Fifty percent of the revisional surgeries were performed due to insufficient weight loss or weight regain; the most frequent causes of reoperation were cholecystitis (38.6%) and internal hernias (9.1%); and the most common causes of readmission were nonspecific abdominal pain (35.5%) and dehydration (24.4%). ConclusionThe most frequent causes of postoperative readmission were nonsurgical events, followed by non-bariatric reoperations, and finally revisional surgeries. There was a low incidence of early reoperations. Knowledge of the abovementioned data is important for identifying higher-risk patients, to prevent major complications.

ROLE OF DIAGNOSTIC LAPAROSCOPY IN NON SPECIFIC ABDOMINAL PAIN

INTRODUCTION:Abdominal pain is very common presentation in emergency department.It is vital that the physician has an understanding and be familiar with the presentations of common diseases that cause abdominal pain. Patients with acute abdominal pain are a heterogenous group that consumes a great deal of a surgical department's resources. AIM AND OBJECTIVE: To evaluate the use of the laparoscopy in the diagnosis and management of patients with nonspecific chronic and acute abdominal pain. MATERIAL AND METHODS: The material consists of patient in all surgical units of P.B.M. and Associated Group of Hospital attached to S.P.Medical College,Bikaner.This study includes 50 patients.In acute NSAP group 21 patients were present and in Chronic NSAP group 29 patients were included. RESULT:We found that the mean age was 29.38 and 26.17 years in acute and chronic group respectively.In acute group additional 4(19%) cases had vomiting, 3(14.2%) had fever, and 2(9.5%) had both vomiting and fever.While in chronic group 3(10.3%) cases had vomiting, 2(6.8%) had fever and 1(3.4%) case had both vomiting and fever. Efficacy of laparoscopy in chronic group was 86.2%.Laparoscopy made correct diagnosis in 25(86.2%) cases,3(10.3%) cases had normal study and 1(3.4%) case diagnosed as PID pain was not relieved. CONCLUSION: Our study establishes role of laparoscopy as a safe and accurate modality in diagnosis of both acute and chronic abdominal pain in cases where diagnosis can't be made with physical examination and non invasive methods.

Sudden death related to the gastrointestinal system in Tunisia: A 13 year autopsy study.

Sudden gastrointestinal (GI) death is an unexpecteddeath due to digestive system causes mainly found after autopsy. The literature is rich in articles that studied sudden death due to cardiac causes while sudden GI deaths remain less well-documented. We retrospectively investigated all cases of gastrointestinal death at the Department of Forensic Medicine in Tunis, over 13years (January 1, 2006 to December 31, 2018). Two hundred and eight cases were collected. The mean age of our series was 51.06±20.99years. No history of digestive disorders was reported in 78.4%, and no family history of sudden death was found in any cases. A male predominance was found in most epidemiological characteristics of the sample with a significant statistical rate in some features. Non-specific abdominal pain was the most described symptom (n=92). Perforation of GI tract was the common mechanism involved in the death of 55 cases, of which 44 were related to ulcer perforation. These ulcer perforations were statistically more reported in smokers and people suffering from schizophrenia. Intestinal obstruction was the second commonest cause of death, mainly found in the elderly. Sudden death in children was most frequently caused by acute intussusception. This study highlights that systematic study of sudden death due to GI causes might provide opportunities to identify avenues for overall health improvement.