Acute Non-specific Abdominal Pain Research Articles

Feasibility and safety of laparoscopy in acute non-traumatic emergency abdominal surgery: A prospective study

Introduction: The use of laparoscopy in emergency abdominal surgery is considered high-risk due to its elevated morbidity, requiring expertise in laparoscopic surgery. Objective: Assessing the feasibility, reproducibility, and safety of laparoscopy in non-traumatic acute abdominal surgery. Methods: Descriptive, prospective and evaluative study, conducted between February 2018 and October 2021. We have included in this study: acute appendicitis and its complications, lithiasis acute cholecystitis (LAC), peritonitis by perforation of peptic ulcer, adhesive acute intestinal obstruction, adnexal torsion, extra-uterine pregnancies, and non-specific acute abdominal pain. Results: We operated on 337 patients laparoscopically, with an average of 02 surgeries per medical shift. In 62.6%, surgeries were performed outside of regular working hours. We encountered temporary, material, and human difficulties in 10.8% of the cases. Average age of the patients is 38 years ±15 years. F/H sex ratio =1.29. Diagnostic accuracy of laparoscopy was 100 %. Intraoperative laparoscopic scanning corrected the preoperative diagnosis in 15.73% of cases. Average operative time was 52.09 min ± 24.14 min. One conversion recorded (0.3%). Rate of postoperative complications was 6.2%. These complications are classified at grade I according to the Clavien-Dindo classification in 85.71%. Only one patient (0.3%) required a second operation. Average length of overall hospitalization was 1.5 days. Conclusion: Our results suggest that emergency laparoscopy is feasible, safe, and reproducible. So it can claim to replace laparotomy in the management of acute, non-traumatic abdominal emergencies.

Outcome of diagnostic laparoscopy in young patients presenting with acute nonspecific abdominal pain.

Objective: To assess the role of diagnostic laparoscopy in young patients with Non-specific abdominal pain. Study Design: Prospective study. Setting: General Surgery Department, Hayatabad Medical Complex Peshawar. Period: January 2021 to December 2021. Material & Methods: A total of 140 young patients between the ages of 15 and 30 who had diagnostic laparoscopy for non-specific abdominal pain and met the inclusion criteria were included. Dates of admission, dates of operation, demographic and clinical information about patients were recorded. Results: 140 patients in all were enrolled. The mean age was 22.5 years, with a range of 15 to 30 years. There were 50(35.7%) females and 90(64.3%) males, of the total. Diagnoses and therapeutic treatment were feasible in 95 cases (67.8%), no pathology was found in 29 cases (20.7%), the preoperative picture was uncertain in 11 cases (7.8%), and no diagnosis was obtained following laparoscopy in 5 cases (3.6%), respectively. Conclusion: Early diagnostic laparoscopy in young patients is a safe and effective procedure. As a result, it is a useful investigative technique for acute abdominal pain that has not been properly identified.

Efficacy of Hyoscine Butylbromide Versus Drotaverine in Relieving Acute Nonspecific Abdominal Pain in Children- A Non - Randomized Trial

Introduction: Acute abdominal pain is a very common complaint for children presenting to the emergency department (ED). The purpose of this study was to compare efficacy of hyoscine and drotaverine for relieving acute nonspecific abdominal pain in children presenting to ED. Methods: Total of 52 children aged six years to 16 years were enrolled in a non-randomized trial at Paediatric ED of TUTH from Dec 2017 to June 2018, and randomly allocated to drotaverine or hyoscine groups; 26 in each group. Face pain score-revised tool was used to measure the efficacy of the drug. The primary outcome was to measure the reduction of face pain score (Self-reported) by at least 2 / 10 at 60 minutes after ingestion of study intervention. Other outcomes were requirement of rescue analgesia and adverse effects of drugs. Results: A total of 20 (77%) in hyoscine and 21 (81%) in drotaverine group responded to oral medication at the end of 60 minutes of oral administration and the difference was not statistically significant (p=0.808). Vomiting was only adverse event present in five (19%) in drotaverine and two (8%) in hyoscine groups, respectively. Conclusions: In this single center randomized controlled trial, both hyoscine and drotaverine were found to be equally efficacious for relieving acute non-specific abdominal pain in children.

Role of Laparoscopy in Diagnosing and Treating Acute Nonspecific Abdominal Pain.

BackgroundNonspecific abdominal pain (NSAP) is a pain for which no immediate cause is evident on acute admission and does not necessitate emergency surgical intervention. NSAP is a frequent reason for presentation in the emergency department (ED). Laparoscopy is a well-established technique that allows a surgeon to visualize the abdominal cavity after insufflation through a few small incision ports. Despite the increasing availability of laparoscopic investigation, the availability of a laparoscope in the ED settings in Pakistan is low due to the expense and maintenance needs of the system.ObjectiveThis study aimed to evaluate the role of laparoscopy in diagnosing the cause of acute NSAP and its role in treating the pathology of disease in patients presenting to the emergency department (ED) of Services Hospital, which is a government sector hospital in Lahore, Pakistan.Materials and methodsThis study was conducted in Services Hospital Lahore, Pakistan, from January 1, 2016 to December 31, 2019. The study included patients aged 12 to 70 years of either sex who presented to the ED with abdominal pain for whom no diagnosis could be achieved on clinical assessment, laboratory findings, and radiological findings (x-ray abdomen, ultrasonography, and computed tomography scan). All study participants underwent diagnostic laparoscopy under general anesthesia. Patients were monitored weekly via follow-up postoperatively for the first month and then monthly for 12 months. All study data were recorded on a predesigned proforma. The data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.ResultsA total of 122 patients diagnosed with acute NSAP were enrolled in our study (mean age, 46.4 ± 20.3 years). The study population consisted of 52 male patients (42.6%) and 70 female patients (57.4%). Our study participants had a mean body mass index of 24.2 ± 3.3 kg/m2. The most common ED presentation was lower abdominal pain. One hundred sixteen patients (95.1%) had positive findings on laparoscopy, while six patients (4.9%) had no identified pathology on laparoscopy. The most frequent pathology was appendicular in origin, followed by pelvic inflammatory disease. Surgical management of patients through laparoscopy was performed in 97 patients (79.5%). Conversion to laparotomy was done in 12 patients (9.8%). Definite diagnosis was established in 118 patients (96.7%). Port site infection occurred in four patients (3.3%), chest infection in five patients (4.1%), deep venous thrombosis in one patient (0.8%), and anastomotic leakage in one (0.8%) patient. Four patients (3.3%) developed recurrence of symptoms.ConclusionsThis study explored the role of laparoscopy in diagnosing and treating patients presenting to the ED with acute NSAP. According to our results, laparoscopy is a safe and effective method for diagnosing and treating acute NSAP with low postoperative morbidity and potentially decreased risk of postoperative complications. Physicians should consider laparoscopy as a first-line invasive investigation for patients presenting with undiagnosed acute abdominal pain.

Role of laparoscopy in diagnosis of acute nonspecific abdominal pain

Background Acute nonspecific abdominal pain (NSAP) is frequently encountered in the daily medical practice. This prospective study was performed to elucidate the role of early laparoscopy in the management of NSAP and to compare it with active clinical observation in such cases. Patients and methods A total of 100 cases with acute NSAP were randomly divided into two groups: early diagnostic laparoscopy (EDL) group included 50 cases who underwent EDL, and observational group included the remaining 50 cases who were closely observed. Outcome measures included the definitive diagnosis, operative time, duration of hospitalization, and postoperative morbidity. Results No statistically significant difference was noticed between the study groups regarding demographics. However, the duration of symptoms showed significant prolongation in the observation group. Regarding the final definitive diagnosis, no significant difference was noticed between the two groups (P Conclusion Diagnostic laparoscopy appears to be a reliable tool to reach a definite diagnosis in patients with NSAP because of its superior diagnostic ability, better visualization, low complications, and the ability to manage the pathology in the same setting.

Результаты Pediatric Appendicitis Score в дифференциальной диагностике острой неспецифической боли в животе у детей: возраст имеет значение

Acute nonspecific abdominal pain in children is the most common problem requiring differential diagnosis with acute appendicitis. Scales for integrated assessment of individual symptoms and their combinations have been proposed and are constantly being developed that allow predicting the likelihood of acute appendicitis. Purpose to assess diagnostic value of Pediatric Appendicitis Score (PAS) in groups of children in different ages. Materials and methods. 374 children aged 4 to 15 years with acute abdominal pain were evaluated in prospective randomized blinded study. Statistical analysis: ROC – curves, specificity and sensitivity, positive and negative predictive values; Kullback criteria; logistic regression analysis; discriminant analysis. Results. Detection frequency and diagnostic significance of the PAS scale predictors as well as obtained results by using the Pediatric Appendicitis Score depend on children age significantly. In terms of diagnosis of acute appendicitis, the PAS scale shows the best results in older children. Conclusions. Results of Pediatric Appendicitis Score depend on children ages due to different diagnostic value of predictors used in the PAS scale. Pediatric surgeons should keep in your mind these data. Modification of the scale is required taking into account the patient’s age. Further analysis of the issue of PAS using is needed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: acute appendicitis, children, diagnosis, PAS scale.

The diagnostic value of ischaemia-modified albumin in acute abdominal pain.

The differential diagnosis of paediatric patients admitted to the emergency department presenting with acute abdominal pain may be difficult. This study aims to investigate the diagnostic value of ischaemia-modified albumin (IMA) in the differential diagnosis of acute abdominal pain in children and in distinguishing surgical from non-surgical cases. The study was conducted with a total of 152 subjects who provided informed consent, including 112 patients admitted to the paediatric emergency department and paediatric surgical clinic and 40 healthy control subjects. Blood samples were collected after initial examination to determine IMA, white blood cell (WBC) and C-reactive protein (CRP) values. Mean IMA values of patients with acute appendicitis (AA), perforated appendicitis (PA) and non-specific abdominal pain were significantly higher compared to the control group. Mean IMA values of the AA and PA cases were also significantly higher compared to the group with non-specific abdominal pain. No significant difference was determined in mean IMA between the AA and PA groups. WBC and CRP levels of the AA and PA groups were significantly higher compared to the group with non-specific abdominal pain. Our study shows that IMA, together with WBC and CRP, may be a biomarker capable of assisting the differential diagnosis of acute abdominal pain in children and distinguishing surgical from non-surgical cases.

Retrospective evaluation of patients presenting with acute abdominal pain in the green area of emergency clinic: A cohort study.

Aim: In emergency services applications, patients are stable as a general condition and have simple health problems that may be provided outpatient treatment, are defined as green area patients. Abdominal pain is a common cause of referral to the emergency clinic. In our study, patients admitted to our hospital with acute abdominal pain in the emergency room green areas were evaluated in all respects.Methods: A retrospective observational study was designed to evaluate patients presenting with acute abdominal pain in green areas. The sample group consisted of 342 patients. Diagnosed / pre-diagnosed patients were identified as specific diagnosis. Diagnosis unclear patients were identified as non-specific diagnosis. Results are evaluated in two categories: 1. Inpatient treatment (surgical or medical treatment), 2. Outpatient (medical treatment ).Results: The values of hematologic parameters such as BASO%, HCT, PDW, RBC and RDW were statistically significant different between the groups of specific and nonspecific diagnosis. (p in order 0.049, 0.003, 0.015, <0.001 and 0.005). Also a statistically significant difference was found in LY%, MO#, NEU#, NEU%, WBC values between discharged from inpatient and outpatient clinic control groups (p <0.0001, 0.0002, <0.0001, <0.0001 and <0.0001, respectively).Conclusion: Although non-specific acute abdominal pain is the most common cause of referral to the emergency services green area, careful history, physical examinations and inspections for detection of acute abdominal pain in our patients are guiding us.

Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring is classical and different modifications of Alvarado score have been introduced but none is ideal and negative appendicectomy rate is still high. The aim of the study is to design a more reliable scoring system which is cost effective, simple, easy to learn, high accuracy, which can be applied by any doctor at any health care facility.Methods: Retrospective study of 160 patients hospitalized with abdominal pain suggestive of acute appendicitis and subsequently operated over a period of 5 year from January 2012 to January 2017 at Max Super Speciality Hospital, Gurgaon.Results: In the present study based on six clinically most significant variables, a diagnostic accuracy of 96.25% was achieved while the same was 85% for classical Alvardo Score. This significantly increased the diagnostic accuracy and lowered the negative appendicectomy rate.Conclusions: Max Appendicitis Score is perfect scoring system for diagnosing appendicitis, it can be specially very handy in peripheral health centers where radiological facilities are sparse.

A study of Alvarado score and its correlation with acute appendicitis

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring system is one of the many scoring systems available for the diagnosis of acute appendicitis and is purely based on history, clinical examination and few laboratory tests and is very easy to apply. The objectives of the study were to evaluate efficacy of Alvarado scoring system in preoperative diagnosis of acute appendicitis and correlating it with postoperative findings. Methods: The present study was a prospective study of 50 patients presenting with symptoms and signs of acute appendicitis to the emergency department during a period of 2 years. Patients who met the inclusion criteria were evaluated using Alvarado scoring system. All the patients were operated by conventional method of open appendicectomy. The efficacy of Alvarado scoring system was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value and negative appendicectomy rate. Results: Pain was the most common presenting symptom (100%). Time of presentation ranged from 1-7 days with a mean of 1.98 days. Out of 50 patients, 35 (70%) are in the score range of 7-10, 12 (24%) in the score range of 5-6 and 3 (6%) in the 1-4 group. Appendix was inflamed in 86% cases. In the present study, negative appendicectomy rate was 14%. Conclusions: Alvarado scoring system is an easy, simple, cheap, reliable and safe tool in pre operative diagnosis of acute appendicitis and can work effectively in routine practice.

Traumatic and non-traumatic adrenal emergencies.

Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.

Mean platelet volume: is it a predictive parameter in diagnosis of acute mesenteric ischemia?

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P < 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP). We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland. Data were analyzed for the whole country and correlated to seasonal and weather parameters (temperature, humidity). Moreover, additional sub-analyses were performed for five geographically different area of Finland. The observation period spanned 21 years, with 186558 appendectomies, of which 137528 (74%) cases were reported as AA. The incidence of AA declined for 32% over the study period. The average incidence of the NSAP was 34/10000 per year. The mean annual temperature, but not relative humidity, showed clear geographical variations. The incidence of AA decreased significantly during the cold months of the year. No correlation was detected between temperature and incidence of NSAP. Humidity had a statistically significant impact on NSAP. The incidence of acute appendicitis is declining in Finland. We detected a clear seasonality in the incidence of AA and NSAP.

Long-term Outcome of Patients with Acute Non-Specific Abdominal Pain Compared to Acute Appendicitis: Prospective Symptom Audit after Two Decades

Background: Non-specific abdominal pain (NSAP) and acute appendicitis (AA) are the two most frequent diagnoses of acute abdomen in the emergency wards. The long-term morbidity, mortality and quality of life of the patients with NSAP compared to AA are unknown.Methods: The study group consisted of 186 patients with acute NSAP compared to 147 patients with AA initially treated during 1985–1986. Medical history, social background, quality of life and abdominal symptoms were assessed with standardized questionnaires in both groups during 2006–2009. The patients who continued to have abdominal symptoms were invited to a check-up visit.Results: During 1985–6, the NSAP group had more previous abdominal symptoms and operations than the AA group. Some 29% of patients with NSAP and 11% of patients with AA had still abdominal symptoms at long-term check-up (p < 0.0001). Chronic abdominal pain (38 vs 17) and peptic ulcer disease (18 vs 2) occurred more often in the NSAP group than in the controls, respectively (p = 0.001). After five years of follow-up, 11 patients in the NSAP group and 6 patients in the AA group had died (ns). During the twenty years of follow-up, mortality was higher (46/22, 25/15%) in the patients with NSAP than in controls (p = 0.013). Ischaemic heart disease was the leading cause of death in both groups (18 NSAP vs 5 AA, p = 0.017). The quality of life scores were comparable in both study groups. Conclusion: Over 70% of NSAP-and almost 90% of AA-patients were free of symptoms after 20 years of follow-up. Mortality was higher and various alimentary track diseases were more frequent in patients with NSAP than in AA.

Acute non‐specific abdominal pain with port‐wine urine

Acute non‐specific abdominal pain with port‐wine urine

“Primum non nocere”—first, do no harm

A 66-year-old male presented with non-specific acute abdominal pain, central abdominal tenderness and guarding. A CT scan performed for further evaluation showed characteristic features of acute appendicitis, a diagnosis confirmed during subsequent laparoscopic surgery. CT also revealed an incidental abnormality in the left lower lumbar region (Figure 1). What is the diagnosis and what is its aetiology?

A 5‐year follow up of patients discharged with non‐specific abdominal pain: out of sight, out of mind?

Acute non-specific abdominal pain (NSAP) is prevalent in 6-25% of the general population and is a common cause of admission to the emergency department (ED). Despite involvement of substantial financial and human resources, there are few data on long-term outcome after initial diagnosis. The aim of this study was to evaluate long-term outcome of patients initially admitted with NSAP to an ED. The study involves a 5-year follow-up analysis of prospectively collected data on 104 patients admitted to our ED in 2003 with NSAP. Primary end-point was clinical outcome 5 years after initial ED admission. Predictive risk factors were assessed using a multivariate regression model. 29 patients (28%) had recurring NSAP 5 years after initial ED admission, 76% of these patients received (multiple) diagnostic examinations and 13% eventually required diagnostic (or therapeutic) surgery. Although approximately half of patients with recurring NSAP eventually received a definite diagnosis, 30% still suffered from recurrent abdominal pain. Using regression analysis, no single factor in our dataset could be identified as a predictor for NSAP persistence. The long-term impact for patients initially admitted to our ED with acute NSAP is significant--28% of patients continue to suffer from recurring NSAP after 5 years. NSAP therefore remains, despite more advanced diagnostic tools, a true and, as yet, unsolved problem.

Ignoring non-specific abdominal pain in emergency department patients may be related to decreased quality of life

Patients suffering from chronic pain have a high prevalence of depression, resulting in a significant impact on overall quality of life. Our aim was to investigate how long term acute non-specific abdominal pain (NSAP) affected overall physical and mental well-being in patients admitted to our emergency department (ED). All patients discharged from the ED with NSAP between 06/2007 and 06/2008 were included for follow up. Current health and well-being was evaluated using the SF-36® health questionnaire. Ordinal linear regression models were chosen to separately assess variables influencing SF-36® outcome, with adjustment for age and gender. Results were expressed as differences of means with corresponding 95% confidence intervals and p-values. Of the 200 patients included (57% female, mean age 33 years), 53 (26.5%) still suffered from NSAP after a 12.5-month mean follow up. Patients with persistent NSAP suffered more from chronic pain (26.4%) or known psychiatric illnesses (15.1%) than unaffected patients (p<0.001 and p=0.028). Mental (MCS) and physical component scores (PCS) were significantly worse in patients suffering from persistent NSAP, even when adjusted for confounding factors including chronic pain syndromes, pre-existing psychiatric illnesses, other concomitant comorbidities and previous abdominal surgery (p<0.001 for both scores). Other risk factors included chronic pain syndromes, pre-existing psychiatric illnesses, other concomitant comorbidities and previous abdominal surgery. NSAP persistence may be associated with a decreased quality of life. Emphasis should be put on providing early counselling and support, with the aim of minimising the long term detrimental side effects of NSAP.