Onset Of Abdominal Symptoms Research Articles

Symptomatic Biliary Pseudolithiasis in Adult Patients Treated with Parenteral Ceftriaxone: A Prospective Study

Introduction: Ceftriaxone is a frequently used antibiotic in inpatients treated for a number of bacterial infections. Biliary calculi formation called pseudolithiasis is a well-known asymptomatic and reversible complication of this drug. However, a percentage of patients do present with new onset of abdominal symptoms which can be attributable to presence of pseudoliths. Aim: To evaluate incidence of pseudolithiasis in inpatients treated with parenteral Ceftriaxone, to assess resolution of pseudoliths and development of abdominal symptoms attributable to pseudolithiasis on long term follow-up over one year. Materials and Methods: A prospective observational cohort study including all patients admitted at our centre and started on Ceftriaxone. These patients were subjected to sonographic examination on day 1 and day 7 of treatment. Patients who developed pseudolithiasis were prospectively followed-up at one month, three months, six months and one year to assess for resolution or whenever they presented with symptoms. Incidence of pseudolithiasis and complications in patients who developed pseudolithiasis was calculated using standard formulae. Descriptive statistics in terms of numbers and percentages were used. Results: A total of 1490 patients were included in the study from August 2016 till July 2017 and followed for a period of one year (June 2018). The incidence of pseudolithiasis in inpatients treated with parenteral ceftriaxone was 8.7% (131 patients) as observed on Sonographic examination performed on day 7 of therapy. Ten (7.6%) patients had pseudoliths at one month and 1 (0.76%) patient out of these had persistent pseudoliths at all subsequent reviews till one year after diagnosis of the condition. Eleven (8.3%) patients who developed pseudolithiasis during therapy with Ceftriaxone had presented with upper abdominal symptoms suggestive of biliary colic before resolution of pseudolithiasis. Conclusion: Biliary pseudolithiasis is a common side effect of ceftriaxone therapy, occurring in approximately 10% of patients. Biliary colic, cholecystitis and pancreatitis may also result due to these pseudoliths complicating the course of primary illness. Further consultations and interventions like cholecystectomy can be reserved not only to symptomatic individuals but also for those with persistent pseudoliths.

Necrotizing enterocolitis after intravitreal bevacizumab in an infant with Incontinentia Pigmenti \u2013 a case report

BackgroundIncontinentia Pigmenti is a rare disease affecting multiple organs. Fifty of patients show affection of the eye with retinopathy and possible amaurosis being the worst outcome. Treatment has commonly been panretinal laser coagulation but intravitreal application of bevacizumab as VEGF-inhibitor has shown to effectively suppress retinal neovascularization.Case presentationA six-week-old female infant with Incontinentia Pigmenti developed a foudroyant necrotizing enterocolitis shortly after intravitreal injection of bevazicumab due to a retinopathy with impending tractional detachment of the left eye. Since the onset of abdominal symptoms occurred immediately after the intravitreal application, a link between the two events seemed likely. Sequential analyses of the VEGF serum concentrations showed a massive suppression of endogenous VEGF with only a very slow recovery over weeks. Such a severe systemic adverse event has not been reported after intravitreal treatment with bevacizumab in an infant.ConclusionThis case report shows a relevant systemic uptake of bevacizumab after intravitreal application as suppressed VEGF levels show. There seems to be a connection between suppressed VEGF levels and the onset of necrotizing enterocolitis. Therefore, treatment with bevacizumab should be carefully considered and further research is needed to assess this drug’s safety profile.

Norovirus outbreak among students of a boarding school in Kluang, Johor, Malaysia.

Norovirus (NoV) is a contagious virus causing acute gastroenteritis and is mainly responsible for diarrheal outbreak in closed settings. The aims of this study were to describe the epidemiological characteristic of an outbreak in a boarding school, to assess the extent of the outbreak and to implement appropriate control measures. A descriptive study was conducted to describe the epidemiological characteristics of the outbreak. Data on demographic details, onset of abdominal symptoms, food intake history and contact with ill person three days prior to illness were obtained. Twelve fresh stool and 14 food samples were tested for NoV and enteric pathogens, respectively. Out of 745 students, 42 (5.6%) were infected during this outbreak. Predominant clinical features were diarrhea (76.1%), vomiting (71.4%) and abdominal pain (67%). Eight (67%) stool samples and six (43.9%)food samples were positive for NoV and total coliforms, respectively. The dissemination of the disease was due to poor hygiene practices among students. Quarantine was imposed until the last case on September 28, 2016. The outbreak was declared over on September 30, 2016. A NoV outbreak was determined first time in Malaysia. Environmental assessment showed poor hygienic conditions in the school's kitchen. The number of infected students increased considerably despite the implementation of preventive and control measures. Quarantine was effective to stop the outbreak which is characteristics of NoV outbreak.

Diagnosis and treatment strategies of tuberculous intestinal perforations

Gastrointestinal tuberculosis (TB) may result in intestinal obstruction and perforation, even after antituberculous therapy has been initiated. Despite surgical intervention tuberculous perforation has a high complication and mortality rate, and it is difficult to predict the subgroup of patients with abdominal TB who progress to perforation. In this study, we retrospectively investigated the clinical features that may predict disease progression in patients in our institution who presented abdominal TB over a 5-year period between January 2006 and August 2011, as well as describe an unreported method of managing tuberculous intestinal perforations when resection with end-to-end anastomosis is unfeasible. Six out of 91 patients (6.6%) with abdominal TB developed perforations. Factors linked with increased complications and mortality were age, comorbidities, multiple perforations and length of time between onset of abdominal symptoms and perforation. Four patients (66.7%) had long histories of abdominal symptoms before perforation. Three patients were receiving or had completed antituberculous therapy before developing perforation. Five patients were managed surgically, two underwent laparostomy as both primary closure and end-to-end anastomosis were deemed too risky. Mortality following perforation was 17%. Patients with prolonged abdominal symptoms, even after antituberculous therapy, should raise suspicion for subacute intestinal obstruction. This should be recognized early and surgical intervention considered in order to prevent mortality secondary to perforation. Laparostomy may be an alternative when resection and end-to-end anastomosis is not possible.

One Early and Three Delayed Distal Pancreatectomies without Splenectomy and with Preservation of the Splenic Vessels After Traumatic Transection of the Distal Pancreas in Children

Four children are presented with Class II pancreas injury as a result of a motor vehicle accident. The first child was taken to the operating room promptly due to concomitant perforation of the hollow viscus (gastric rupture) and underwent successful spleen-sparing distal pancreatectomy with preservation of the splenic artery and vein. The next three cases with isolated abdominal symptoms of pancreatic injury generally experienced a delay of one day before the onset of abdominal symptoms and positive diagnostic investigation results and were managed non-operatively (NOM) on admission; they were then treated surgically due to developing peritonitis after 24, 36, and 38 hours, respectively. The same type of operation, even though delayed and technically much more demanding, was performed, but this was not an obstacle to our efforts to preserve the spleen and its full circulation, in order to provide full immunological and haematological support during the expected prolonged postoperative course. We did not lose any of the children. A reintervention was needed in two children due to the retention of necrotic tissue and intraabdominal abscess. The serum amylase level in all cases remained above normal. We believe that a spleen-preserving distal pancreatectomy with splenic vessel conservation can be safely performed, even in delayed operations, and should be indicated for the surgical management.

Acute Abdomen

The acute abdomen is a clinical entity, defined by the sudden onset of abdominal symptoms (Figure 1). The clinical course can develop over a variable time period, and may result from a wide range of intra- and extra-abdominal pathologies. The key clinical decision is to determine whether surgical intervention is required. A thorough understanding of the pathophysiology will assist in the successful interpretation of the symptoms and signs, and thus guide diagnosis.

A new source of drug-induced acute pancreatitis: codeine

A variety of drugs have been reported to cause acute pancreatitis during the past 40 years. We report the first series of four cases of acute pancreatitis related to codeine ingestion. Four patients (three female, mean age 50.2 yr) presented with clinical, biochemical, and radiological evidence of acute pancreatitis. All four had ingested a therapeutic dose of codeine 1–3 h before the onset of abdominal symptoms. Unintentional rechallenge occurred in three cases and was followed by recurrence of acute pancreatitis in all three. All patients made a full recovery. All four patients had had a previous cholecystectomy. The likely underlying pathophysiological mechanism is codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Codeine ingestion leads to acute pancreatitis in some individuals. Previous cholecystectomy seems to predispose to codeine-induced pancreatitis.

Perforation due to metastatic tumors of the ileocecal region.

We reviewed our department's medical records between April 1986 and April 1994 to identify patients who showed acute abdominal symptoms requiring surgical treatment due to metastatic tumors of the small intestine. In group A, seven patients (30%) were treated for acute peritonitis, and all were found to have an intestinal perforation due to hematogenous metastases (group A). In group B, 16 patients (70%) were treated for an intestinal obstruction, and all were found to have disseminated tumors of the small intestine (group B). In group A all tumors were isolated and located exclusively in the ileocecal region, whereas all tumors in group B showed peritoneal dissemination, with no predominant anatomic localization. In general, the intestinal tumors in group A originated from cancers of the upper aerodigestive tract, whereas those in group B originated from advanced cancers in the abdominal cavity. The tumors were significantly smaller and the period between the onset of symptoms from the original malignancy and the onset of abdominal symptoms (perforation or obstruction) was significantly shorter in group A. In conclusion, intestinal metastases located in the ileocecal region have unique clinicopathologic features and so should be recognized as a distinct disease entity. Therefore when patients with a known upper aerodigestive malignancy exhibit acute abdominal symptoms, intestinal metastasis to the ileocecal region, necrotic changes, and perforation should be considered in the differential diagnosis.

Successful treatment of disseminated strongyloidiasis

To report the successful treatment of Strongyloides stercoralis hyperinfection, which is usually lethal but in this case was diagnosed in its early stages. A 44-year-old woman, who had spent much of her life in Fiji and India, was treated with a high dose of prednisolone for rheumatoid arthritis complicated by gold lung. The onset of abdominal symptoms, an exacerbation of respiratory symptoms, and a persistent high eosinophil count and serum IgE level, led to the detection of numerous Strongyloides larvae in her faeces and sputum. She was treated with thiabendazole for five days, then mebendazole for one month, and the dose of prednisolone was reduced. Clinical symptoms and signs improved within days and after one week parasites could not be found in her faeces. After six months, enzyme-linked immunosorbent assay for Strongyloides infection gave a reading which was 40% of the initial level but still in the positive range. Steroid therapy in individuals with chronic, subclinical strongyloidiasis predisposes to the insidious development of hyperinfection syndrome, which has a high mortality rate. If detected early, this complication can be treated effectively. It can be prevented by actively seeking Strongyloides infection, by faecal microscopy and culture techniques and by serological tests, in high-risk individuals, such as immigrants from endemic areas.

Typhlitis. An 18-year experience and postmortem review

A review of pediatric autopsy results at the Texas Children's Hospital, Baylor College of Medicine from 1970 through 1987 was conducted. Thirty-three cases of typhlitis were identified in patients with acute leukemia and two cases each in patients with lymphoblastic lymphoma and aplastic anemia. Patients ranged in age from 10 months to 17 years. Fifty-seven percent were male and 43% were female. All were myelosuppressed. A postmortem incidence rate of 24% was determined for patients with acute leukemia. Common symptoms included abdominal pain and distention in 78% of patients and acute lower gastrointestinal bleeding in 35%. Abdominal radiographs varied in spectrum from a nonspecific bowel gas pattern to frank right colonic pneumatosis intestinalis. Thirty-three patients received chemotherapy within 30 days before onset of abdominal symptoms. All patients were febrile (greater than 38.5 degrees C), and 33 received broad-spectrum antibiotics. Three patients received amphotericin B. Premortem, 84% of organisms cultured from blood were bacterial whereas 16% were fungal. Fungal pathogens accounted for 53% of new microorganisms seen at autopsy. Postmortem examination showed typhlitis in the following anatomic distributions: (1) confined to the cecum; (2) involving the cecum and ileum; (3) involving the cecum, ileum, and ascending colon; or (4) involving the cecum, with sporadic ulcers throughout the intestine. This review includes clinical and postmortem features of typhlitis and current strategies for diagnosis and management.

Malignant lymphoma presenting as an ovarian tumour: A clinicopathological analysis of 34 cases

The clinicopathological features of 34 patients with malignant lymphoma or leukaemia where the initial presentation was as an ovarian tumour are described. Nineteen patients died, usually within 1 year of diagnosis, whilst 15 survived, some for long periods. Factors indicating a poor prognosis were rapid onset of abdominal symptoms, the presence of systemic symptoms, bilateral ovarian tumours, advanced stage and a histological pattern other than that of a B-cell lymphoma. For staging purposes the Ann Arbor method appeared a more sensitive prognostic indicator than did the FIGO staging system. It is suggested that primary malignant lymphomas of the ovary are extremely rare and that for therapeutic purposes all lymphomas of the ovary should be regarded as local manifestations of systemic disease.

An association between increased porphyrin precursors and onset of abdominal symptoms in lead poisoning

To examine a potential role of porphyrinopathy induced by lead (Pb) exposure in the pathogenesis of constipation in Pb poisoning, a Pb-intoxicated worker was subjected to the serial determinations for various biochemical indicators of Pb exposure in relation to the onset of constipation. The results have shown that the onset of constipation parallels a rapid rise in either urinary δ-aminolevulinic acid (ALA) or coproporphyrin (CP), or both. The present evidence is not yet conclusive as to the involvement of porphyrinopathic mechanism in the development of constipation in Pb intoxication.

Susceptibility to lead toxicity.

Adverse effects of lead on human health have been recognized for centuries. Nevertheless, current public health measures require a greater understanding of the pathobiology of chronic low level exposure (1-3). Such considerations are related to the question of what level of lead intake is harmful and why specific clinical manifestations of lead poisoning are encountered under particular circumstances. The recognition of factors, both synergistic and antagonistic, which influence the toxicity of lead is essential for adequate understanding of the effects of environmental lead on human health. The immense body of literature already written about lead contains many clues to and impressions of such factors, both adverse and beneficial, modifying the toxicity of lead. This brief review will discuss a number of such factors. Few of these have as yet been subjected to rigorous experimental confirmation. A consideration of antagonisms and synergisms is based on certain assumptions with regard to the metabolism of lead; that is, the daily intake and excretion of lead as well as the movement of lead between various tissues and effects on cells and subcellular organelles.

Pulmonary Tuberculosis and Peptic Ulcer

categories. In the interpretation of these figures we should remember that not until recently did we become fully alert to the problem and to the need for a more detailed investigation of the gastrointestinal system in tuberculous patients. In recent years we also had the opportunity to witness among our admissions the prevalence of tuberculosis in elderly men, a fact which was emphasized by the transfer of such patients from another hospital. Only three of the cases were women. The age of our patients at the time of admission ranged from 38 to 79 with an average of 55. The average age at the time of diagnosis was 50 for pulmonary tuberculosis and 48 for peptic ulcer. In one the tuberculosis was moderately advanced. All others had far advanced disease. The first group includes 12 patients who developed tuberculosis after surgery for peptic ulcer. Nine had gastrectomy, total or subtotal, and two gastroenterostomy. The last one had “closure” of a gastric ulcer but required gastrojejunostomy at a later admission. The interval between abdominal surgery and onset of tuberculosis ranges widely from less than one year to 37 years. In case seven the sequence of events is difficult to determine since the patient’s lung disease may well antedate his operations. The second group is made up of four patients whose gastrointestinal symptoms appeared after surgical treatment of pulmonary tuberculosis by thoracoplasty. The interval between operation and discovery of the peptic ulcer varies from four months to seven years. In this group there were three duodenal and one gastric ulcers. These patients also received chemotherapy including oral PAS medication before the onset of abdominal symptoms. In case 13 a gastric ulcer developed in the wake of cortisone therapy for severe rheumatoid arthritis which complicated the tuberculosis. The third group includes seven cases in which pulmonary tuberculosis preceded the onset of peptic ulcer. The latter was discovered at autopsy