Paroxysmal Abdominal Pain Research Articles

A CASE OF INTESTINAL ISCHEMIA WHICH APPEARED TO BE ABDOMINAL ANGINA

We experienced a transient intestinal ischemia which appeared to be abdominal angina. A 64-year-old man was seen at the hospital because of upper abdominal pain suddenly occurred during drinking. The abdominal pain was intensified, and melena and shock developed. The patient presented significant acidosis, as shown by pH 7.184, BE-17.9mEq/l, and HCO-3 8.5mEq/1 in an arterial blood gas analysis. Conservative treatment successfully improved the abdominal pain and gas analysis values were also improved: pH 7.548, BE 8.0mEq/l, and HCO-3 29.3mEq/l. However, a possibility of strangulated ileus could not be denied, and laparotomy was performed. There was 1, 850ml of white puruloid ascites in the abdominal cavity and the entire small intestine coloured dark red brown and lapsed into ischemia. To confirm the cause of the ischemia, the small intestine was dragged out of the surgical wound, and pulsation was confirmed at the artery of intestinal verge presenting as ischemia. Lavage of the small intestine with warmed saline was done, and discolored small intestine was gradually normalized. The small intestine was not excised and the wound was closed. Postoperatively, paroxysmal abdominal pain occurred with after meals, but was alleviated by isosorbide nitrate tape preparation. He has been well, as of one year and 5 months after the operation.

A CASE REPORT OF INFLAMMATORY ABDOMINAL AORTIC ANEURYSM

Recently, inflammatory abdominal aortic aneurysm has been in the spotlight since it was reported that the disease represented about 20% of all abdominal aortic aneurysms. This paper presents our experience with a case and the recent treatment of inflammatory abdominal aortic aneurysm. A 62-year-old woman was admitted to the hospital because of nocturnal paroxysmal abdominal pain and lumbago. There were no abnormalities in the laboratory data. Abdominal echography and CT revealed a folicular aneurysm, 8.5×4cm in size, just below the bifurcation of the renal artery. Arterial wall, which we call a “Mantle”, was thick and surrounded by perianeurysmal fibrosis of the width of 1cm. In addition, calcification was showed in it's lumen. The intima showed only slight atherosclerotic change. The abdominal aorta was reconstructed using Φ18×9mm Y-shaped Dacron graft. The patient was diagnosed as inflammatory abdominal aortic aneurysm by histological picture. It has been said that incidence of rupture of inflammatory abdominal aortic aneurysm was low, but the aneurysm repair should be proposed as a rutine treatment in the case with clinical symptoms.

Insomnia and Cow's Milk Allergy in Infants

In Reply.— Dr Lecks reminds us that the entity called "infantile colic" is frequently encountered in infants younger than 3 months of age. It is characterized by signs of paroxysmal abdominal pain, severe crying, a flushed face, and a tense abdomen. The painful episodes occur mainly during the late afternoon or early evening hours. The paroxysmal pain can last several hours and appears to be relieved with the passage of feces or when the child falls asleep, usually exhausted.

Abdominal Epilepsy

Four patients, aged 17 to 47 years, had paroxysmal abdominal pain associated with symptoms suggestive of a CNS disturbance. None had a discernible primary gastrointestinal process, but each had EEG abnormalities and a striking response to anticonvulsant medication. These findings suggest that abdominal epilepsy should be considered in the differential diagnosis of unexplained paroxysmal abdominal pain. (<i>JAMA</i>240:2450-2451, 1978)

Hereditary Angioneurotic Oedema in Finland

A total of 7 families with hereditary angioneurotic oedema (HANE) have been found in Finland. Six HANE patients have died from laryngeal oedema, 27 patients with diagnosed HANE are alive and 21 members have a haematological abnormality typical of HANE, i.e. a deficiency of the inhibitor of the activated first component of complement (C1-INH), but no manifest symptoms. The largest family has 363 living members, 303 of whom were investigated for C1-INH, C4 and C3. Fourteen patients had HANE, 18 relatives were symptomless but had C1-INH deficiency, and 3 members of the family had died from laryngeal oedema. In two families only one case of HANE was diagnosed, the parents in both cases being symptomless with normal C1-INH levels. All patients who had died from laryngeal oedema and 10 of the 27 HANE patients still alive had a typical triad of paroxysmal abdominal pain, peripheral oedema and laryngeal oedema. Six patients have had abdominal attacks alone, three peripheral oedema alone and two only laryngeal oedema. The age at onset of symptoms was 1-51 years. Three patients, who have received continuous methyltestosterone therapy, had hardly any symptoms during the treatment. Thirteen patients have received tranexamic acid, either during an attack or continuously, with positive effects in all except two. Cinnarizine treatment was beneficial in three out of four cases, both when given continuously or during an attack.

Abdominal Epilepsy and the Surgical Abdomen

THE SYNDROME of abdominal epilepsy or paroxysmal abdominal pain of origin has been so amply documented that the diagnosis now is usually entertained when the bouts of abdominal pain mimic an epileptic pattern, an abnormal electroencephalogram is obtained, thorough studies rule out disease of the abdominal viscera, and the criteria for establishing the diagnosis are adhered to. Prior to the recognition of this disorder, numerous patients had been subjected to needless abdominal surgery and some to multiple futile operations. On the other hand, the too-ready acceptance of the diagnosis of abdominal epilepsy, because of recurrent attacks of abdominal pain, and a single, suggestive abnormal electroencephalogram, can obscure the presence of abdominal visceral disease requiring surgical intervention. The following case report is an illustration of this. Report of a Case A 13-year-old, well-developed male was admitted to the Graduate Hospital, University of Pennsylvania, Jan. 11, 1961, with the presenting complaint

Convulsive equivalent states.

Introduction The number of terms applied to this disorder is exceeded only by the numerous and widespread symptoms and signs that the illness may manifest. In the medical literature, the condition has been described under the following titles: abdominal epilepsy, 2 paroxysmal abdominal pain, 3,4 hypothalamic and thalamic epilepsy, 5 masked epilepsy, 6 the periodic syndrome, 7 visceral epilepsy, 11 diencephalic autonomic epilepsy, 8 and diencephalic autonomic discharge. 9 The term convulsive equivalent state 1 signifies a paroxysmal cerebral dysrhythmia manifested clinically by symptoms in various organ systems. Convulsive movements and loss of consciousness need not be present. 1 Of interest to internists are such symptoms as paroxysmal abdominal pain, hypertension, nausea, vomiting, fever, borborygmi and belching, flushing, blanching, cyanosis, urinary incontinence, syncope, and migraine headaches. 1,3-5,7,10-19 The paroxysmal nature of the symptoms is the clue to this diagnosis and should lead to a request for an electroencephalogram. Among several patterns that may be noted, the occurrence of 14- and

Paroxysmal abdominal pain as a manifestation of epilepsy.

Paroxysmal abdominal pain as a manifestation of epilepsy.

INFANTILE COLIC IN INSTITUTIONS

THE TERM "colic" has been considered by almost all writers on the subject as merely a symptom: paroxysmal abdominal pain. However, the characteristic clinical picture in infants and the inability to explain the cause of this condition on a definite pathologic basis have resulted in "colic" persisting in pediatric literature as a separate entity. Infantile colic is commonest in the first three months of life but also occurs, although much less frequently, in the second quarter of the first year. Attacks of colic usually begin suddenly, with an agonizing, loud and more or less continuous cry, accompanied with congestion or a somewhat cyanotic appearance of the face with pinched features. The abdomen is distended with the legs flexed on the abdomen. The feet are often cold. The arms may be flexed with the fists clenched and drawn to the chest. These paroxysms end abruptly after a few minutes or hours,

PEDIATRIC PROCTOLOGY

TABLE OF CONTENTS Introduction Anatomy Examination Malformations Colonie Disorders Atresia Duplication Rotational Defects Absence of Sigmoid Megacolon Obstruction Microcolon Anorectal Deformities Atresia Imperforate Anus Stricture Megarectum Diarrhea Chronic Ulcerative Colitis Amebiasis Allergy Oxyuriasis Pruritus Ani Fissures Anal Suppuration and Fistula Prolapse Intussusception Hemorrhoids Neoplastic Lesions Polyps and Adenomas Familial Adenomatosis or Polyposis of Colon Adenomatosis of Entire Gastrointestinal Tract Carcinomas and Sarcomas Miscellaneous Sarcoidosis (Boeck) Epileptic Paroxysmal Abdominal Pain Psychosexual Aspects Bleeding Digital Rectal Examination Venereal Diseases Venereal Lymphogranuloma Anorectal Gonorrhe INTRODUCTION In this review the subject of proctologic disease in juvenile patients has been approached from the same broad point of view as in our reviews of general proctology. 1 An attempt has been made to concentrate and correlate recent theories and developments as they have appeared in the literature up to July 1949 (save for a few later references) and to reemphasize established principles, concepts and procedures.

Primary Myxosarcoma of Liver

Myxomatous tumors primary in the liver are rare. Beggiato (1) reports one occurring in the liver of a six-year-old girl, simulating abscess. The microscopic structure was very similar to that in the case reported here, although the tumor was much smaller. Report of Case A. B., a fifty-eight-year-old white male, entered the hospital shortly after the onset of severe generalized paroxysmal abdominal pain which was worse in the lower right quadrant. There was no previous history of abdominal distress or tumor. The abdomen was distended and a mass was felt in the epigastrium. The temperature was 99.4° and the red and white blood counts were normal. At laparotomy, shortly after admission, the upper abdomen appeared to be entirely filled by the greatly enlarged left lobe of the liver. This mass contained a large ruptured cyst from which a considerable amount of bloody fluid had drained into the peritoneal cavity. The cyst was evacuated and a drainage tube inserted. A biopsy of the cyst wall showed the presence of mucoid connective tissue. The course was uneventful for the first week, but after this the drainage became scanty and foul, and the temperature rose. The patient continued to have a low-grade, septic type of fever, became progressively more emaciated and anemic, and died four months after the onset of the illness.

BASAL PERICARDITIS

There are numerous difficulties in making a diagnosis of a low grade active rheumatic state. The laboratory has been of little service in this regard. One of us 1 observed adventitious friction-like murmurs, somewhat musical in character, in the majority of children who at various times experienced one or several symptoms of childhood rheumatism, such as muscular and joint pains, paroxysmal abdominal pain, 2 sore throats, stiff neck, involuntary twitchings resembling tics, 3 pallor, weight fixation and persistent low grade elevation in temperature (to be found only when carefully lookedfor). From our studies, these friction-like, at times somewhat musical, murmurs appear to be the earliest objective signs in low grade childhood rheumatism and are apparently due to pericarditis at the base of the heart, in the region of origin of the great vessels, involving the fold of the pericardium at the point of reflexion of the latter structure. The