Preoperative Abdominal Pain Research Articles

Incidence and risk factors associated with negative postoperative behavioral changes in children undergoing painless gastroscopy

ObjectiveTo investigate the incidence of and risk factors associated with negative postoperative behavioral changes (NPOBCs) in children undergoing painless gastroscopy.MethodsInclusion criteria: ASA I–II and outpatients aged 6–12 years undergoing painless gastroscopy. Exclusion criteria: history of surgery or anesthesia, children with developmental or intellectual abnormalities, refusal to participate, preoperative abdominal pain score > 3 points, history of chronic abdominal pain of > 3 months duration, and serious intraoperative complications. On the 1st, 14th, and 30th day after the gastroscopy, the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) was used to assess NPOBCs in children.ResultsA total of 1,670 children were included in this prospective observational cohort study. The incidence rates of NPOBCs were 14.13%, 4.55%, and 2.14% on the 1st, 14th, and 30th day after gastroscopy, respectively. The risk factors for the first day were female sex (OR 1.34, 95% CI 1.00–1.79), parental anxiety (OR 2.23, 95% CI 1.75–3.12), and severe anxiety in children (OR 2.83, 95% CI 1.96–4.07). The risk factors on the 14th day were parental anxiety (OR 3.71, 95% CI 2.19–6.29), a parental educational level above high school (OR 1.65, 95% CI 1.00–2.70), and severe anxiety in children (OR 11.87, 95% CI 5.85–24.07). The risk factors on the 30th day were female sex (OR 2.99, 95% CI 1.41–6.34), being an only child (OR 4.42, 95% CI 2.18–8.95), a parental educational level above high school (OR 2.66, 95% CI 1.27 NPOBCs 5.56), and severe anxiety in children (OR 6.84, 95% CI 2.84–16.49).ConclusionIn children undergoing painless gastroscopy, the incidence rates of NPOBCs on the 1st, 14th, and 30th day were 14.13%, 4.55%, and 2.14%, respectively. The risk factors for NPOBCs were severe anxiety in children, female sex, parental anxiety, and a parental educational level above high school. In particular, severe preoperative anxiety in children was a persistent risk factor for NPOBCs within 30 days.

Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections.

With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses. A retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay. Five hundred and ninety-two patients: 46% male, median age 58years undergoing colorectal resections for indications including cancer, inflammatory bowel disease, and diverticulitis were identified. Less opioid use was found to be associated with female gender (β = - 42), patients who received perioperative lidocaine infusion (β = - 30), and older adults (equivalents/year) (β = - 4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use, and smoking were all independently associated with increased postoperative opioid requirements. In this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.

Efficacy of preoperative transversus abdominis plane block in acute appendicitis pain and its success in postoperative pain: a retrospective study.

The aim of this study is to determine the analgesic efficacy of Transversus Abdominis Plane (TAP) block applied before anesthesia on preoperative abdominal pain and postoperative surgical pain in acute appendicitis. Among the patients aged 18 years and older who underwent open appendectomy with the diagnosis of acute appendicitis, patients who underwent TAP block were identified retrospectively. To the aim of this study, demographic data of the patients, preoperative change in pain scores at rest and with coughing, postoperative pain scores, need for postoperative analgesics were evaluated. Twenty-two patients who underwent preanesthetic lateral TAP block were accepted as the sample of the study. Preoperative 0th minute resting and rebound pain scores due to appendicitis before TAP block were 4.63 and 7.63, respectively. Resting and rebound pain scores at the 1st, 3rd, 5th, 10th, 15th, and 20th minutes after TAP block were respectively 2.95, 2.04, 1.27, 0.68, 0.50, 0.45 and 5.59, 4.68, 3.72, 2.77, 2.22, 1.86. Both resting and rebound pain scores decreased from the 1st minute to the 15th minute, with a statistically significant difference (p<0.05). The mean pain scores at the 1st, 2nd, 6th, 12th and 24th hours postoperatively were 3.72, 2.81, 2.13, 1.86, and 1.5, respectively. Six patients did not need analgesics in the first 24 hours. Opioid was administered to only one patient postoperatively. TAP block provides effective analgesia in the preoperative abdominal pain treatment of acute appendicitis cases. It also shows that effective postoperative analgesia can be achieved even when applied preoperatively.

Computed Tomography Image Segmentation of the Proximal Colon by U-Net for the Clinical Study of Somatostatin Combined with Intestinal Obstruction Catheter.

Objective U-Net technology is implemented for image segmentation to diagnose cases of intestinal obstruction. To evaluate the application value of somatostatin combined with transanal intestinal obstruction decompression catheter in the treatment of distal colonic malignant intestinal obstruction and to explore the therapeutic effect of somatostatin on acute abdomen surgery in patients with intestinal obstruction. Methods After the segmentation technique, a retrospective analysis of 30 patients with acute and complete distal colonic malignant obstruction treated by surgery was divided into a control group and an observation group according to a random number table. The treatment efficiency, clinical symptoms, disappearance time after treatment, and the incidence of complications were compared between the two groups of patients. Results The image segmentation using U-Net can effectively assist in the medical diagnosis of the colon. Our study found that patients with combined treatment with somatostatin and anal intestinal obstruction catheter were relieved of preoperative abdominal pain and abdominal distension; compared with the abdominal circumference at the time of admission, the abdominal circumference was significantly reduced. Abdominal examination was performed 3 days after comprehensive treatment, and combined with computed tomography (CT), we observed that the measured maximum transverse diameter of the proximal colon was significantly smaller than that before treatment. Before treatment, all patients were divided into a control group and a treatment group. After treatment, the symptoms of the two groups of patients were alleviated. The treatment effective rate of the observation group was 93.3%, and the treatment effective rate of the control group was 73.3%. The effective rate was significantly higher than that of the control group, and the difference was statistically significant. Conclusions Through the use of image segmentation technology, somatostatin treatment of early inflammatory bowel obstruction after acute abdomen surgery can effectively improve the treatment efficiency of patients, shorten the disappearance of clinical symptoms, reduce the incidence of complications, and have a significant therapeutic effect, which is worthy of clinical application. Somatostatin combined with enteral obstruction catheter treatment is safe and effective for elderly patients with acute distal large bowel malignant intestinal obstruction. It has a higher completion rate of laparoscopic surgery and a first-stage anastomosis power, which reduces the risk of perioperative period and reduces the patient's financial burden.

Acute appendicitis over the age of 50: The evaluation of the impact of clinical variables on operative and post-operative outcomes.

Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis. Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail. A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively). The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.

Prevalence and predictors of chronic postsurgical pain after colorectal surgery: A prospective study.

The aim was to investigate the incidence, characteristics and the potential predictors of chronic postsurgical pain (CPSP) after colorectal surgery. Patients who underwent colorectal surgery at our institution from July 2014 to December 2016 were prospectively enrolled in this study. Perioperative potential demographic, clinical and psychological predictors for CPSP were collected. The follow-up visits were conducted through telephone interviews at 3 and 6months postoperatively. The interview questionnaire comprised items regarding pain intensity, frequency, site, analgesic administration and impact on activities of daily living. A total of 624 patients completed the 6-month follow-up and were included in the analysis. CPSP was reported by 32.1% of these patients at 3months and 21.8% at 6months after colorectal surgery. The pain interfered with several activities of daily living in a considerable proportion of CPSP cases. At 3months, the identified predictors of CPSP were young age, preoperative abdominal pain and pain elsewhere, preoperative anxiety and depression, longer duration of surgery, and high pain intensity on movement within 24h after surgery. Predictors of CPSP at 6months were young age, preoperative abdominal pain, preoperative anxiety, longer duration of surgery, and high pain intensity on movement within 24h after surgery. Chronic pain after colorectal surgery is a common complication associated with young age, preoperative abdominal pain and pain elsewhere, preoperative anxiety and depression, longer duration of surgery, and high pain intensity on movement within 24h after surgery.

Perforated Diverticulitis of the Transverse Colon: An Unexpected Cause of Abdominal Pain During Preoperative Bowel Preparation

Diverticulitis affecting the transverse colon is uncommon, with perforation being exceptionally rare. It is not usually considered in the differential diagnosis of a patient with acute abdominal pain. We report a case of nonspecific abdominal pain secondary to a perforated diverticulum in the transverse colon during preoperative bowel preparation. A 74-year-old Caucasian female had sudden onset abdominal pain and nausea with routine bowel preparation. This undifferentiated acute abdomen was suggestive of a bowel perforation, which was later confirmed by a computed tomography scan. Surgical exploration determined the location of the perforation in the transverse colon. We report an unusual presentation of preoperative abdominal pain during routine bowel preparation. It is extraordinarily uncommon to see rupture of a transverse colon diverticulum in a patient with sigmoid involvement, and bowel preparation as a cause of rupture has not been previously documented. Because perforation of a transverse colon diverticulum generally has a nonspecific clinical presentation, it should be considered in the differential diagnosis for a patient with known diverticular disease who has acute onset abdominal pain and signs of peritonism.

Prevalence and predictors of pain and opioid analgesic use following total pancreatectomy with islet autotransplantation for pancreatitis

Background & objectivesTotal pancreatectomy with islet autotransplantation (TPIAT) is employed for the management of refractory pain in chronic pancreatitis (CP) with the prospect of partial beta cell preservation. The primary aim of this study is to evaluate the prevalence and predictors of abdominal pain and opioid use following TPIAT. MethodsA single center cohort study of all adult patients who underwent TPIAT from 2011 to 2015 for CP. Postoperative pain outcomes included: opioid use, ongoing abdominal pain and new characteristic abdominal pain. Multiple logistic regression analysis was used to evaluate known and potential predictors of postoperative pain outcomes. ResultsDuring the study period, 46 patients underwent TPIAT. Following surgery, 89% of patients had resolution of their pre-operative abdominal pain; however, 83% of patients developed a new characteristic abdominal pain. Opioid independence was achieved in 46% of patients. Acute recurrent pancreatitis (ARP) (OR: 11.66; 95%CI: 1.47–92.39; p = 0.02) but not pain duration >3 years or ≥ 5 ERCPs was independently associated with resolution of pre-operative abdominal pain on multiple logistic regression. None of these factors were associated with cessation of opioid use. ConclusionWhile the majority of patients have resolution of their initial abdominal pain following TPIAT, many will also develop a new characteristic abdominal pain and only half of all patients achieve opioid independence. ARP is the only independent factor associated with positive postoperative pain outcomes and should be considered a standard criterion for patient selection.

Computed Tomography Scan Predicts Abdominal Interventions but Not Stroke after Surgery for Acute Type A Aortic Dissection.

We hypothesized that preoperative computed tomography (CT) is a predictor of abdominal intervention for visceral malperfusion and stroke after emergent surgery for acute type A aortic dissection (AAAD). A total of 90 patients, mean (± SD [standard deviation]) age 62 (± 12) years, 76% males, undergoing emergent surgery for AAAD at our institution from May 2008 to August 2013 were included. All clinical data were collected prospectively and correlated to CT images. At initial presentation 9 (10%) patients showed preoperative focal neurologic deficit or coma, 10 patients (11%) complained of abdominal pain, and the logistic EuroSCORE was 44 (± 22). Hemiarch replacement was performed in 96%, total arch in 4%. The duration of hypothermic circulatory arrest (HCA) at 28°C bladder temperature was 26 (± 19) minutes. Cross-clamp time was 88 (± 39) minutes, and cardiopulmonary bypass (CPB) time 148 (± 49) minutes. Overall 30-day mortality was 13%. Moreover, 12 (13%) patients required postoperative abdominal interventions for suspected visceral malperfusion; stroke occurred in 25 (28%) patients. Logistic regression revealed that "dissection of the celiac trunk and/or the superior mesenteric artery" in preoperative CT images is a predictor of postoperative abdominal interventions for visceral malperfusion (p = 0.03), but preoperative abdominal pain is not similarly predictive. Postoperative stroke is best predicted by preoperative neurologic symptoms (p = 0.01), but not by supra-aortic vessel dissection in preoperative CT images. In patients undergoing surgery for AAAD, analysis of preoperative CT images allows identifying those with a high risk of postoperative abdominal intervention for visceral malperfusion. Postoperative stroke is best predicted by preoperative neurologic symptoms.

Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia

To assess the functional outcomes and quality of life in patients with laparoscopic total colectomy for slow-transit constipation (STC). All patients undergoing laparoscopic colectomy with ileorectal anastomosis for colonic inertia at two referral centers were analyzed. Their preoperative, intraoperative and postoperative details were recorded with a one-year follow-up. Their quality of life was assessed using the SF-36 questionnaire. Between 2004 and 2007, 710 patients were evaluated. Eight female patients (1.1%) fulfilled the criteria for STC without obstructive defecation syndrome. Their mean age was 38years±15 (range from 22 to 62). The conversion rate was 12.5%. The morbidity rate was 37.5%, and mortality was nil. The preoperative abdominal pain was 6.6±0.3 and had decreased to 3.6±2.3 postoperatively (P=0.008). At 1year, the defecation frequency per week had increased from 0.84±0.24 to 6.75±3.4 (P=0.001). Three patients developed nocturnal leakage (37.5%). Eighty-eight percent of the patients recommend the procedure. All parameters of the SF-36 questionnaire had improved at the one-year follow-up examination. Laparoscopic colectomy for slow-transit constipation is safe and increased the number of evacuations per week. Although nocturnal leakage may occur, these patients experience improvements in their quality of life.

Living with Stoma: Long-term Effects on Patients’ Quality of Life

Introduction: Constructing end stoma is a recognized surgical option for management of anatomical anomalies and bowel dysfunctions. Yet, the long-term outcome for that creation is not known. For finding answer for the question on “the long term outcome for living with permanent stoma after five years of creation” we conducted this survey. Objective: Patients have right to know about the possible adverse that may result after surgical operations before giving consent to proceed. However, the long-term outcome after the first five years after construction of end stoma has not been examined. This study is aimed at identifying these possible adverse. Methods and patients: Members of the United Ostomy Association of America have been requested to complete online survey. Results: Seventy-eight respondents took part in this survey. The diagnosis was ulcerative colitis in 33, Crohn’s disease in 11, colonic perforations in 10, bowel tumors in 5, post-radiation severe bowel damage in 3, severe constipation in 4, and no diagnosis was given by further 4 participants. Two participants gave history of congenital malformations (Ehlers Danlos Syndrome and Imperforate anus respectively) Conditions, such as: intestinal obstruction, infected J pouch, diverticulitis, Familial Adenomatous Polyposis (FAP), Ovarian carcinoma and indeterminate colitis were diagnosed in one participant each. Out of the 33 ulcerative colitis patients, 25 identified their pre-operative abdominal pain as it was severe (75.8%) and this pain completely disappeared after surgical resection in 18 (72%). At analyzing the responses to question (3): (How do you feel in general?), it was found that those in the group with a longer elapsed time after diagnosis were more likely to feel better (p=0.042). But those in the older age group (>50years) were more likely to feel worse (p0.024); Patients in the older age group (>50 years) tended to experience more pain after creation (p=0.046); Patients with a longer elapsed time after diagnosis (>5 years) were more likely to say no at answering question (7): (Has your treatment changed the way you see yourself as a man/woman?) (p=0.039) and to say no at answering question (8) (Has your treatment caused any change in your sexual functioning (sex life)?) (p=0.007 ) as well; this group of patients were more likely to enjoy the things they used to before conducting the disease (p=0.025); there were no significant statistical differences were found between those who presented with an established stoma of less than five years old and those with stomas of more than five years old. Conclusion: Participants in the group with a longer elapsed time after diagnosis were more likely to feel better (p=0.042), to have better self-perception (p=0.039), to be more satisfied about their sexual performance (p=0.007), and to enjoy the things they used to before conducting the disease (p=0.025). However, the effect of self-perception on sexual act is significantly high in the two groups.

The influence of age on clinical and patient-reported outcomes after cholecystectomy

To examine the relationship between the age of cholecystectomy patients and surgical complications, length of stay, symptom relief, and postdischarge functional status. Patients' medical records were reviewed and patients were sent a questionnaire three months after hospital discharge. Four university-affiliated teaching hospitals. 372 patients who had a primary operation of total cholecystectomy. In-hospital complications, length of stay, patient satisfaction, symptom relief, and functional status after discharge. Patients over the age of 60 years experienced a higher major postoperative complication rate than did younger patients (p < 0.01), although the overall major complication rate was too low to determine whether factors other than age were important predictors. There was no age-related difference in minor postoperative complication rates. The older patients had a longer mean length of stay, even after statistical adjustment for covariates (p < 0.05). The older patients reported similar levels of patient satisfaction, but reported recurrence of preoperative abdominal pain less often than did the younger patients (OR = 0.4, 95% CI = 0.2, 0.7). There was no statistically significant difference between the older and younger patients in postoperative functioning, except for work performance. The younger patients reported improvement in postoperative work performance, while the older patients reported a decline (p < 0.01). Older cholecystectomy patients may experience more postoperative complications but report less recurrence of preoperative abdominal pain than do younger patients. The decline in work performance in older patients may indicate the need for a longer recuperation period.

A comparison of lamicel tents and gemeprost (Cervagem) pessaries prior to first trimester abortion

In an open, randomized study 108 women were treated with either a Lamicel tent or a 1 mg gemeprost pessary (Cervagem) 4 h before first trimester abortion. Both treatments were effective in producing cervical dilatation, however further dilatation was significantly easier after Cervagem. Preoperative abdominal pain and gastrointestinal side-effects were significantly more frequent in the Cervagem group. The incidence of postoperative pain and blood loss were similar in the two groups. Advantages and disadvantages of the two treatments are mentioned.

Treatment of chronic pancreatitis by longitudinal pancreaticojejunostomy

A series of fifteen patients is presented in whom pancreaticojejunostomy was performed for chronic pancreatitis. Preoperative abdominal pain and pancreatic calcification were the most constant findings. Three modifications of the original Puestow's procedure were employed in this series. The most satisfactory technical procedure at present consists of side to side pancreaticojejunostomy with preservation of the spleen and pancreatic tail. The pancreas at operation was invariably indurated, and ductal obstruction and the chain-of-lakes phenomenon were found in thirteen cases. Microscopic examination of pancreatic tissue revealed severe degrees of atrophy and fibrosis. Good results were achieved in thirteen of the fifteen patients, as evidenced by dramatic relief of pain, often despite continued alcoholic excesses. There were no deaths in this series and no postoperative diabetes occurred. Steatorrhea was corrected by the procedure in two patients and appeared postoperatively in another. In the fibrotic, stone-containing pancreas in which ductal obstruction is the basis for persistent pain, pancreaticojejunostomy offers a physiologic means of treatment. It sacrifices little or no glandular tissue, accomplishes drainage of enzyme to the lumen of the gut, relieves obstruction and usually relieves pain.