Presentation Of Acute Abdomen Research Articles

Closed-loop obstruction due to internal hernia: An atypical clinical presentation of acute abdomen - A case report

Abstract Internal hernia is the protrusion of a viscus through a normal or abnormal peritoneal or mesenteric aperture within the confines of the peritoneal cavity. They can be congenital or acquired after abdominal surgery. We report a case of a 58-year-old woman who presented with complaints of abdominal pain and nonbilious vomiting for 2 days. She underwent an abdominal hysterectomy 15 years ago. After baseline blood investigations and imaging, a diagnosis of subacute intestinal obstruction was made. As she clinically worsened over 24 h, CT imaging was done, which suggested acute small bowel obstruction secondary to adhesions. Surgery revealed herniation with incarceration of distal ileal loops through a defect in the sigmoid mesocolon. Bowel resection was done, and the defect was closed. The clinical presentation of internal hernias, especially transmesosigmoid hernia, is nonspecific, and they rapidly progress to bowel ischemia. Early intervention and surgical correction are prudent for good clinical outcomes.

Primary Disseminated Peritoneal Hydatidosis: A Rare Presentation of Common Infectious Disease

Introduction: Human hydatidosis, being caused by the larvae of Echinococcus granulosus, rarely presents as disseminated peritoneal disease which can be either primary or secondary. Iatrogenic secondary peritoneal echinococcosis is more common while primary form of infection is found occasionally. Radiological imaging including ultrasonography or computed tomography (CT) scan is considered the most essential diagnostic modality. The mainstay of treatment for localized hydatid cysts or infected cysts and multiple septations is the surgical management in the form of excision. Disseminated hydatid disease presents with varied manifestations involving multiple organs. However, primary peritoneal hydatidosis is being rare entity, accounting for only 2% of cases of abdominal hydatidosis. The dissemination to multiple organs usually occurs through either lymphatic or systemic circulation. Case Report: In this case report, we present an uncommon presentation of primary disseminated peritoneal hydatidosis. On further evaluation, the patient was diagnosed to have peritoneal hydatidosis with hepatic and lung hydatid cyst involvement on contrast-enhanced CT abdomen. The patient was managed conservatively with oral tablet albendazole 400 mg twice a day during his 1st admission and later presented again with acute abdomen, and then, radical surgery in the form of pericystectomy was carried out but patient developed large gastric perforation, for which again surgery was attempted, but patient succumbed to his illness. In this case, the rare presentation of primary disseminated peritoneal hydatidosis as acute abdomen was observed. Conclusion: Primary disseminated peritoneal hydatidosis as the presentation of acute pain abdomen is rare entity. This case emphasizes an atypical presentation of hydatidosis.

Enteric duplication cyst as a rare presentation of adult acute abdomen

Enteric duplication cyst as a rare presentation of adult acute abdomen

Quiste de duplicación entérica como presentación poco frecuente de abdomen agudo en adulto

Quiste de duplicación entérica como presentación poco frecuente de abdomen agudo en adulto

Small bowel volvulus with large mesenteric defect in paediatric patient: An unusual presentation of acute abdomen

Small bowel volvulus with large mesenteric defect in paediatric patient: An unusual presentation of acute abdomen

Acute Abdomen in Pregnancy

Ovarian torsion is not uncommon in pregnancy and presents as one of the causes of acute abdomen in pregnancy. It is more common in the 1st and the early 2nd trimesters but uncommon in the late 2nd and 3rd trimesters. An hemorrhagic cyst has been described as a predisposing factor, and even an imitator of ovarian torsion with ultrasonography been the imaging modality of first choice in its evaluation. The index case is an unusual presentation at the late 2nd trimester gestation, for which ultrasonography revealed a hemorrhagic cyst with normal Doppler findings. However, intraoperative findings were that of an adnexal torsion with infarction warranting salpingo-oophorectomy. Therefore, ultrasonographic findings of hemorrhagic ovarian cyst and relatively normal adnexal Doppler in a pregnant patient with clinical presentation of acute abdomen could highly be suggestive of ovarian torsion, necessitating urgent surgical evaluation and intervention to prevent adnexal infarction.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1st Jan 2017 to 31st Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.

Rare Presentation of Acute Abdomen in a Posttransplant Patient

Infective complications continue to be a big hurdle to patient and graft survival after transplantation. Fungal infections can occur anytime posttransplant. They often present with nonspecific symptoms leading to a delay in diagnosis and treatment. Pain abdomen in a posttransplant patient should always be evaluated in detail to rule out invasive fungal infections. Here, we present a case of gastric mucormycosis presenting as acute abdomen in a diabetic patient who was a 1-month posttransplant.

NEUTROPHIL-LYMPHOCYTE RATIO'S ROLE IN FORETELLING MILD ACUTE PANCREATITIS: TERTIARY CARE CENTRE STUDY.

Introduction: Acute pancreatitis is a common presentation of acute abdomen in emergency room. Identifying the patients who might develop severe disease is a challenging task. Neutrophil-Lymphocyte ratio (NLR) is being used in various conditions to predict severity and same has been extended to pancreatitis. Materials And Methods:We did as retrospective analysis of patients admitted with mild pancreatitis during the period of March 2021 to July 2022 by comparing the NLR, BISAPscore in mild acute pancreatitis. Results:There were 26 patients admitted with mild acute pancreatitis during this period, 20 males and 6 females. They belong to mean age group of 39.07years (SD 12.54). Gallstone and alcohol were most common cause of pancreatitis. The mean NLR was 5.78 (SD 3.15). 20 patients had BISAPscore of 0. Conclusion: NLR is an economical, one time investigation that can be done at the time of admission which can predict severity of pancreatitis. However, optimal cut-off values are yet to be dened.

Recurrence Rate of Abdominal Tuberculosis in Cases Presenting With Acute Abdomen

Background: Acute abdomen is considered as one of the major causes leading to surgical emergencies and intestinal obstruction, perforation and many other underlying causes resulting in surgical consultation. Aim: To determine rate of recurrence of abd. TB in cases presenting with acute abdomen to Sh. Zayed Hospital, Rahim Yar Khan. Study Design: The Cross sectional study Sampling Technique: Consecutive sampling non probability Sampling Technique Methods: This particular study was conducted at teaching hospital Rahim Yar Khan from 10-04-2021 to 31-12-2022 in which the cases of both genders with age ranging from 15 to 60 years having acute abdomen presenting within 24 hours were included. Abdominal tuberculosis (TB) was labeled on histopathology when there was caseating granuloma. Results: There were around 90 cases included in this present study. Out of these 50 (55.55%) were male patients and the rest of 40 (44.44%) were female patients. Approximately 34.91±11.35 was the Mean age in years of the patients and 67.13±21.39 in Kilograms was the mean weight. There were about 22 (24.44%) cases which had previous history of abdominal surgery. The abdominal tuberculosis was diagnosed in 30 (33.33%) of the cases as shown in figure 12. Abdominal TB was observed in 16 (32%) males and 14 (35%) females in their respective groups with p= 0.81. TB was detected in 20 (35.71%) out of 56 cases in age group 15 to 39 years as compared to 6 (25%) out of 24 cases with age 40-60 years with p= 0.44. There was no significant difference in terms of abdominal TB and weight (p= 1.0) and also with cases that had previous surgery with p= 0.57. Conclusion: The abdominal tuberculosis (TB) is detected in one third of all the cases presenting with acute abdomen and there is no significant association of this with any of the confounding variable of the study. Key words: Acute abdomen, abdominal TB, Granuloma, Biopsy

A prospective cohort study to assess the clinical profile of acute appendicitis and evaluate the combined use of modified Alvarado score and ultrasonography in a tertiary care center in India

Background: Acute appendicitis is one of the most common causes of acute abdomen presentation to the hospital. If not treated in time, it may lead to perforation. Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. The score is based on laboratory findings, clinical symptoms, and signs. We stipulate that ultrasonography and modified Alvarado score (MAS) can be synchronously and concomitantly be used to reach a trustable diagnosis of acute appendicitis. Aims and Objectives: The aims of this study were to assess the clinical profile of acute appendicitis and evaluate the combined use of MAS and ultrasonography (USG) in a tertiary care center in India. Materials and Methods: This is a prospective observational study, in which a cohort of patients presenting with acute abdomen due to acute appendicitis to the department of general surgery (Out Patient Department and Emergency) of L.L.R. Hospital attached to G.S.V.M. Medical College, Kanpur and meeting specific inclusion criteria were sampled between October 2021 and January 2022. Results: Our study re-enforces and supports demographic findings of prevalence as well as clinical findings reported in the previous studies on acute appendicitis. Conclusion: CECT of the abdomen can prove to be financially straining for people seeking treatment at public health care centers in developing or underdeveloped countries. Our study suggests that USG can be concomitantly and synchronously be used with MAS to reach a trustable diagnosis without the need for a CECT of the abdomen.

Ovarian small cell carcinoma by ovarian torsion feature: A cytopathology challenging case.

Introduction and importanceOvarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and pulmonary type (SCCOPT).Case presentationA 23 years old girl was admitted to the emergency room with the presentation of acute abdomen. The ultrasound and Magnetic resonance imaging revealed a right adnexal huge mass with adnexal torsion. In laparotomy, she underwent unilateral salpingo-oophorectomy due to ovarian torsion and possible malignancy. The histopathological evaluation was challenging and was finalized by a team of pathologists as hypercalcemic small cell carcinoma. She refused reoperation and unfortunately relapsed during chemotherapy and died 6 months after the initial diagnosis.Clinical discussionConclusion: We do not yet have comprehensive information on small cell ovarian cancer. Cytopathology diagnosis is still challenging and the treatments are not usually effective. Further clinical trials and studies are recommended to find appropriate treatments for these patients.

Comparison of Postoperative Complications Early Vs Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Background: Acute cholecystitis, which is typically associated with gallstones, is one of the most common causes of acute abdomen presenting in emergency departments around the world. The aim of this study was to compare the incidence of biliary leak and hospital stay between early and delayed laparoscopic cholecystectomy for acute cholecystitis.Objectives: To compare the incidence of biliary leak and hospital stay between early and delayed laparoscopic cholecystectomy for acute cholecystitis.Material and Methods: Patients with radiologically confirmed acute calculus cholecystitis and ASA grade I/II were selected from the surgical OPD and prospectively randomized into two equivalent classes between August 1, 2015 and July 31, 2017. Early laparoscopic cholecystectomy was performed on patients in group A, while delayed laparoscopic cholecystectomy was performed on patients in group B. The data was collected from the patients using a non-probability sampling technique.Results: The research included 200 patients with radiologically proven acute calculus cholecystitis and an ASA grade I/II. Overall, patients who had an early laparoscopic cholecystectomy had a shorter hospital stay and less billary leak than those who had a delayed laparoscopic cholecystectomy (P=0.01) (0.00 and 0.11). In comparison to Group-II, the number of post-operative complications was lower in Group-I.Conclusion: When compared to delayed laparoscopic cholecystectomy, early laparoscopic cholecystectomy allows for substantially shorter biliary leak frequency and overall hospital stay.Key Words: Acute cholecystitis, Cholecystectomy, Laparoscopic.

Unusual presentation of coronavirus disease2019(COVID-19): two cases of acute abdomen

December 2019 SARS-CoV-2 is responsible for the novel coronavirus-infected pneumonia associated with acute respiratory distress syndrome, organ dysfunction and death. Since its discovery, a myriad of clinical presentations have surfaced and the past year has been a learning experience for all. We present two cases of acute abdomen presenting as a “surgical abdomen”; one had a negative laparotomy and negative PCR test, and the other who did not have surgery eventually tested positive on PCR testing. Both were incidentally diagnosed with COVID-19 pneumonia on a chest computed tomography scan and managed accordingly. It is unclear whether reported gastrointestinal manifestations are a direct causal effect of the virus in the gastrointestinal tract. Surgeons should be aware that COVID-19 can present as a “surgical abdomen” which may lead to negative laparotomies.

Jejunal Perforation Secondary to Migration of a Biliary Stent in a Liver Transplantation Patient: A Case Report

Endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently performed procedure for treating biliary strictures. Although small bowel perforation secondary to the biliary stent migration is rare, it can be life-threatening. Treatment strategies for such perforation continue to be debated. We report a case of 54-year male patient who was admitted to our hospital complaining of severe abdominal pain and fever. The patient has a history of a biliary stenting for anastomotic stricture following an orthotopic liver transplantation at another facility. Abdominal computerized tomography (CT) revealed migration of the biliary stent and perforation of the jejunum. Due to acute abdomen presentation, ERCP retrieval was not attempted, and exploratory laparotomy was carried out showing the stent perforating two adjacent jejunal loops resulting in adherence of two loops together. The patient had an uneventful recovery with no need for further endoscopic intervention for biliary re-stenting

Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

A Prospective Study on Clinico-Radiological Correlation and Conservative Management of Non-Traumatic Acute Abdomen at a Tertiary Care Centre

Background: Acute abdomen is a condition in which the patient complains of a sudden or gradual attack of abdominal pain over a duration of several hours and presents with a set of symptoms which indicatea life threateningillness that needs an urgent or quick diagnosis for early treatment. Delay in diagnosis will worsen the condition of the patient and can even have a fatal outcome. It is crucial to recognize situations where laparotomy can be avoided in order to bring down morbidity and financial costs. Hence this study is being conducted to evaluate various clinical presentations, accuracy of clinical diagnosis, causes, better imaging studies and effectiveness of conservative management of non-traumatic acute abdomen.
 Objectives: 
 
 To study various clinical presentation of non-traumatic acute abdomen.
 To study the accuracy of clinical diagnosis of non-traumatic acute abdomen
 To study different causes of acute abdomen.
 Compare different imaging studies in cases of acute abdomen and to evaluate their accuracy in diagnosing the condition.
 To study the effectiveness of conservative management (OchsnerScherren regimen) in cases of acute abdomen.
 
 Methods: The study will be doneat Dept. of General Surgery, J.N.M.C and AVBRH, Wardha. The duration of the study will be 2 years from September 2020 to August 2022. In this study, 80-100 Patients of acute abdomen attending the routine OPD and Emergency room at AVBR Hospital will be studied. Thorough clinical examination will be done and Patients with Abdominal pain will be categorized according to inclusion and exclusion criteria. Clinical findings with Radiological findings will be correlated and the sensitivity of imaging studies in diagnosing acute abdomen will be evaluated. The outcome of conservative management of non-traumatic acute abdomen will be observed.
 Results: We expectto study various clinical presentations of acute abdomen, causes, evaluate the accuracy of imaging studies and to study the effectiveness of conservative management all of which in turn would lead to early and better management of acute abdomen.
 Conclusion: Better understanding about presentation, causes, the accuracy of radiological studies and effectiveness of conservative management would help in identification of cases in which laparotomy can be avoided to prevent unnecessary surgery with its associated morbidity and financial burden.

Clinical study of adhesion obstruction at a tertiary care hospital: a prospective observational study

Background: Adhesion obstruction is one of the most common presentations of acute abdomen and an important cause of general surgical consultation. This study aimed to analyse demographic features, clinical features, predisposing factors, and management of this surgical problem.Methods: The present study was a prospective observational study and was conducted in the Department of General Surgery of SMHS hospital entitling 267 patients who were diagnosed and treated over 5 years from May 2014 to April 2019.Results: The most common age group diagnosed with acute intestinal obstruction was between 31 to 40 years, with the incidence more in males (65.5%) as compared to females (34.4%). The most common clinical feature was abdominal pain (98.1%) followed by vomiting (93.6%), constipation (86.1%) abdominal distension (82.3%). Postoperative adhesions (40.07%) followed by obstructed hernias (23.3%) and malignancies (14.6%) were the most common predisposing factors. Ischemia was the most common complication in 11.2% of patients followed by necrosis at 6.7% and perforation at 2.9%. Adhesiolysis was the most common surgical procedure performed 43.8% followed by anatomical repair 21.7% and resection and end to end anastomosis 15.3%, enterotomy 10.86%, and Hartman’s procedure 8.2%.Conclusions: Adhesive intestinal obstruction is an important surgical emergency. Post-operative adhesions remain the most common cause of acute intestinal obstruction, with patients most commonly presenting with pain abdomen, all necessary steps must be taken to lessen the chances of adhesions after any surgical procedure.

Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges.

The present study investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of acute surgical abdomen. A retrospective study of emergency hospitalizations with a diagnosis of acute surgical abdomen between April and July 2020 vs. a similar period in 2019 was performed. The observation sheets and the operating protocols were analyzed. Between April and July 2020, 50 cases of acute surgical abdomen were hospitalized and treated, compared to 43 cases in the same period last year. The main types of pathology in both groups included: Occlusions (60%, respectively 44.2% in 2019) and peritonitis (32%, respectively 41.8% in 2019). There was an increased rate of patients with colorectal cancers neglected therapeutically or uninvestigated, who presented during the pandemic period with emergencies for complications such as occlusion or tumor perforation (32 vs. 6.97%, P=0.0039). One case, with gastric perforation, was COVID-positive, with no pulmonary symptoms at admission. The number of postoperative infectious complications was lower during the pandemic (2 vs. 13.95%, P=0.0461). As the COVID-19 pandemic appears to be still far from ending, we should learn to adapt our surgical protocols to the new evidence. Oncological patients are a vulnerable group, who were neglected in the first months of the pandemic. SARS-Cov-2 infection may be a cause of abdominal pain and should be taken into account in different diagnoses of acute abdomen in surgical wards. Correct wearing of adequate personal protective equipment (PPE) and respecting strict rules of asepsis and antisepsis are required for preventing in-hospital transmission of infection.

Sacral chordoma incidentally discovered in a patient with acute gastrointestinal perforation during his first visit to the hospital

Introduction: Chordoma is a rare recurrent locally malignant bone tumor. Case Report: A 41-year-old male patient presented to Emergency Medicine Department (EMD) with features of an acute abdomen. His chest X-ray showed air under the diaphragm, and the computed tomography (CT) abdomen revealed a soft tissue mass suggestive of a sacral chordoma. A few months before his EMD visit, he has received multiple courses of nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain. The patient was operated upon as an emergency for the gastrointestinal perforation. He was operated upon electively for the mass later on. Histopathological exam after total resection at other center confirmed the diagnosis of chordoma. Conclusion: After stabilization of patient and pain control, further history taking will be valuable to know the primary cause for the acute abdomen presentation.