Severe Left Lower Abdominal Pain Research Articles

Case report on severe splenic injury following colonoscopy with disproportionately stable presentation: A rural hospital perspective

Detection of splenic injury following routine colonoscopy is slowly on the rise. Mostly presenting as left upper abdominal or shoulder tip pain along with a sharp fall in haemoglobin level and hemodynamic instability, sometimes the presentation and initial workup may be vague and falsely reassuring. This is demonstrated in the case of a 72year old male who presented with vague but severe left lower abdominal pain following colonoscopy, during which one caecal polyp was removed and no intraoperative complications were reported. On emergency presentation, abdominal examination was not particularly concerning with only mild left lower tenderness and minimal guarding. Vital signs remained largely normal and blood counts were reasonable. Close to being discharged, patient demonstrated brief hypotension post ambulation which was easily reversed with a fluid bolus. Upon surgical review, a high index of suspicion prompted further investigation which revealed an unsuspected complication necessitating urgent laparotomy and splenectomy. Splenic injury is slowly becoming an increasingly reported complication following colonoscopy. While many cases present with typical features, others may only display subtle signs of deterioration, and warrant a high degree of suspicion. Rural doctors should be aware of and able to recognise this potentially fatal complication to ensure timely successful management.

Spontaneous Abdominal Wall Hematoma

A 56-year-old woman presented to our emergency department because of sudden onset of severe left lower abdominal pain. She suffered a severe cough for 2 weeks and denied using anticoagulation agents. Physical examination showed some purple-bluish lesions in her left abdominal wall (Figure A). A big tender mass was palpated in her left lower abdomen. Her hemoglobin level was 10.1 g/dL. Abdominal ultrasound showed a 7-cm hyperechoic mass in the left abdominal wall (Figure B). Abdominal computed tomography showed a large hematoma with contrast extravasation in the left lateral abdominal wall (Figure C, arrow). Emergency transarterial embolization was performed and her abdominal wall bleeding was halted. She underwent a debridement for hematoma and was discharged uneventfully. Spontaneous abdominal wall hematoma is an unusual entity and its most common presentations are acute abdominal pain, vomiting, and fever. Physical examination showed cutaneous ecchymosis and an abdominal palpable mass. Predisposing factors of this disease include severe cough, vomiting, or use of anticoagulants. Abdominal ultrasound and computed tomography are useful modalities to evaluate active bleeding from ruptured arteries. Conservative treatment is acceptable for patients with stable hemodynamics, but surgery is restricted for patients with complications (rupture, infection, or hematoma progression). Angiography with embolization can control bleeding and avoid surgical intervention.

Spontaneous rectus sheath haematoma due to cough on apixaban

A 69-year-old woman on apixaban for 4 years due to her atrial fibrillation presented with severe left lower abdominal pain. She was discharged from the hospital 4 days prior after...

Dynamic FDG PET/CT Imaging With Diuresis Demonstrates an Enterovesical Fistula in a Lymphoma Patient With Repeated Colon Diverticulitis

A 43-year-old male patient with follicular B-cell lymphoma was referred for a FDG PET/CT scan due to severe left lower abdominal pain to rule out recurrent cancer. These FDG PET/CT images and previous FDG PET/CT images 5 months ago both revealed an air bubble in the urinary bladder on the CT images. He had a recurrent urinary tract infection history for 6 months. A list-mode dynamic data acquisition with diuresis intravenous injection revealed linear FDG activity extending from the upper-left portion of the bladder to a soft tissue mass in the lower-left pelvic region. An enterovesical fistula was confirmed by surgery.