Sudden Onset Of Lower Abdominal Pain Research Articles

An adult case of large defect of small mesenteric hiatal hernia causing small bowel obstruction

BackgroundSmall mesenteric hiatal hernias (SMHHs) are defined as a small group of internal hernias (IHs) that frequently diagnosed in children. However, SMHHs are relatively rare in adults. Bowel loop herniation via an abnormal mesenteric defect can lead to strangulated intestinal obstruction. Congenital SMHHs are commonly observed in pediatric patients, with some cases involving neonatal death.Case presentationA 24-year-old healthy male patient visited our hospital with a 2-day history of a sudden onset lower abdominal pain. He was initially diagnosed with enteritis. However, his symptoms worsened, and he was brought to our hospital. Contrast-enhanced computed tomography (CT) scan showed formation of a closed loop in the small intestine within the pelvis and signs of ischemia. As the patient was diagnosed with small bowel obstruction (SBO) caused by IH, emergency laparoscopic surgery was performed to loosen the obstruction. The patient was found to have ascites and small-bowel necrosis. A part of the small intestine that measured 30 cm was strangulated via a large-diameter defect (17 × 11 cm) in the ileal mesentery. Via a small abdominal incision, the necrotic bowel was resected, and the mesenteric defect was repaired.ConclusionSMHHs are rare in adults, and they should be considered as potential causes of strangulated intestinal obstruction in adults without a history of laparotomy or trauma.

Challenges in the diagnosis and management of a ruptured heterotopic gestation following ultrasound-guided embryo transfer in low resource settings: a case report

BackgroundHeterotopic pregnancies are increasing in incidence with the advent of rising prevalence of in vitro fertilization and embryo transfer (IVF-ET) globally. Although rare, this condition is a serious potentially life-threatening gynaecological complication.Case presentationWe present the case of a 36-year-old Ghanaian woman who conceived following IVF and presented two weeks after confirmation of intrauterine gestation with sudden onset lower abdominal pain. A diagnosis of ruptured heterotopic pregnancy was made, laparotomy and salpingectomy was done followed with further management of the intrauterine gestation.ConclusionTo the best of our knowledge, this is the first reported case of heterotopic pregnancy in Ghana. A high index of suspicion for heterotopic pregnancy is required even in the presence of a confirmed intrauterine gestation following IVF-ET.

Sequential Multiple Visceral Artery Dissection within a Short Time, without Aortic Dissection.

A 65-year-old Japanese man without medical history presented with sudden onset lower abdominal pain to our emergency department. Contrast-enhanced computed tomography (CT) revealed dissections of the inferior mesenteric artery and left renal artery with false lumen thrombosis without aortic dissection. He was immediately hospitalized, and conservative treatment was administered. However, on the third-day post-onset, the patient reported severe upper abdominal pain and contrast-enhanced CT showed a new superior mesenteric artery dissection. He continued to receive conservative treatment, and his symptoms improved. He was discharged after ten days of hospitalization.

940 Mesenteric Haematoma Complicated by A Perforated Sigmoid Diverticulum Following Extracorporeal Shockwave Lithotripsy

Abstract A 78 year old female presented with sudden onset lower abdominal pain, vomiting and fresh rectal bleeding. She had undergone extracorporeal shockwave lithotripsy (ECSL) for a left renal stone two weeks earlier and was taking Rivaroxaban for atrial fibrillation. A CT Abdomen & Pelvis revealed a large mesenteric haematoma and a contained sigmoid perforation secondary to compressive forces of the haematoma on the sigmoid artery, resulting in ischaemia. While mesenteric angiogram-guided embolisation initially controlled the active sigmoid artery bleed, the patient clinically deteriorated the following day warranting a laparotomy. This revealed an ischaemic sigmoid colon with contained faeculent material within the mesentery. An extended left hemi-colectomy with end-colostomy was performed. Despite optimal critical care input, the patient developed multi-organ failure and passed away one week later. Mesenteric haematoma should be considered as a rare complication in patients with sudden onset abdominal pain following ECSL; especially with concurrent anti-coagulation use.

Spontaneous ruptured iliac artery aneurysm causing acute secondary AV fistula

A 73-year-old woman presented with a 6-hour history of sudden onset lower abdominal pain. Her comorbidities included chronic obstructive pulmonary disease and hypertension. She was under surveillance for a known...

A Mysterious Cause of a Surgical Abdomen

BackgroundEpiploic appendagitis is a rare cause of acute-onset abdominal pain. The severity of pain at presentation and the infrequency with which it is encountered make it a diagnostic challenge. ObjectivesTo present a case report exemplifying a diagnostic challenge posed by acute-onset abdominal pain that eventually led to the diagnosis of epiploic appendagitis. Case ReportA 50-year-old woman presented to the Emergency Department complaining of excruciating, sudden-onset lower abdominal pain. All routine laboratory investigations were within normal limits, as were an acute abdominal X-ray series. Computed tomography scan of the abdomen and pelvis with contrast showed a focal fatty infiltration in the left lower quadrant with fat-stranding towards the colon, representing the classical radiological presentation of epiploic appendagitis. The patient was admitted and successfully managed conservatively with intravenous fluids and ibuprofen. The patient made a full recovery and was discharged 3 days after admission. ConclusionsDue to its benign, self-limited course, it is important to recognize this disease process to avoid unnecessary surgical and medical interventions. Epiploic appendagitis should be suspected in patients presenting with acute onset abdominal pain localized to the left lower quadrant or right lower quadrant with no associated systemic manifestations. Improvements in imaging technology have enabled confirmation of the diagnosis with non-invasive methods.

An unusual case of abdominal pain

Free AccessCase of the monthAn unusual case of abdominal painG Ananthakrishnan and J FlinnG AnanthakrishnanSearch for more papers by this author and J FlinnSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/22587841SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutA 50-year-old Caucasian woman presented with sudden-onset lower abdominal pain with associated nausea and vomiting. There was a history of hysterectomy and treated breast cancer. Of note, the patient was a vegetarian and a keen traveller.Plain radiography of the abdomen, blood tests and an ultrasound examination were unremarkable.As the patient was still symptomatic, a contrast-enhanced CT of the abdomen was performed after administration of oral contrast (Figure 1). This showed a long tubular intraluminal lesion in the distal small bowel, which was outlined by oral contrast. Segments of this lesion were noted to be air-filled. No other significant abnormality was identified.Figure 1 Coronal oblique CT image shows a partly gas filled intraluminal filling defect in the terminal small bowel, outlined by oral contrast. Download Figure What is the abnormality and what is the diagnosis? What are complications associated with this condition?DiagnosisTubular intraluminal lesion consistent with Ascaris lumbricoides infestation of the small bowel was diagnosed.Small bowel obstruction is one of the commonest complications. Others include cholecystitis, cholangitis, pancreatitis, appendicitis and respiratory symptoms.DiscussionIt is estimated that 25% of the world's population is infected with Ascaris lumbricoides (intestinal roundworm), mostly people in developing countries [1, 2]. The clinical and radiological manifestations of Ascariasis are variable as the organism travels through many organ systems during its life cycle.Respiratory symptoms are usually the first and occur after the larvae penetrate the intestinal mucosa, traverse the portal and hepatic veins, and finally settle in the pulmonary alveoli [1]. Following this, the larvae migrate to the larynx and are swallowed. Larval maturation occurs in the small bowel and patients can present with abdominal symptoms.Although many patients are symptom free during the intestinal phase of the disease, others can present with a variety of symptoms including nausea, vague abdominal discomfort, colicky pain, diarrhoea or obstruction. Migration of the worms into ducts may result in cholangitis, cholecystitis or pancreatitis [1, 3]. Blockage of the lumen of the appendix may lead to appendicitis.CT diagnosis of Ascariasis was first described in 1994 [4], with few subsequent case reports. Reported findings describe a long tubular filling defect with a thin line of contrast occasionally seen in the gut of the worm [4, 5]. If the worm is visualised perpendicular to the imaging plane, a “bull's eye” appearance is seen [6]. Reports have also previously indicated that some of these worms can appear partly air-filled [7] (Figure 2). Diagnostic laparoscopy in our patient was normal.Figure 2 Axial CT of lower abdomen at the same level showing multiple rounded intraluminal filling defects, one of which is air-filled. Download Figure Radiologists must be cautious about dismissing the finding as an artefact or a feeding tube without proper consideration. Although it is not common in developed countries, it should be suspected in patients with a history of travelling.References1 Reeder M , Palmer P . Infections and infestations. In: Freeny PCStevenson GW, editors. Margulis and Burhenne's alimentary tract radiology. St. Louis: Mosby, 1994: 926–30. Google Scholar2 Walsh JA , Warren KS . Selective primary care: An interim strategy for disease control in developing countries. N Eng J Med 1979;301:967. Crossref Medline ISI, Google Scholar3 Price J , Leung JW . Ultrasound diagnosis of ascariasis lumbricoides in the pancreatic duct: the “four-lines” sign. Br J Radiol 1988;61:411–13. Link ISI, Google Scholar4 Hommeyer SC , Hamill GS , Johnson JA . CT diagnosis of intestinal ascariasis. Abdom Imaging 1995;20:315–16. Crossref Medline, Google Scholar5 Beitia AO , Haller JO , Kantor A . CT findings in pediatric gastrointestinal ascariasis. Comput Med Imaging Graph 1997;21:47–9. Crossref Medline ISI, Google Scholar6 Lal A , Sood BP , Saxena A , Suri S . Intestinal ascariasis: a new CT sign. Indian J Gastroenterol 2002;21:88. Medline, Google Scholar7 Rodriguez EJ , Gama MA , Ornstein SM , Anderson WD . Ascariasis causing small bowel volvulus. Radiographics 2003;23:1291–3. Crossref Medline ISI, Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byEpidemiology and management of foodborne nematodiasis in the European Union, systematic review 2000–201629 June 2018 | Pathogens and Global Health, Vol. 112, No. 5 Volume 83, Issue 991July 2010Pages: 543-e164 2010 The British Institute of Radiology History ReceivedDecember 07,2009AcceptedJanuary 26,2010Published onlineJanuary 28,2014 Metrics Download PDF

Massive hemoperitoneum due to rupture of an artery overlying a uterine leiomyoma: a case report

Hemoperitoneum is usually caused by ectopic pregnancy, ruptured corpus luteum, or adnexal torsion (1). Acute bleeding from a blood vessel overlying a uterine myoma occurs rarely and may be life threatening unless promptly treated by surgery. In most cases the bleeding is the result of trauma or torsion; spontaneous rupture of a superficial uterine blood vessel is extremely rare (2) and the involved vessel was reported to be a vein (1, 2). We describe the spontaneous rupture of a superficial uterine artery overlying a subserous myoma. To the best of our knowledge, this is the first such report in the literature. A 48-year-old woman, gravida 3, para 3, presented herself to our emergency department with complaints of sudden-onset lower abdominal pain of several hours' duration. She was in her fifth day of her menstruation. There were no accompanying genitourinary, gastrointestinal, or inflammatory symptoms, and the woman denied any precedent abdominal trauma. Her past medical history was uneventful. Examination revealed an afebrile woman in moderate distress. Blood pressure was 90/45 mmHg and pulse was 138 beats/min. Urine beta-human chorionic gonadotropin was negative. Hemoglobin measured 13·7 g/dl. No signs of acute abdomen were present. Pelvic examination revealed mild vaginal bleeding and a tender 16-gestational-week-sized uterus. Sonography demonstrated a large (14 cm) uterus and an excessive amount of fluid in the pelvic cavity. As the woman soon became hemodynamically unstable (decrease in hemoglobin to 10·3 g/dl and in blood pressure to 60/29 mmHg), immediate laparotomy was performed under general anesthesia. During surgery, 2000 cm3 of blood were drained from the abdominal cavity. A pulsatile bleeding superficial artery, approximately 0·5 in diameter, was noted, located on the serosal surface of a fundal myoma on a 16-gestational-week-sized uterus (Fig. 1). The bleeding artery was ligated. A thorough search of the pelvic and abdominal cavities revealed no other source of bleeding or pathology. Subtotal transabdominal hysterectomy and bilateral salpingo-ophorectomy (subtotal TAH + BSO) were performed. The postoperative course was uneventful, and the woman was discharged on the fifth postoperative day in good condition. The pathologic diagnosis confirmed that the ruptured vessel was an artery and that there were no abnormalities of the artery or the uterus and adnexae other than the uterine myoma. Specimen of uterus and adnexae. The ligated ruptured artery overlying a myoma is seen in the center of the uterus. There are two theories for the cause of spontaneous rupture of a uterine vessel, and both refer to veins. The first claims that spontaneous rupture of blood vessels occurs only in the presence of myomas larger than 10 cm in diameter, and the tear in the overlying vessel is caused by the underlying pressure exerted by the growing myoma (1). The second theory relates the tear in the blood vessel to uterine contractions during menstruation that may distend the blood vessel to the breaking point (1). This theory is supported by the feeling that the majority of women with ruptured uterine vessels (including our patient) were menstruating when the rupture occurred. The reason for spontaneous tear of a superficial uterine artery overlying a myoma remains unclear, but the data of our case match both theories. Hemoperitoneum, caused by active bleeding, is an emergency situation and calls for immediate diagnosis and treatment to lower morbidity and mortality (3). The two state-of-the-art modalities for accurate diagnosis of intra-abdominal bleeding are contrast-enhanced two- and three-dimensional sonography (3) and three-dimensional contrast-enhanced magnetic resonance imaging (4). Treatment consists of laparotomy or laparoscopy. Laparoscopic surgery is considered to be as safe and effective as laparotomy, but it is usually contraindicated in the presence of active bleeding and hemodynamic instability (5). Nevertheless, there are reports of successful laparoscopy for intra-abdominal bleeding in women with ectopic pregnancy who were in hypovolemic shock (5). In our case, we used sonography for diagnosis and laparotomy for treatment. Considering the age and parity of our patient and her hemodynamic instability, we opted for subtotal TAH + BSO in order to shorten the operating time. However, conservative myomectomy might be attempted in such cases if future fertility is desired (1). The authors thank Gloria Ginzach for her editorial assistance.

Liver cirrhosis with synchronous gas gangrene and spontaneous bacterial peritonitis due toE. coli

We report a case of synchronous gas gangrene and spontaneous bacterial peritonitis associated with liver cirrhosis. The patient was a 52-year-old man who was being followed for decompensated liver cirrhosis. He experienced sudden onset lower abdominal pain with distension and pain in the left leg. A bullous lesion, with crepitation, later appeared in the thigh and showed air-bubbles on X-ray. Eschericia coli was cultured from ascites and the bullous lesions; there was associated gas gangrene. The patient died of bacteremia with disseminated intravascular coagulopathy 26 h after admission, despite receiving intensive care. We discuss the route of bacteria causing the spontaneous bacterial peritonitis and simultaneous gas gangrene.