Treatment Of Acute Abdomen Research Articles

The acute abdomen in children

Because 8-10% of children in the emergency room present with acute abdominal pain, asystematic work-up is essential to rule out acute abdomen. This article highlights the etiology, symptoms, diagnostic workup, and treatment of acute abdomen in children. Review of the current literature. Abdominal inflammation, ischemia, bowel and ureteral obstruction, or abdominal bleeding are causes of acute abdomen. Extra-abdominal diseases such as otitis media in toddlers or testicular torsion in adolescent boys can also lead to symptoms of acute abdomen. Abdominal pain, (bilious) vomiting, abdominal guarding, constipation, blood-tinged stools, abdominal bruise marks, and poor condition of the patient with symptoms such as tachycardia, tachypnea, and hypotonia up to shock are leading symptoms of acute abdomen. In some cases, emergent abdominal surgery is needed to treat the cause of the acute abdomen. However, in patients with pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV‑2 infection (PIMS-TS), anew disease causing an acute abdomen, surgical treatment is rarely needed. Acute abdomen can lead to nonreversible loss of an abdominal organ, such as bowel or ovary, or develop into acute deterioration of the patient's condition up to the state of shock. Therefore, acomplete history and thorough physical examination are needed to timely diagnose acute abdomen and initiate specific therapy.

Role of Minimally Invasive Surgery (Laparsocopic Surgery) in the Management of Acute Abdomen

Objective: The study's goal is to evaluate the diagnostic and therapeutic efficacy of non-invasive surgery (laparoscopy) in the treatment of acute abdomen. Methods: This is an observational study, conducted in Peshawar Medical College Group of Hospitals, Peshawar from January, 2020 to July, 2021. Total 60 patients presented with acute abdomen were included in the study. Patients underwent Laparoscopic surgery after initial work-up. The outcome of Laparoscopy was assessed in terms of diagnostic accuracy, conversion rate, inadvertent injury, hospital stay, wound infection and pain score. Result: Total 60 patients with acute abdomen underwent Laparoscopy during study period. Male to female ratio 1: 1.2 (27:33) while mean age was 36.18 years (12-75). In 93% (56/60) cases per-operative diagnosis was compatible with pre-operative diagnosis. The conversion rate from laparoscopic to open surgery was 1.6%. The average length of hospital stay was 1.45 days (1-4 days). On a visual analogue scale, the mean pre-operative pain level was 6.28. (3-9). On the first post-operative day, the mean post-operative pain score on a visual analogue scale was 1.68. (1-4). Infection at the port site occurred in 3.3% (2/60). Conclusion: Laparoscopy is a safe and effective method of diagnosing and treating acute abdomen so it can be safely adopted in patients presenting with acute abdomen as Laparoscopy eliminates diagnostic delays and unneeded laparotomy and its complications. Keywords: Acute Abdomen, Laparoscopy, Minimally Invasive Surgery, Laparotomy

Role of CT Images in the Diagnosis of Common Acute Abdominal Diseases in General Surgery.

Acute abdomen is a clinical emergency disease with acute abdominal pain as the main prominent feature. Through severe disease changes in intra-abdominal, extrapelvic, and retroperitoneal tissues and organs, symptoms and clinical signs led by abdominal pain are formed. This article mainly explores the role of CT imaging diagnosis in common acute abdominal diseases in general surgery. In this paper, the use of computer-aided CT scan imaging technology in pulmonary nodules was firstly investigated, and the image segmentation algorithms based on CT images were given, including the spatial domain fuzzy C-mean clustering separation algorithm and the spatial domain fuzzy clustering level set semiautomatic separation algorithm, then the treatment of acute abdomen under the concept of ERAS was explored, and the treatment of ERAS under CT images of the acute abdomen was analyzed and studied. The empirical research results show that the ERAS's concept is guided by the undergoing national nutritional support with the traditional perioperative management. Compared to 12.9% of complications in traditional CPM groups, the recall rate of complications after ERAS group was only 6.01%, the improvement was obvious and the results were statistically significant (P < 0.05). Postoperative hospitalization time was also 4.62 days from 7.93 days, thus controlling the clinical risks of perioperative periods, providing a benefit to patient life.

Clinical Value of Abdominal Ultrasonography in the Diagnosis of Acute Abdomen in Children.

In order to study the practical application value of abdominal ultrasonography in the diagnosis and treatment of acute abdomen in children, this study uses the method of collecting clinical actual cases and scientific analysis to estimate the clinical diagnostic value of high-frequency ultrasound and low-frequency ultrasound. In order to further clarify its curative effect and treatment advantages, a retrospective analysis of medical records was conducted, and 95 children with acute abdominal pain and suspected appendicitis who were admitted to a hospital from September 2021 to November 2021 were reviewed. ATIL HD15000 color Doppler ultrasound was used for diagnosis. The results are as follows: the sensitivity, specificity, positive predictive value, and negative predictive value of low-frequency probe in the diagnosis of intussusception in children were 83.61%, 73.33%, 92.73%, and 52.38%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 80.00%, 81.97%, 52.17%, and 94.34%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of high-frequency probe in the diagnosis of intussusception in children were 93.44%, 80.00%, 95.00%, and 75.00%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 93.33%, 95.08%, 82.35%, and 98.31%, respectively. Among the children with appendicitis confirmed by operation and pathology, 69 cases were detected by high-frequency ultrasound and 4 cases were missed (including 3 cases of acute simple appendicitis and 1 case of perforated appendicitis). The false negative was 4%, there was no false positive, and the sensitivity, specificity and accuracy were 95%, 100%, and 96%. In the same cases, 28 cases were detected by low-frequency ultrasound, 45 cases were missed, the false negative was 61%, and there was no false positive. The sensitivity, specificity, and accuracy were 39%, 100%, and 53%. The sensitivity, accuracy, and false negative of high-frequency ultrasound in the diagnosis of acute appendicitis were significantly higher than that of low-frequency ultrasound. This study shows that ultrasound has high accuracy, sensitivity, and specificity in the diagnosis of acute appendicitis. Low-frequency ultrasound can show the whole picture of the disease and the situation in the abdominal cavity, which can better guide the clinical treatment. Color Doppler hemodynamics is a useful supplement to two-dimensional ultrasound, and ultrasound also plays a positive role in the differential diagnosis of acute appendicitis in children.

Clinical Analysis of Laparoscopic Treatment of Acute Abdomen in General Surgery

Clinical Analysis of Laparoscopic Treatment of Acute Abdomen in General Surgery

Patient Satisfaction in Treatment of Acute Abdomen in Emergency Hospital

Patient Satisfaction in Treatment of Acute Abdomen in Emergency Hospital

Evaluating the cost-effectiveness of laparoscopy in the acute abdomen

Cost-effectiveness analysis (CEA) is a tool for selecting an alternative solution to achieve the same quantifi ed objective in physical units of measurement. CEA provides the analytical framework for identifying the most effective tactics for using limited resources. The analysis of the data from the specialized literature, allowed to determine the degree of implementation of the cost-eff ectiveness analysis in the public health system both at international and national level, and its practical application in clinical medicine. The origin of the CEA comes from the military service, where it was first requested to identify the most rational way to use financial resources to achieve the proposed objectives, being subsequently applied in various social fi elds, including the health system, stipulating data on technology, principles of application of the CEA. The need to evaluate the profi tability of surgical interventions is determined by the progressive increase of the costs of the medical services offered, by the appearance of alternative methods of treatment of a pathology, the limitation of the fi nancing of highly specialized technologies. Economic evaluation of the effectiveness of treatment in the acute abdomen is an important goal of clinical medicine. CEA evaluation is a tool for argumentation and promotion laparoscopic methods in the diagnosis and treatment of acute abdomen, compared to traditional classical methods.

Diagnostic Value of Ultrasound Imaging in Obstetrics and Gynecology Acute Abdomen

Common types of gynecological acute abdomen include ovarian cyst pedicle torsion, ectopic pregnancy, luteal rupture, and acute pelvic inflammatory disease. Make accurate diagnosis and surgical treatment of acute abdomen patients in obstetrics and gynecology in time, otherwise it will cause life danger or loss of organ function, therefore, accurate and timely diagnosis and treatment of gynecological acute abdomen is very important for the prognosis of patients. Ultrasound imaging has important clinical value for the diagnosis of acute abdomen in obstetrics and gynecology. Ultrasound imaging has the advantages of simple examination, rapid reporting, and no pain in the subject, which is one of the best methods for diagnosing acute abdomen in obstetrics and gynecology. This study analysed and summarized the imaging principles of ultrasound imaging in acute obstetrics and gynecology and the imaging characteristics of various acute abdomen. A retrospective analysis of patients with acute obstetrics and gynaecology performed in our hospital from December 2017 to June 2019 was performed. The diagnostic analysis of ultrasound imaging in acute obstetrics and gynaecology was performed. The results showed that the ultrasound imaging diagnosis results of 202 obstetric and gynecological acute abdomen patients were compared with the results of surgery and pathological diagnosis. Among the 182 cases with correct ultrasound imaging diagnosis, the coincidence rate was 90.1%, and 20 cases were misdiagnosed, accounting for 9.9%. The research of this study shows that the ultrasound examination technique for patients with acute obstetrics and gynaecology is simple, fast, non-invasive, and has high accuracy. Ultrasound imaging can provide reliable objective evidence for the diagnosis and differential diagnosis of most acute abdominal diseases, in order to improve the diagnosis rate and reduce the misdiagnosis rate.

Emergency diagnosis and treatment skills of acute abdomen

Acute abdomen is a common clinical disease and frequently-occurring disease. It has the characteristics of acute onset, rapid progress and many changes in clinical manifestations. It often involves multiple systems in treatment, and often requires multidisciplinary cooperation in diagnosis and treatment. As a first-line doctor, it is not easy to quickly diagnose and make correct decisions. Once it is handled improperly, it can lead to serious consequences. Although there are many related articles on the diagnosis and treatment of acute abdomen, with the continuous development of clinical diagnosis and treatment methods, it is still necessary to update the emergency diagnosis and treatment skills of acute abdomen. This article introduces the classification, characteristics, diagnosis, treatment of acute abdomen both inthe common population and special population, and hopes to cultivate the clinical diagnosis and treatment thinking of young doctors. Key words: Abdomen, acute; Diagnosis; Therapeutic uses; Medical acute abdomen; Surgical acute bdomen

Tianjin characteristics of integrated traditional Chinese and Western medicine in first aid medical system

Tianjin, as the earliest city to open up, the exchange of Chinese and Western cultures also started earlier. Therefore, today's emergency medicine system with integrated features of Chinese and Western medicine is formed. Professor Wang Jinda, who works in Tianjin First Center Hospital, makes the theory of "treating bronchitis and treating diseases" and "three methods of three syndromes" for the treatment of severe diseases such as sepsis. The surgical aspect is the treatment of acute abdomen with the combination of Chinese and Western medicine which is proposed by Academician Wu Xianzhong who worked in Tianjin Nankai Hospital. In the aspect of acupuncture and moxibustion, Professor Guo Yi, who works in Tianjin University of Traditional Chinese Medicine, provides the twelve Jing points blood-letting therapy for cerebral diseases such as stroke. Professor Liu Xinqiao from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine also conducts in-depth studies on brain protection after cardiopulmonary resuscitation (CPR). He proposes the importance of traditional Chinese medicine in addition to mild hypothermia and neuroprotective agents. The author summarized these achievements, in light of which looked forward to the future and proposed the concept of establishing a multi-specialist collaboration and an emergency center with obvious characteristics of integrated Chinese and Western medicine, which would pave the way for the development of integrated Chinese and Western medicine first aid.

Diagnosis and treatment in elderly male patients with incarcerated groin hernias caused acute abdomen: a retrospective study of 35 cases

Objective To investigate the treatment and clinical result of the elderly patients with incarcerated groin hernias caused acute abdomen. Methods We collected 35 cases of the elderly incarcerated groin hernias which can′t be reducted and be treated by emergency operation from January 2011 to January 2016 in the PKUCare Luzhong Hospital. All patients′ were analyzed by general condition, surgical procedures, surgical time, complications, length of hospital stay and follow-up. Results All 35 cases of the elderly incarcerated groin hernias were accepted surgical treatment, onset time were from 2 hour to 48 hour, 18 cases of all were treated by high ligation of hernia sac; 10 cases were treated by traditional hernioplasty; 7 cases were tension-free hernioplasty. The surgical time was from 60 minutes to 140 minutes, The average time was 85 minutes. There were 5 patients had postoperative complications. Among them, 1 case of patients with incarcerated groin hernias was reducted and happened the rupture of sigmoid colon and septic shock, resulting in multiple organ failure, 3 days after the rescue invalid death; 1 cases of postoperative intestinal obstruction, 2 cases of incision infection, 1 cases of hematoma of scrotum, All patients recovered well after treatment. The length of hospital stay was 3 ~13 d, average 7 d; patients were followed up for more than 6 months, there were 2 patients with inguinal hernia recurrence, and the other patients did not have symptoms. Conclusion Elderly patients with inguinal hernias caused acute abdomen should be preferred treatment of acute abdomen and be taken timely surgical treatment, to minimize bowel necrosis, abdominal infection, recurrence of hernia and other complications and promote the rehabilitation of patients. Key words: Hernia, inguinal; Hernia repair; Abdomen, acute; Aged

Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn's acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment.

IntroductionLaparoscopy for abdominal surgical emergencies is gaining increasing acceptance given the spreading of advanced laparoscopic skills among modern surgeons, as it may allow at the same time an accurate diagnosis and appropriate treatment of acute abdomen. The use of the laparoscopic approach also in case of diffuse peritonitis is now becoming accepted provided hemodynamic stability, despite the common belief in the past decades that such severe condition represented an indication for conversion to open surgery or an immediate contraindication to continue laparoscopy. Crohn’s Disease (CD) is a rare cause of acute abdomen and peritonitis, only a few cases of CD acute perforations are reported in the published literature; these cases have always been approached and treated by open laparotomy.Case descriptionWe report on a case of a faecal peritonitis due to an acute perforation caused by a terminal ileitis in an undiagnosed CD. The patient underwent diagnostic laparoscopy followed by a laparoscopic ileo-colic resection and primary intracorporeal anastomosis, with a successful postoperative outcome.ConclusionsComplicated CD has to be considered within the possible causes of small bowel non-traumatic perforation. Emergency laparoscopy with resection and primary intra-corporeal anastomosis can be feasible and may be a safe and effective minimally invasive alternative to open surgery even in case of faecal peritonitis, in selected stable patients and in presence of appropriate laparoscopic colorectal surgical skills and experience. To the best of our knowledge the present experience is the first ever reported case managed with a totally laparoscopic extended ileocecal resection with intracorporeal anastomosis in case of acutely perforated CD and diffuse peritonitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1619-x) contains supplementary material, which is available to authorized users.

Predicting ICU interventions in intentional drug overdose

JPN guidelines for the management of acute abdomen 2015 Toshihiko Mayumi, Masahiro Yoshida, Kouichi Hirata Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Japan Background/Purpose: There have not been the practical guidelines for the management of acute abdomen in the world. Therefore, the Japanese Society for Abdominal Emergency Medicine and collaborated 4 other societies began to make the practical guidelines for the management of acute abdomen (JPN guidelines for acute abdomen) in 2012 and finally published them in 2015. Here, we present brief summary of them. Methods: The working group of JPN guidelines consists of 18 specialists, primary care physicians, surgeons, gastroenterologists, radiologists, vascular surgeon, obstetrician and gynecologist, and epidemiologists. The guidelines were made using EBM methods with level of evidence (body of evidence) and recommendations. Results: JPN guidelines for acute abdomen 2015 contain 108 clinical questions and major topics as described below: (1) definitions, (2) epidemiology, (3) practical algorithms of acute abdomen and tables of pain location anddisease, (4) history taking, (5)medical examination, (6) laboratory and radiological examination, (7) differential diagnosis, (8) initial treatment, and (9) educational program. For algorithm of initial treatment for acute abdomen, 2 steps method were proposed (Figure). Conclusions: Since these brand-new JPN guidelines for acute abdomen 2015 are the first guidelines, these need a lot of update to be in line with a clinic in the near future.

JPN guidelines for the management of acute abdomen 2015

JPN guidelines for the management of acute abdomen 2015 Toshihiko Mayumi, Masahiro Yoshida, Kouichi Hirata Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Japan Background/Purpose: There have not been the practical guidelines for the management of acute abdomen in the world. Therefore, the Japanese Society for Abdominal Emergency Medicine and collaborated 4 other societies began to make the practical guidelines for the management of acute abdomen (JPN guidelines for acute abdomen) in 2012 and finally published them in 2015. Here, we present brief summary of them. Methods: The working group of JPN guidelines consists of 18 specialists, primary care physicians, surgeons, gastroenterologists, radiologists, vascular surgeon, obstetrician and gynecologist, and epidemiologists. The guidelines were made using EBM methods with level of evidence (body of evidence) and recommendations. Results: JPN guidelines for acute abdomen 2015 contain 108 clinical questions and major topics as described below: (1) definitions, (2) epidemiology, (3) practical algorithms of acute abdomen and tables of pain location anddisease, (4) history taking, (5)medical examination, (6) laboratory and radiological examination, (7) differential diagnosis, (8) initial treatment, and (9) educational program. For algorithm of initial treatment for acute abdomen, 2 steps method were proposed (Figure). Conclusions: Since these brand-new JPN guidelines for acute abdomen 2015 are the first guidelines, these need a lot of update to be in line with a clinic in the near future.

Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents.

IntroductionOvaries are one of the most common locations of tumor masses in children. Some of them require surgery due to the risk of malignancy or necrosis. This organ seems to be ideal for the laparoscopic approach.AimTo evaluate the usefulness of laparoscopy in surgery of lesions located in the ovaries in patients under 18 years of age and assess the risk of changes in the ovaries in girls with acute abdominal symptoms.Material and methodsRetrospective evaluation of hospital records of the period 1996–2012 from a single hospital was performed. 105 laparoscopic procedures of ovarian pathology in patients aged 0–18 (mean: 13.5) years were reviewed. The overall sample was divided into groups depending on the indication and mode of surgery. Group I: elective or emergency surgery, imaging findings of ovarian cysts bigger than 5 cm or causing pain. Group II: elective surgery, the ovarian tumor visible in imaging (solid mass or mixed). Group III: treatment for acute abdomen, without visible ovarian pathology in the preoperative imaging studies. Group IV: elective treatment of other indications, incidental finding.ResultsThere were no deaths or major complications. There were no conversions. Average length of hospital stay after surgery was 2.5 days. The risk of appendicitis in patients referred for surgery due to ovarian cysts visualized in ultrasound, in the factual absence of ovarian pathology (false positive ultrasound), in the presented material was 5.2%. The risk of lesions in the ovaries in patients operated on due to acute abdominal pain, with no findings in the pre-operative ultrasound (false negative ultrasound), in the presented material was 7.4%. The risk of coexistence of changes in the ovaries with appendicitis found during the procedure due to acute abdominal pain in the study group was 6%.ConclusionsThe laparoscopic treatment for ovarian masses is safe and efficient. The risk of wrong preoperative diagnosis (ovary mass vs. appendicitis) is in any direction between 5 and 8%, which is a number large enough to be taken into consideration when surgical training and legislation is concerned.

Diagnosis and Treatment for Acute Abdomen

Diagnosis and Treatment for Acute Abdomen

Clinical value of CT in early diagnosis and treatment of acute abdomen

Clinical value of CT in early diagnosis and treatment of acute abdomen

Surgical treatment of acute abdomen in geriatric patients: an analysis of 97 cases

Surgical treatment of acute abdomen in geriatric patients: an analysis of 97 cases

Is Laparoscopy Safe and Effective in Nontraumatic Acute Abdomen?

Progress in laparoscopic experience has increased the number of laparoscopic procedures performed, even in emergency cases. Herewith, results in a prospective series of 300 patients laparoscopically treated for nontraumatic abdominal emergencies are presented with the intent to prove the safety and feasibility of laparoscopic approach in the treatment of acute abdomen. From a prospective multicenter study performed between June 2008 and December 2009, the authors collected data on 300 patients with a provisional diagnosis of acute abdomen, laparoscopically treated or who underwent explorative laparoscopy. A correct diagnosis was made by means of laparoscopy in all 300 (100%) patients, and therapeutic laparoscopy was successfully performed in 270 (90%) patients. With laparoscopy, it was possible to modify the preoperative diagnosis and the treatment in 17 cases (5.6%). Upon statistical analysis, the conversion rate was correlated to the age of the patients (P<.0001) and to the operative time (P<.0001). The overall postoperative morbidity rate was 8%. Statistical analysis revealed that morbidity is correlated to the age of patients (P<.0001) and to the operative time (P<.0001). The mean hospital stay was 5.4 days. Laparoscopy has been shown to play a crucial role in the management of almost every abdominal emergency, offering, compared with the open approach, an initial diagnostic or explorative tool and a valid alternative in the treatment of the cause of acute abdomen with low morbidity and mortality rates.

GISTs múltiplos em neurofibromatose tipo 1: diagnóstico incidental em paciente com abdome agudo

INTRODUÇÃO: Tem sido descrito na literatura incidência aumentada de tumores estromais gastrointestinais (GISTs) em portadores de neurofibromatose tipo 1. Estes tumores tipicamente ocorrem no intestino delgado e, frequentemente, são múltiplos. RELATO DO CASO: Diagnóstico incidental de GIST em um paciente portador de neurofibromatose tipo 1 com abdome agudo. No trans-operatório foi identificada apendicite retrocecal perfurada e massa neoplásica no jejuno proximal. A referida lesão ocupava aproximadamente 70% da circunferência do órgão e não apresentava invasão de estruturas adjacentes. Além disso, observaram-se dezenas de pequenos nódulos disseminados por toda a extensão do jejuno e íleo. O anatomopatológico revelou neoplasia compatível com GIST, com grau moderado de atipias, baixo índice mitótico (&lt;5/50) e ausência de necrose. Na análise imunoistoquímica, as células neoplásicas foram positivas para CD-34 e CD-117 (c-KIT), e negativas para a desmina. Depois da operação, o uso do quimioterápico Imatinib foi indicado. Após período de acompanhamento de 12 meses, o paciente não demonstrou sinais de recidiva. CONCLUSÃO: A ocorrência de GISTs deve ser sempre lembrada na avaliação de pacientes com massas abdominais e neurofibromatose tipo 1, principalmente em intestino delgado. Muitas vezes o comportamento da neoplasia é favorável e o uso de Imatinib deve ser individualizado.