SP3.2.1 Consultant-led Urgent Ambulatory Management of Righted-sided Lower Abdominal Pain: Prospective data collection

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mubashar Hussain
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Clinical History ◽  
P Value ◽  
Prospective Data ◽  
Female Ratio ◽  
Blood Tests ◽  
Complications Rate ◽  
Male To Female

Abstract Aims To study if right lower abdominal pain could be managed safely on ambulatory basis when referred from emergency department or primary healthcare as suspected acute appendicitis to surgical ambulatory unit (SAU). Methods Data collated prospectively involving 586 patients, who presented with right iliac fossa/right-sided pelvic pain from january 2019 to January 2021. Results 0ut of 586 patients, 234 (40%) were admitted and 352 (60%) managed in ambulatory settings after being reviewed by Consulant-lead surgical oncall team. Age ranged from 3 to 92 years. Male to female ratio was 3:2. Their management included clinical history/and examination, urinalysis and blood tests. 157 (44%) patients had scans, 43 (12%) had CT scans and 114 (32%) had pelvic USS the same day or the following morning/day and were reviewed by oncall-surgeons and 107 (30%) patients had repeat blood tests. 39 (11%) out of 352 paitents were admitted the following day review, of which 18 (5%) patients underwent laproscopic appendicectomy (LA) and 8 (2.2%) patients treated conservatively. 9 (1.98%) patients represented with persistent/or worsening symptoms and 5 (1.4%) patients of these had LA and 2 (0.56%) patients had pelvic collection, drained radiologically and 2 (0.56%) had wound infections treated with antibiotics. Complications rate in ambulatory patients compared to in-patients was insignificant, P-value set at 0.05% using Mann-Whitney U test. Conclusions

The effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari - A Randomized Comparative Clinical Study

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Anil M. Sanshi ◽  
Dr.Pallavi A. Hegde
Keyword(s):  
Abdominal Pain ◽  
Renal Calculi ◽  
Renal Calculus ◽  
P Value ◽  
Standard Group ◽  
Standard Drug ◽  
Female Ratio ◽  
Comparative Clinical Study ◽  
Group B ◽  
Trial Drug

Background: Mutrashmari is a stone like structure anywhere in the Mutravaha Srothas which can be compared with renal calculi and one among the Astamahagada, clinical features as renal angle pain, haematuria, pyuria and dysuria. Peak age is 3rd to 5th decade while majority of patients report regarding onset of disease in 2nd decade of life and male to female ratio is 3:1. Objectives: To compare the effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari with special reference to Renal calculi. Materials and Methods: 30 patients were selected on the basis of inclusion criteria and divided into 2 groups with 15 patients in each group by chit method. Group A was treated with standard drug Tilanalakshara Yoga and Group B was traeted with trial drug Gokshura Churna. Results: It was found that standard group reduced the abdominal pain by 85.1%, dysuria by 89.4%, renal angle tenderness 88.4%, haematuria 100%, pyuria 100%, size of renal calculus 41.9% by 21st day of treatment. In study group it was observed that abdominal pain reduced by 92%, dysuria 96.1%, renal angle tenderness 91.6%, haematuria 100%, pyuria 100% and size of renal calculus 48.5% by 21st day of treatment. Conclusion: This assessment showed Gokshura Churna had significant result over Tilanala Kshara Yoga in both subjective and objective parameters with P value less than 0.0001.

scholarly journals OUTCOME OF DACRYOCYSTORHINOSTOMY WITH OR WITHOUT SILICON INTUBATION IN PRIMARY NASOLACRIMAL DUCT OBSTRUCTION

1969 ◽  
Vol 1 (2) ◽  
pp. 55-59
Author(s):  
Haroon Rashid ◽  
Faizur Rahman ◽  
Abid Naseem ◽  
Arshad Iqbal.
Keyword(s):  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Interventional Study ◽  
Female Ratio ◽  
Duct Obstruction ◽  
Number Of Patients ◽  
Silicon Tube ◽  
Complications Rate ◽  
Age Range ◽  
Male To Female

Objectives: The objective of the study was to compare the outcome of Classical Dacrocystorhinostomy(DCR) alone or with Slicon intubation in patients of primary nasolacrimal duct obstruction.Study design: This is a randomized prospective interventional study performed at Saidu Teaching Hospitalform from 1st January'2006 to 31st December 2006.Material and methods: Diagnosis of nasolacrimal duct obstruction was made on basis of history, clinicalexamination, regurgitation test and syringing of the nasolacrimal passage. Patients were selected byconvenient sampling and were randomized to two groups, for DCR with and without Silicon tube. Silicontube was removed after 4 months of surgery. Patients were followed up to 6 months.Results: Total number of patients was one hundred. Fifty (50%) patients were operated with siliconintubation and 50 (50%) without silicon intubation. Male to female ratio was 1:1.27.Age range was 15 yearsto 80 years. Mean, median and mode ages were 42.54, 47 and 30 years respectively. Eleven patients werelost from the study at various stages and were not included in the results of the study. The complicationsnoted were silicon tube loss in 2 cases, silicon tube displacement in 3 cases and DCR failure in 4 cases.Among the failure, 2 cases belonged to each group with and without silicon intubation.Conclusions: We conclude that the complications rate with and without silicon intubation is the same inprimary nasolacrimal duct obstruction. It is therefore, recommended that silicon intubation may not benecessary in such cases.Key words: DCR, Intubation, NLD Obstruction.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

Henoch-Schoenlein Purpura

1992 ◽  
Vol 13 (4) ◽  
pp. 130-137
Author(s):  
Shelley Lanzkowsky ◽  
Leora Lanzkowsky ◽  
Philip Lanzkowsky
Keyword(s):  
Abdominal Pain ◽  
Leukocytoclastic Vasculitis ◽  
Renal Involvement ◽  
Gastrointestinal Symptoms ◽  
Female Ratio ◽  
Course Of Illness ◽  
Colicky Abdominal Pain ◽  
Allergic Vasculitis ◽  
Male To Female ◽  
First Descriptions

The distinctive syndrome of Henoch-Schoenlein purpura (HSP) was first described by Heberden before 1800, and in 1808 English physician Robert Willan described a patient who had swollen, painful joints and a rash. The syndrome owes its name to two German physicians. In 1837, Johan Schoenlein described several cases of purpura associated with arthritis, which he termed "peliosis rheumatica." In 1868, Edouard Henoch pointed out that the term "peliosis rheumatica" was inappropriate and restrictive because patients who had urticarial purpura and acute arthritis also manifested gastrointestinal symptoms, such as vomiting, colicky abdominal pain, and melena. He described four children who had purpura, colicky abdominal pain, gastrointestinal hemorrhage, and joint pain as well as renal involvement.1 Since these first descriptions, HSP also has been referred to as anaphylactoid, allergic, or rheumatoid purpura; leukocytoclastic vasculitis; and allergic vasculitis.1,2 Epidemiology Seventy-five percent of all cases of HSP occur in children between 2 and 11 years of age, with younger children rarely affected. Children younger than 2 y experience a milder course of illness, with less frequent renal and gastrointestinal manifestations.3 HSP is exceedingly rare in adults, among whom other causes of vasculitis should be considered more likely. The incidence of HSP is greater in males, with a male-to-female ratio of 1.5 to 2.0:1.

Midthoracic Punctate Midline Myelotomy for Treatment of Chronic, Intractable, Nonmalignant, Abdominal Visceral Pain: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E183-E183 ◽  
Author(s):  
Tyler Ball ◽  
Zaid Aljuboori ◽  
Haring Nauta
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Surgical Procedure ◽  
Visceral Pain ◽  
Lower Abdominal Pain ◽  
Clinical History ◽  
Dorsal Column ◽  
Complete Relief ◽  
Patient Reported

Abstract Punctate midline myelotomy (PMM) is a surgical procedure that damages the ascending fibers of the postsynaptic dorsal column (PSDC) pathway to interrupt visceral pain transmission.1-3 It can offer relief to patients with chronic visceral pain conditions that are refractory to other treatments. Here, we present a surgical video of midthoracic PMM in a patient with chronic, intractable, nonmalignant visceral abdominal pain that failed over a decade of medical treatment. We choose T7-8 as the level for laminectomy in patients with pelvic or lower abdominal pain, because the postsynaptic pain fibers transmitting visceral pain sensation from the lower abdominal organs will invariably be caudal to this level. The patient developed immediate and complete relief of her visceral pain after the procedure, which was sustained through the 11-wk follow-up period to date and was able to be weaned off narcotics. Postoperatively, she remained full strength and had no impairment of light touch or proprioception of her lower extremities. Detailed physical examination showed a reduced vibratory sensation on the glabrous skin of her great toes. Regarding patient-reported sensory changes (not detected on physical examination), she reported some numbness on the insides of her feet that had resolved by 11-wk follow-up. She also reported some numbness of the vulva, but not of the vagina. However, by 11-wk follow-up, she reported this had resolved and she had normal sexual function. The only persistent sensation at 11-wk follow-up was slight tingling in her toes that was not bothersome to her.4 The patient presented in the following video consented to both the surgical procedure and the publication of her clinical history and operative video.

scholarly journals Caesarean scar endometriosis

2021 ◽  
Vol 10 (11) ◽  
pp. 4331
Author(s):  
Garima Kumari
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Caesarean Section ◽  
Lower Abdominal Pain ◽  
Clinical History ◽  
Lower Segment ◽  
Scar Endometriosis ◽  
Lower Segment Caesarean Section ◽  
Caesarean Scar ◽  
Menstrual History

 Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. The symptoms are nonspecific, typically involving abdominal wall pain at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of scar the diseased tissue. A case report of 34 year old female patient presenting with scar endometriosis 7 years after her last LSCS (lower segment caesarean section). The patient came with the complaint of supra pubic swelling since 6 months, which was growing slowly. Her menstrual history was regular, but she had lower abdominal pain during menstruation. On clinical history, examination and USG finding the swelling was diagnosed as scar endometriosis.

scholarly journals Torsion of caecal appendices epiploicae: mimicking acute appendicitis

2020 ◽  
Vol 7 (7) ◽  
pp. 2407
Author(s):  
A. P. Roshini ◽  
Dattaprasad Samant ◽  
F. P. Noronha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Free Fluid ◽  
Normal Appendix ◽  
Menstrual Cycles ◽  
Rebound Tenderness ◽  
Appendices Epiploicae ◽  
The Right

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion.  Preoperative diagnosis of this condition is rarely made.

scholarly journals Behcet’s Disease: Pakistani Experience

2020 ◽  
Vol 36 (5) ◽  
Author(s):  
Asadullah Khan ◽  
Muhammad Haroon ◽  
Farhan Bashir ◽  
Zia ud Din
Keyword(s):  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Neurological Symptoms ◽  
P Value ◽  
Female Ratio ◽  
Behcet's Disease ◽  
Initial Symptoms ◽  
Eye Symptoms ◽  
Male To Female

Objective: To analyze the clinical manifestation of patients with Behcet’s disease, and performance of different classification criteria of Behcet’s disease in our population. Methods: It was a retrospective analysis of all Behcet’s disease patients attending Department of Rheumatology at Fatima Memorial Hospital, Lahore, Pakistan from April 2019 to July 2019. We performed a comprehensive clinical evaluation of patients with Behcet’s disease, with focus on patients’ age, gender and different clinical manifestations. Results: A consecutive cohort of 20 patients was studied. All patients met the International Criteria of Behcet’s Disease criteria, and 18 out of 20 patients also met International Study Group criteria. Mean age of the cohort was 33.5±10.4 years and 45% was female (male to female ratio of 1:1.2). Around 90% of cohort had recurrent oral and genital ulcers. Ocular involvement was present in 80% patients, while Joint manifestations were present in 75% of patients. Cutaneous, neurological (both central and peripheral nervous system involvement), and GIT symptoms were present in 50%, 30%, and 15% of patients, consecutively. Joint pain and eye symptoms were major initial symptoms in males, while eye symptoms and neurological symptoms were more common in female patients at disease onset. Reaching border line significance, Cutaneous (p-value=0.479), ocular (p-value=0.61), and GIT involvement (p-value=0.59) were more prevalent in males while neurological involvement (p-value=0.336) in females. Conclusion: Behcet’s disease occurs commonly in middle age population with equal male to female ratio, with mucocutaneus aphthosis, ocular disease and joint pains being common manifestation. Gastrointestinal symptoms are more common in males while neurological symptoms in females. doi: https://doi.org/10.12669/pjms.36.5.1916 How to cite this:Khan A, Haroon M, Bashir F, Zia-ud-Din. Behcet’s Disease: Pakistani Experience. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1916 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

EP.TH.74An incidental finding of liver haemangioma on diagnostic laparoscopy for right sided abdominal pain in a young woman

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Elsllabi ◽  
Muhammad Shams
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Vascular Malformations ◽  
Incidental Finding ◽  
Benign Neoplasm ◽  
Lower Quadrant ◽  
Female Ratio ◽  
The Right ◽  
Male To Female ◽  
Liver Haemangioma

Abstract Introduction Cavernous liver haemangiomas or hepatic haemangiomas are the most common benign neoplasm of the liver. They are more common in women with a male to female ratio of 2.5-5.1- likely due to estrogenic influence. They are composed of hepatic endothelial cells and are usually small in size (< 4 cm). They are asymptomatic in most of the cases and incidentally discovered on diagnostic tests. Occasionally haemangiomas can exceed a size of 5 cm where they can cause symptoms such as nonspecific abdominal pain. Their exact aetiology is not well understood; they are thought to be vascular malformations with hormonal or congenital background. Haemangiomas belong to ‘Incidentaloma’ tumours, since they can be found incidentally while investigating for other unrelated pathologies. Although rare, but rupture and hemorrhage of liver hemangiomas can be fatal. Case presentation A 33-year-old woman was presented with abdominal pain which was started in central abdomen and then shifted to right lower abdomen abdomen. No other significant symptoms at presentation or past medical history. On serial physical examination, the patient was more tender at the right lower quadrant of the abdomen. Although her inflammatory markers were normal the decision was made to proceed with diagnostic laparoscopy to rule out acute appendicitis. During laparoscopy normal appendix was found with multiple liver lesions. Appendix was not removed. Postoperatively CT Thorax, Abdomen and Pelvis with contrast and CT Liver Triple Phase was performed which confirmed benign liver haemangioma. The patient recovered well after surgery and was discharged home with no routine surgical follow up.

Success of Ponseti Method in Idiopathic Club Feet of <2 Years and 2-5 years of age – A Comparative Study

2021 ◽  
Vol 15 (11) ◽  
pp. 3022-3025
Author(s):  
Usman Ahmed ◽  
Ayesha Saeed ◽  
Mian Maqbool Hussain ◽  
Mumtaz Hussain ◽  
Abdul Latif Sami ◽  
...  
Keyword(s):  
Success Rate ◽  
Study Groups ◽  
Ponseti Method ◽  
P Value ◽  
Congenital Talipes Equinovarus ◽  
Female Ratio ◽  
Talipes Equinovarus ◽  
Group A ◽  
Group B ◽  
Male To Female

Background: The Ponseti technique is the gold standard for treatment of clubfoot. However, the data in walking children is still limited and results are ill defined. Aim: We prospectively compared Ponseti method in clubfoot patients aged <2 and between 2 to 5 years in our local scenario. Methods: A total of 40 patients were included in the study through non-probability purposive sampling. The patients were examined, classified (Goldner and Fitch classification) and demographic information was recorded. They were explained about the risk and informed consent was taken. In group A, patients were below 2 years of age while in group B, patients were between 2-5 years of age. Ponseti casting was performed by a designated team. Follow-up was done for 6 months from the correction of feet. Results: We received 27(67.5%) male and 13(32.5%) female patients .The male to female ratio was 2:1. The mean age of patients in group A and B was 0.8±0.70 years and 4.3±2.1 years respectively. There was no statistical difference of severity of deformity of clubfoot in both study groups, p-value>0.05. In group A, 17 (85%) patients had success of procedure while in group B the success was achieved in 11 (55%) patients. The success rate was statistically significantly higher in group-A as compared to group B, p-value<0.001 Conclusion: Patient aged <2 years have significantly higher success rate as compared to patients aged between 2-5 years. So we recommend the Ponseti method as standard therapy in clubfoot management for patients with age<2 years and for correction of mild and moderate deformities in patients between 2 to 5 years. Keywords: Clubfoot, Congenital talipes equinovarus, Ponseti method

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