scholarly journals Paediatric abdominal pain in the time of COVID-19: a new diagnostic dilemma

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Rachel Harwood ◽  
Roland Partridge ◽  
Joanne Minford ◽  
Sarah Almond
Keyword(s):  
Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Diagnostic Dilemma ◽  
Cross Sectional ◽  
Diagnostic Uncertainty ◽  
Common Causes ◽  
Multidisciplinary Working ◽  
Cross Sectional Imaging ◽  
Mesenteric Adenitis ◽  
Symptom Progression

Abstract The diagnostic uncertainty for children with abdominal pain has increased during the COVID-19 pandemic with the additional consideration of both COVID-19 and paediatric inflammatory multisystem syndrome—temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) alongside appendicitis, mesenteric adenitis and other less common causes of abdominal pain. We describe the cases of two children who presented with severe abdominal pain, non-bilious vomiting and high temperatures during the UK’s first peak of the COVID-19 pandemic. Laboratory and abdominal ultrasound features were similar for both children but symptom progression in combination with cross-sectional abdominal imaging enabled differentiation between PIMS-TS and appendicitis with concurrent COVID-19. These cases highlight the importance of regular clinical review, multidisciplinary working and the utility of early cross-sectional imaging to determine the underlying condition.

scholarly journals Causes of Acute Abdominal Pain in Geriatrics: A Review

2021 ◽  
pp. 20-28
Author(s):  
Abdullah Saed Albalawi ◽  
Mohammed Omar Amer ◽  
Mohammed Ghannam Alharbi ◽  
Etizaz Ayed Alshaleikhi
Keyword(s):  
Abdominal Pain ◽  
Elderly Population ◽  
Renal Colic ◽  
Acute Abdominal Pain ◽  
The Elderly ◽  
Current Evidence ◽  
Biliary Disease ◽  
Timely Manner ◽  
Cross Sectional ◽  
Common Causes

Background: Aging affects all functions of the gastrointestinal system (GIS). The elderly commonly has atypical presentation of a disease with more subtle symptoms; hence physicians who are not familiar with these might miss the opportunity to make a diagnosis of abdominal pain in timely manner. The main objective of our study is to summarize the current evidence regarding causes and management of acute abdominal pain in elderly.                      Methodology: MEDLINE, Embolic, CINAHL, PsycInfo, and ASSIA were searched from 2000 until April 2021, and reference lists of included studies were searched. Studies were included that described causes and management of abdominal pain in elderly. No software has been utilized to analyze the data. The data was extracted based on specific form that contains (Author’s name, publication year, country, methodology and results). Results: The study included 7 papers. 2 cross sectional, 2 prospective and 3 retrospective studies all reporting causes and management of acute abdominal pain in elderly. Conclusion: The most common causes of abdominal pain in elderly population were biliary disease, appendicitis and bowel obstruction. Renal colic, hernia and ischemia were also reported in different rates. Diagnosis and management of abdominal pain especially in elderly should be immediate to avoid potential complications.

scholarly journals Aseptic abscess syndrome

2020 ◽  
Vol 13 (10) ◽  
pp. e236437
Author(s):  
Hannah Fillman ◽  
Patricio Riquelme ◽  
Peter D Sullivan ◽  
André Martin Mansoor
Keyword(s):  
Abdominal Pain ◽  
Immunosuppressive Agents ◽  
High Dose ◽  
Cross Sectional ◽  
Abdominal Abscesses ◽  
Intravenous Antibiotics ◽  
Cross Sectional Imaging ◽  
Aseptic Abscess ◽  
Intravenous Steroids ◽  
The Right

A 43-year-old woman with Crohn’s disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.

scholarly journals Surgical causes of abdominal pain in children: a retrospective study

2018 ◽  
Vol 5 (6) ◽  
pp. 2283
Author(s):  
Balaji Dhanaram ◽  
Sakthivel Chandrasekar ◽  
Baskar Muthukumaraswamy
Keyword(s):  
Abdominal Pain ◽  
Retrospective Study ◽  
Surgical Intervention ◽  
Clinicopathological Features ◽  
Age Group ◽  
Common Causes ◽  
Mesenteric Adenitis ◽  
The Common ◽  
Surgery Department ◽  
Age And Sex

Background: Abdominal pain is a very prevalent problem in children and one of the common causes for visit to the hospital. They may be of acute or chronic presentation and depending on severity may also require admission to hospital.Methods: This is a retrospective study conducted in our hospital over a period of 3 years. About 200 children who came to the hospital with abdominal pain and received treatment in surgical outpatient or referred to surgery department from emergency were included in this study and all relevant data were collected.Results: The pain was found to be more in boys and in the age group of 9 to 12years. The most common cause was found to be mesenteric adenitis followed by acute appendicitis. About 38% of children required surgical intervention on that admission due to various surgical causes.Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

scholarly journals Cystic adnexal lesion on USG – causing a diagnostic dilemma in oncology institute

2016 ◽  
Author(s):  
Abhinav Aggarwal
Keyword(s):  
Imaging Modality ◽  
Reproductive Age ◽  
Age Group ◽  
Diagnostic Dilemma ◽  
Cross Sectional ◽  
Common Cause ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Adnexal Lesion ◽  
Reproductive Age Group

Adnexal lesions are one of the most common cause of gynecological complains, including possibility of ectopic pregnancy in reproductive age group. Ultrasound is the first imaging modality used for evaluation of adnexal lesions. On ultrasound large non-adnexal lesions can be confused as adnexal lesions causing a diagnostic dilemma, rendering use of cross-sectional imaging mandatory. We present a case of middle-aged female who was diagnosed with a right adnexal lesion (possibly malignant) on ultrasound, but on further evaluation was found to be suffering from a benign non-adenexal etiology.

scholarly journals Impact of Endoscopic Ultrasound in Evaluation of Upper Abdominal Pain

2021 ◽  
Vol 33 (1) ◽  
pp. 1-6
Author(s):  
Bimal Chandra Shil ◽  
Madhusudan Saha ◽  
Md Royes Uddin ◽  
ANM Saifullah ◽  
Md Rehan Habib ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Epigastric Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Medicine Today ◽  
Upper Abdominal

Introduction: Upper abdominal pain is found to be one of the most common presenting symptoms. Endoscopic ultrasound may be a useful tool to yield a specific diagnosis. Aim of our study was to find the etiology of upper abdominal pain with normal endoscopic findings and compare the findings of endoscopic ultrasound with those of trans-abdominal ultrasound. Materials and Methods: This was a cross sectional study conducted in the department of gastroenterology, Sir Salimullah Medical College from January 2015 to December 2019. Total 238 patients suffering from upper abdominal pain who previously underwent endoscopy with normal results and trans abdominal ultrasound with doubtful findings were enrolled in this study. All patients were evaluated properly with history, clinical examination and relevant blood investigations. Then the patients underwent endoscopic ultrasound with conscious sedation. Computed tomorgraphy, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were done in cases where needed and correlated with endoscopic ultrasound results. Results: Among the total 238 patients, 137 were male and 101 were female. Most predominant age range was 31-40 years. Pain was moderate in severity in 43.27%, epigastric pain was in 59.66% and pain referred to back was in 37.39% patients. Comparison with trans abdominal ultrasound regarding etiologies of upper abdominal pain was statistically significant (P=0.000). Comparative analysis between the two modalities regarding gall bladder, common bile duct, pancreas were also found significant with P values of 0.040, 0.005, 0.000 respectively. Forty two patients were diagnosed as chronic pancreatitis based on Rosemont criteria by endoscopic ultrasound. Conclusion: Endoscopic ultrasound is a modern diagnostic tool which can detect hepato-pancreato-biliary pathologies and also mucosal irregularities of stomach and esophagus. So, it can be considered as a first line investigation to diagnose the underlying etiology of upper abdominal pain. Medicine Today 2021 Vol.33(1): 1-6

Cross-Sectional Imaging of Nontraumatic Peritoneal and Mesenteric Emergencies

2013 ◽  
Vol 64 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Michael N. Patlas ◽  
Abdullah Alabousi ◽  
Mariano Scaglione ◽  
Luigia Romano ◽  
Jorge A. Soto
Keyword(s):  
Emergency Department ◽  
Correct Diagnosis ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Emergency Radiologist ◽  
Mesenteric Adenitis ◽  
Sectional Imaging ◽  
High Index Of Suspicion

Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities.

Vascular disorders of the gastrointestinal tract

2020 ◽  
pp. 2997-3007
Author(s):  
Ray Boyapati
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Vascular Occlusion ◽  
Vascular Lesions ◽  
Intestinal Bleeding ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Mesenteric Ischaemia ◽  
Cross Sectional ◽  
Vascular Disorders ◽  
Cross Sectional Imaging

A wide range of vascular disorders and vasculitides may affect the gastrointestinal tract. Most are quite uncommon, but presentations are often dramatic with intestinal bleeding or gangrene. Intestinal ischaemia is most commonly due to atherosclerosis or thrombosis causing arterial or venous mesenteric vascular occlusion. There are four primary syndromes. (1) Ischaemic colitis—presents with abdominal pain, nausea, vomiting, and tenderness followed by passage of loose bloody stool. Supportive management is usually sufficient, but a key challenge is early identification of patients with severe injury who are likely to progress to transmural ulceration and perforation. (2) Acute mesenteric ischaemia—typically presents with sudden abdominal pain, initially without localizing signs such that diagnosis is often delayed. Priorities of management are resuscitation, exclusion of other causes of apparent abdominal catastrophe, and prompt laparotomy to resect ischaemic bowel. (3) Chronic mesenteric ischaemia—most often caused by atherosclerotic disease and presents with severe and poorly localized cramping abdominal pain after eating. Diagnosis requires evidence of vascular occlusion on imaging, and revascularization is the definitive management strategy. (4) Mesenteric venous thrombosis—diagnosis is most commonly via cross-sectional imaging. The mainstay of treatment is supportive, as well as anticoagulation and a search for predisposing factors. Vasculitides affecting the intestine may be primary or secondary. Abdominal symptoms rarely dominate the clinical picture. Vascular lesions of the gastrointestinal tract may present with acute haemorrhage, chronic iron deficiency anaemia, or obstruction. Lesions include angiodysplasias, telangiectasias, haemangiomas, Dieulafoy lesions, and gastric antral vascular ectasia. These lesions may occur in isolation or as part of a syndrome (e.g. hereditary haemorrhagic telangiectasia).

scholarly journals Ectopic ACTH syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1217-1225 ◽  
Author(s):  
Andrea M. Isidori ◽  
Andrea Lenzi
Keyword(s):  
Small Cell Lung Carcinoma ◽  
Ectopic Acth Syndrome ◽  
Extensive Experience ◽  
Cross Sectional ◽  
Ectopic Acth ◽  
Cell Lung Carcinoma ◽  
Common Causes ◽  
Cross Sectional Imaging ◽  
The Common ◽  
Best Localization

Ectopic adrenocorticotropic secretion (EAS) is responsible for 12-17% of cases of Cushing's syndrome (CS) and covers a range of tumours, from undetectable benign lesions to widespread metastases. The syndrome is often associated with severe hypercortisolaemia, which aggravates the underlying condition. EAS requires a complete workup that includes the establishment of endogenous CS, diagnosis of adrenocorticotropic hormone (ACTH) dependency, localization of the source of ACTH secretion and rapid biochemical control of hypercortisolaemia. Dynamic endocrine tests should include inferior petrosal sinus sampling with CRH stimulation. Localization studies depend on the availability of reliable high-resolution cross-sectional imaging. This systematic review of the largest published series of patients with EAS (over 380 patients) reveals the common trends in the prevalence and management of this syndrome. The concept of 'occult' EAS has been revisited and the terms 'overt' and 'covert' EAS introduced. In addition to small cell lung carcinoma, the most common causes of ectopic EAS are bronchial carcinoids, thymic tumours, islet cell tumour of the pancreas, medullary thyroid carcinomas, and phaeochromocytomas. Their prevalence and the best localization modalities are presented. Medical and surgical management is discussed on the basis of the extensive experience of major referral centres.

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