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

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.

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Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v10i1.38906 ◽

2018 ◽

Vol 10 (1) ◽

pp. 59-65

Author(s):

Khairun Nahar ◽

SM Amjad Hossain ◽

Ashia Khatun

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Clinical Feature ◽

Complete Relief ◽

Pathology Report ◽

Repeated Treatment ◽

Diagnostic Dilemma ◽

Chronic Appendicitis ◽

Female Patients

Background: Many female patients presented to gynecologist with chronic lower abdominal pain, suspecting chronic PID or UTI, but found no improvement inspite of repeated treatment. It remains as diagnostic dilemma for gynaecologist. Proper diagnosis ultimately shows that it is a case of chronic appendicitis. The main purpose of this study was to evaluate the clinical feature of chronic appendicitis and its correlation with operative and histological findings & to create alertness of physicians and prevention of later complication.Methods: This cross-sectional study was carried out in female patients in private practice from January 2014 to December 2017.All patientswho complained frequent attacks of pain in their right lower abdomen were included in our study. The patient’s history, clinical and lab findings were closely evaluated. All the patients underwent appendectomy and all their appendices were histopathologically examined. Chronic appendicitis was ruled in with a positive pathology report confirming chronic inflammation. All the patients referred for their follow-up visits in a period of one year.Results: A total100 female patients were studied.66% patient were in age group 26 to35 years.87% patients were multiparous. Duration of pain varied from 2weeks to 2.5 years. Histopathology report confirmed chronic appendicitis in 96% cases. From them 94% cases expressed complete relief of pain following removal in the follow-up visit.Conclusion: Chronic appendicitis seems to be a cause of recurrent lower abdominal pain. The disease is easily cured by appendectomy.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 59-61

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

British Journal of Surgery ◽

10.1093/bjs/znab361.068 ◽

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

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Erratum: Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain. J Shaheed Suhrawardy Med Coll Vol. 10 No. 1, June 2018 Page - 59-61

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v10i2.41163 ◽

2019 ◽

Vol 10 (2) ◽

pp. 83-85

Author(s):

Khairun Nahar ◽

SM Amjad Hossain ◽

Ashia Khatun

Keyword(s):

Abdominal Pain ◽

Female Patient ◽

Lower Abdominal Pain ◽

Clinical Feature ◽

Pathology Report ◽

Repeated Treatment ◽

Diagnostic Dilemma ◽

Chronic Appendicitis ◽

Female Patients

Erratum: Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain J Shaheed Suhrawardy Med Coll Vol. 10 No. 1, June 2018 Page - 59-61 The author of this article brought attention to publishers that this is an original article an previous issue Vol. 10 No. 1, June 2018 Page - 59-61 it was published as a Case report. These error have been corrected to enhance credibility to readers and the article has been published in this issue of J Shaheed Suhrawardy Med Coll --------------------------------------------------------------------------------------------------------------------------------------------------------- Background: Many female patients presented to gynecologist with chronic lower abdominal pain, suspecting chronic PID or UTI, but found no improvement inspite of repeated treatment. It remains as diagnostic dilemma for gynaecologist. Proper diagnosis ultimately shows that it is a case of chronic appendicitis. The main purpose of this study was to evaluate the clinical feature of chronic appendicitis and its correlation with operative and histological findings & to create alertness of physicians and prevention of later complication. Methods: This cross-sectional study was carried out in female patients in private practice from January 2014 to December 2017.All patientswho complained frequent attacks of pain in their right lower abdomen were included in our study. The patient’s history, clinical and lab findings were closely evaluated. All the patients underwent appendectomy and all their appendices were histopathologically examined. Chronic appendicitis was ruled in with a positive pathology report confirming chronic inflammation. All the patients referred for their follow-up visits in a period of one year. Results: A total100 female patients were studied.66% patient were in age group 26 to35 years.87% patients were multiparous. Duration of pain varied from 2weeks to 2.5 years. Histopathology report confirmed chronic appendicitis in 96% cases. From them 94% cases expressed complete relief of pain following removal in the follow-up visit. Conclusion: Chronic appendicitis seems to be a cause of recurrent lower abdominal pain. The disease is easily cured by appendectomy. J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 83-85

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Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach

Case Reports in Vascular Medicine ◽

10.1155/2017/5470909 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jose Maria Pereira de Godoy ◽

Henrique Jose Pereira de Godoy ◽

Aline Aparecida de Sene Souza ◽

Ricardo Budtinger Filho ◽

Maria de Fatima Guerreiro Godoy

Keyword(s):

Body Weight ◽

Physical Examination ◽

Female Patient ◽

Therapeutic Approach ◽

Clinical History ◽

Calcium Dobesilate ◽

Intracellular Fluid ◽

Total Reduction ◽

Clinical Control ◽

Patient Reported

Idiopathic cyclic edema is a type of generalized edema that mainly affects women. Diagnosis is made by the patient’s clinical history and an evaluation of the accumulation of weight during the day. The objective of this study is to report the clinical control of lymphedema associated with idiopathic cyclic edema using calcium dobesilate. A 55-year-old female patient reported generalized edema for years in that she woke up in the morning with her legs swollen and the edema worsened during the day. The physical examination revealed generalized edema. After four days of treatment with calcium dobesilate, the patient returned to the Clínica Godoy, Brazil, with less edema and reductions in body weight and the amount of extracellular and intracellular fluid. With further treatment, there was a total reduction of the edema. It is concluded that calcium dobesilate helps to control lymphedema secondary to idiopathic cyclic edema.

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Haematometra in one half of the uterus or rudimentary horn?

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i1.1480 ◽

1970 ◽

Vol 2 (1) ◽

pp. 59-62

Author(s):

Suniti Rawal ◽

Josie Baral ◽

Meeta Singh ◽

Samira Khan ◽

Beemba Shakya ◽

...

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Key Words ◽

Uterine Cavity ◽

Lower Abdominal Pain ◽

Rudimentary Horn ◽

Unicornuate Uterus ◽

Post Operative Period ◽

Endometriotic Cyst

A unicornuate uterus with functioning and non communicating rudimentary horn is a rare Mullerian abnormality, difficult to diagnose at times usually low in the list of differential diagnosis for pelvic pain and dysmenorrhea. A 22 years P1 presented with severe lower abdominal pain and dysmenorrhoea, following laparotomy that was done for endometriotic cyst of left ovary 7 months back. Radiographic studies revealed the haematometra in the rudimentary horn with normal uterus, right ovary and the tube. Laparotomy with drainage of haematometra and excision of septum along with the reconstruction of uterine cavity was performed thus anatomizing it with the cavity of the rudimentary horn. Both the intra and the post operative period were uneventful. She was discharged on OCP along with the advice to follow up regularly. She is asymptomatic till date. Key words: Endometriosis, haematometra, rudimentary horn doi:10.3126/njog.v2i1.1480 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 59 - 62 May -June 2007

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Caesarean scar endometriosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214356 ◽

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.

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Conservative management of early uncomplicated appendicitis in children

International Surgery Journal ◽

10.18203/2349-2902.isj20170855 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1024 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Maini ◽

Neeraj Kumar Jain ◽

Manjari Goel Jain ◽

Vicky Khobragade

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Conservative Management ◽

Medical Management ◽

Surgical Intervention ◽

Lower Abdominal Pain ◽

Primary Treatment ◽

Research Centre ◽

Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

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Abdominal Pain and Abdominal Mass

10.2310/tywc.2001 ◽

2018 ◽

Author(s):

Blake D. Babcock ◽

Alexander E. Poor ◽

Mohammad F. Shaikh ◽

Wilbur B. Bowne

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Physical Examination ◽

Acute Abdominal Pain ◽

Abdominal Mass ◽

Gastroesophageal Junction ◽

Percutaneous Biopsy ◽

Clinical History ◽

Diagnostic Process ◽

Abdominal Masses

Acute abdominal pain and abdominal mass are intimately connected; therefore, the diagnostic process for evaluating abdominal pain and abdominal masses is largely the same and has been preserved since ancient times. The primary goals in the management of patients with abdominal pain and/or abdominal mass are to establish a differential diagnosis by obtaining a clinical history, to refine the differential diagnosis with a physical examination and appropriate studies, and to determine the role of operative intervention in the treatment or refinement of the working diagnosis. This review describes the process of diagnosing abdominal pain, including taking a clinical history and performing a physical examination. Investigative studies, including laboratory tests, imaging, and pathology are reviewed. Management, including surgical treatment, is discussed. Tables describe intraperitoneal and extraperitoneal causes of acute abdominal pain, frequency of specific diagnoses in patients with acute abdominal pain, and common abdominal signs and findings noted on physical examination. Figures show abdominal pain in specific locations, a data sheet, the differential diagnosis of an abdominal mass by quadrant or region, characteristic patterns of abdominal pain, acute appendicitis with associated appendicolith, bilateral adrenal masses, adrenocortical carcinoma, retroperitoneal leiomyosarcoma, pancreatic mass, a sagittal ultrasonogram of the pancreas, ultrasonograms of the liver, a dark and well circumscribed abdominal mass, gastroesophageal junction adenocarcinoma, and percutaneous biopsy of a large abdominal mass. An algorithm outlines the assessment of acute abdominal pain and abdominal mass. This review contains 14 figures, 5 tables, and 143 references.

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Hanging Noncalculous Gallbladder

HPB Surgery ◽

10.1155/1996/60802 ◽

1996 ◽

Vol 9 (3) ◽

pp. 137-139 ◽

Cited By ~ 5

Author(s):

E. Tzardinoglou ◽

J. Prousalidis ◽

S. Apostolidis ◽

C. Katsohis ◽

H. Aletras

Keyword(s):

Abdominal Pain ◽

Gall Bladder ◽

Gallbladder Disease ◽

Pathological Examination ◽

Complete Relief ◽

Biliary Pain ◽

Abnormal Position ◽

The Mean ◽

One Year

The removal of acalculous and not acutely inflamed gall-bladder in patients with typical biliary pain remains a questionable procedure. This study was conducted to present our experience. In the period 1982- 90, 1089 cases of calculous and acalculous gallbladder disease were treated in our clinic. In this period, 27 patients were subjected to cholecystectomy because of an acalculous, non inflamed gallbladder which was elongated lying in an abnormal position with a long cystic duct. The mean duration ofsymptoms supportive of cholelithiasis, was 5 years. Oral cholecystogram and ultrasonography led to the diagnosis and other causes ofchronic abdominal pain were excluded. There were 13 lumbar, 9 pelvic and 5 iliac gallbladders, with poor function in 20 of them. During cholecystectomy, the organ was invested by peritoneum and suspended in 7 cases from a mesentery. On pathological examination mild chronic inflammation was reported in 19 cases and minimal changes in 8. The minimum follow up was one year and the maximum 9 years. Complete relief of symptoms was achieved in all the cases. In conclusion, cholecystectomy should be offered in these symptomatic "hanging" gallbladders.

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