An unusual cause of abdominal pain in a pregnant woman - a diagnostic dilemma

2012 ◽  
Vol 52 (4) ◽  
pp. 404-406
Author(s):  
Meleesa J. Schultz ◽  
Triveni Nanda
Keyword(s):  
Abdominal Pain ◽  
Pregnant Woman ◽  
Diagnostic Dilemma

scholarly journals The role of laparoscopy in diagnosis of patients with chronic abdominal pain

2016 ◽  
Vol 4 (1) ◽  
pp. 326 ◽  
Author(s):  
Pradeep Saxena
Keyword(s):  
Abdominal Pain ◽  
Clinical Picture ◽  
Descriptive Analysis ◽  
Abdominal Tuberculosis ◽  
Chronic Abdominal Pain ◽  
Diagnostic Dilemma ◽  
Chronic Appendicitis ◽  
Fluid Analysis ◽  
Conclusive Diagnosis

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Results:Laparoscopy was performed in 142 patients of chronic abdominal pain with unsettled diagnosis. A conclusive diagnosis could be made in 136 of these patients. The common causes of chronic abdominal pain were abdominal tuberculosis, adhesions, bands, small intestinal strictures, chronic appendicitis, abdominal malignancy and various gynecological diseases. Gynecological problems causing chronic abdominal pain were pelvic inflammatory disease, ovarian cyst, tubo-ovarian mass, hydrosalpinx, fibroid uterus, bulky uterus, endometriosis. Thus laparoscopy provided positive diagnosis of in 136 (95.77%) patients based on laparoscopic findings, histological reports, ascitic fluid analysis and cytology.Conclusions:In patients suspected to have abdominal pathology early laparoscopy may be useful to establish a conclusive diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

A 23-year-old pregnant woman with acute-onset abdominal pain and hypotension

2014 ◽  
pp. 106-108
Author(s):  
Rachel K. Love ◽  
Nicole Calloway Rankins ◽  
David Chelmow ◽  
Christine R. Isaacs ◽  
Ashley Carroll
Keyword(s):  
Abdominal Pain ◽  
Pregnant Woman ◽  
Acute Onset

scholarly journals 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

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

scholarly journals Intussusception in a pregnant woman

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Ana Cristina Silva ◽  
Pedro Soares Moreira ◽  
Vitor Costa Simões ◽  
Mónica Sampaio ◽  
Marisa Domingues Santos
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Pregnant Woman ◽  
Pregnant Patient ◽  
Computed Tomography Scan ◽  
Intestinal Necrosis ◽  
History Of ◽  
Emergent Laparotomy ◽  
Tomography Scan

Abstract Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.

scholarly journals Lower abdominal pain in fertile females – A diagnostic dilemma in emergency surgery

2012 ◽  
Vol 10 (8) ◽  
pp. S89
Author(s):  
Andrew Torrance ◽  
John Hardman ◽  
Lewis Taylor ◽  
Alex Coupland
Keyword(s):  
Abdominal Pain ◽  
Emergency Surgery ◽  
Lower Abdominal Pain ◽  
Diagnostic Dilemma

scholarly journals A Rare Cause of Abdominal Pain and Mass in an 18-Year-Old Patient: A Diagnostic Dilemma

2018 ◽  
Vol 11 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Hassan Tariq ◽  
Muhammad Umar Kamal ◽  
Vamshidhar Vootla ◽  
Mohamed ElZaeedi ◽  
Masooma Niazi ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Dilemma

scholarly journals A High Urinary Urobilinogen / Serum Total Bilirubin Ratio Reported in Abdominal Pain Patients Can Indicate Acute Hepatic Porphyria

2021 ◽  
Author(s):  
Chengyuan Song ◽  
Shaowei Sang ◽  
Yuan Liu
Keyword(s):  
Abdominal Pain ◽  
Roc Curve ◽  
Total Bilirubin ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Control Groups ◽  
Diagnostic Dilemma ◽  
Laboratory Test Results

Abstract Background: Due to its variable symptoms and nonspecific laboratory test results during routine examinations, acute hepatic porphyria (AHP) has always been a diagnostic dilemma for physicians. Correct diagnosis mainly depends on the elevated urinary porphobilinogen (PBG) level, which is not a routine test performed in the emergency department. Therefore, identifying a more convenient indicator during routine examinations is important to improve the diagnosis of AHP.Methods: In this retrospective study, we enrolled 12 AHP patients and 100 patients with abdominal pain of other causes as the control groups in Qilu hospital of Shandong University between 2015 and 2021. The clinical manifestations and laboratory result data including urinary urobilinogen/serum total bilirubin ratio were compared between these two groups. The diagnostic performance of urinary urobilinogen/serum total bilirubin ratio was measured as sensitivity, specificity, and accuracy. The cut-off for optimal clinical performance was determined by the receiver operator characteristic (ROC) curve. Results were considered significant at a P < 0.05.Results: Compared with the control groups, AHP patients showed a significantly higher urinary urobilinogen level (P < 0.05). However, we showed that the higher urobilinogen level was caused by a false-positive result due to elevated urine PBG. Hence, we used serum total bilirubin, an upstream substance of urinary urobilinogen synthesis, for calibration. A remarkable increase in the urinary urobilinogen/serum total bilirubin ratio was observed in AHP patients. The area under the ROC curve of this ratio for AHP was 1.000 (95% confidence interval, 1.000–1.000, P < 0.01). A cutoff value of 3.22 for the urinary urobilinogen/serum total bilirubin ratio yielded a sensitivity of 100% and a specificity of 100% to distinguish AHP patients from the controls.Conclusion: A reported high urinary urobilinogen level that was adjusted by the serum total bilirubin level (urinary urobilinogen/serum total bilirubin ratio) could be used as a sensitive and specific indicator for AHP in patients with abdominal pain.

scholarly journals Disseminated Strongyloides Stercoralis Hyperinfection in An Immunocompetent Patient First Diagnosed by Metagenomic Next-Generation Sequencing in Cerebrospinal Fluid: A Case Report

2021 ◽  
Author(s):  
Junyan Qu ◽  
Zhiyong Zong
Keyword(s):  
Cerebrospinal Fluid ◽  
Abdominal Pain ◽  
Next Generation Sequencing ◽  
Clinical Manifestations ◽  
Good Health ◽  
Strongyloides Stercoralis ◽  
Next Generation ◽  
Diagnostic Dilemma ◽  
Disseminated Strongyloidiasis ◽  
Generation Sequencing

Abstract Background Disseminated Strongyloides stercoralis hyperinfection is rarely described in immunocompetent individuals and can lead to fatal outcomes if not recognized and diagnosed early. Non-specific clinical manifestations, such as pneumonia and gastroenteritis, pose a diagnostic dilemma. Case presentation: We report a case of a 67-year-old Chinese male who presented with two months of abdominal pain, fever, headache, vomiting, constipation, and slight cough with sputum. He had been in good health and had no history of glucocorticoid use. He was diagnosed with enterococcal meningitis and intestinal obstruction at a local hospital and improved after treatment with vancomycin, but symptoms of headache and abdominal pain soon recurred. The metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid using Illumina X10 sequencer revealed 7 sequence reads matching Strongyloides stercoralis. Disseminated strongyloidiasis was suspected. Next, microscopic examination of gastric fluid revealed Larvae of S. stercoralis. DNA extracted of larvae, the presence of both S. stercoralis ribosomal DNA gene and mitochondrial cytochrome c oxidase subunit 1 gene was identified. Disseminated strongyloidiasis was diagnosed. Albendazole (400 mg, twice daily) was used and the patient recovered gradually. Conclusions S. stercoralis hyperinfection can occur in immunocompetent individuals, imposing challenges for diagnosis. mNGS may be a useful tool for detecting rare infectious disease. The case would help clinicians to raise awareness of strongyloidiasis in non-endemic areas and reduce fatality.

scholarly journals Left flank pain during pregnancy with an unpredictable etiology: think of nonhemorrhagic adrenal infarction

2021 ◽  
pp. FSO718
Author(s):  
Myriam Jerbaka ◽  
Tracy Slaiby ◽  
Zahraa Farhat ◽  
Yara Diab ◽  
Nawal Toufayli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Pregnant Woman ◽  
Pregnant Patient ◽  
Flank Pain ◽  
Computed Tomography Scan ◽  
Left Flank ◽  
Left Flank Pain ◽  
Tomography Scan ◽  
Adrenal Infarction

Abdominal pain is the most presenting complaint during pregnancy with multiple etiologies. The diagnosis could be unpredictable. We present a case of 36-year-old pregnant woman gravida 10 para 7 abortus 2 at 36 + 5 weeks of gestation presenting twice for an increasing left abdominal pain, not relieved despite analgesics. She was delivered for severe oligohydramnios. After delivery, she was found to have a left adrenal infarction on computed tomography scan. She was found to have two mutations of the gene  MTHFR 677CC. Our presented case should remind physicians to consider the presence of thromboembolic state during pregnancy. The diagnosis of adrenal infarction should be among the differentials of an ambiguous flank pain that is resilient to medical therapy. Diagnosis in a pregnant patient can be easily confirmed with MRI, after which anticoagulation should be started and the workup for hypercoagulable state investigated.

scholarly journals The diagnostic dilemma of a pregnant woman presenting with an isolated sixth nerve palsy: A case report

2019 ◽  
Vol 13 (4) ◽  
pp. 195-197
Author(s):  
Nithya Rengaraj ◽  
Anish Keepanasseril ◽  
Gowri Dorairajan ◽  
Murali Subbaiah ◽  
Pradeep P Nair ◽  
...  
Keyword(s):  
Case Report ◽  
Pregnant Woman ◽  
Pregnant Women ◽  
Nerve Palsy ◽  
Sinus Thrombosis ◽  
Abducens Nerve ◽  
Cavernous Sinus Thrombosis ◽  
Diagnostic Dilemma ◽  
Sixth Nerve Palsy ◽  
Sixth Nerve

Pregnant women presenting with isolated cranial palsies are uncommon. Isolated sixth nerve (abducens nerve) palsy can occur for a variety of reasons and neuroimaging is often performed to identify an underlying cause. We report a case of a woman in her third pregnancy with preeclampsia who presented with an isolated sixth nerve palsy. The diagnosis of aseptic cavernous sinus thrombosis was made and she subsequently made a full recovery.

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