Segmental arterial mediolysis: a commonly overlooked aetiology of acute abdominal pain

2020 ◽  
Vol 13 (6) ◽  
pp. e234576
Author(s):  
Moni Roy ◽  
Ashish Kumar Roy ◽  
Mary E McCrate
Keyword(s):  
Abdominal Pain ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Abdominal Discomfort ◽  
Mesenteric Arteries ◽  
Mesenteric Ischaemia ◽  
Management Options ◽  
Segmental Arterial Mediolysis ◽  
Abdominal Bleeding ◽  
Uncommon Condition

Segmental arterial mediolysis (SAM) is an uncommon condition and commonly missed diagnostic aetiology of acute abdominal pain, initially described in 1976. SAM is a non-inflammatory, non-atherosclerotic vasculopathy mostly involving the abdominal arteries with notable asymmetric involvement of the walls of the mesenteric arteries and their branches. Clinical presentation ranges from postprandial abdominal discomfort suggestive of mesenteric ischaemia to intra-abdominal bleeding. Pathophysiological explanation and prognosis of these cases are not well understood and therefore no clear guidelines for management exist. In this case report, we emphasise the imaging modalities used to reach the diagnosis and the management options available.

scholarly journals Spontaneous Abdominal Bleeding from an Infundibulopelvic Ligament Tear in a Patient with Large Ovarian Fibroma

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Justin To ◽  
Cui-lan Li
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Abdominal Discomfort ◽  
Ca 125 ◽  
Surgical Removal ◽  
Ligament Tear ◽  
Ovarian Fibroma ◽  
Abdominal Bleeding ◽  
Minimally Invasive Surgical ◽  
Invasive Surgical Approach

Ovarian fibromas are rare benign solid tumors of the ovary which are often difficult to differentiate from uterine leiomyomas preoperatively. The symptoms usually include abdominal discomfort and may have ascites and/or an elevation in CA-125 levels. There have been no publications of associated abdominal bleeding to date. The treatment is surgical removal via a laparoscopic or laparotomic approach. We present a case of a 19 cm unilateral ovarian fibroma with abdominal bleeding from a spontaneous right infundibulopelvic ligament (IPL) tear who underwent a laparoscopic and mini-laparotomic right salpingo-oophorectomy. Patients with large ovarian fibromas should be cautioned that abdominal bleeding and/or acute abdominal pain can occur and that a minimally invasive surgical approach is feasible.

scholarly journals Intestinal Obstruction in a Child with Massive Ascariasis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Munanura Turyasiima ◽  
Paul Matovu ◽  
Gloria Kiconco ◽  
Walufu Ivan Egesa ◽  
Phillip Sunday ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Postoperative Management ◽  
Soft Mass ◽  
History Of ◽  
Abdominal Examination ◽  
The Tropics

Soil-transmitted helminths are so prevalent in the tropics and low developing countries. Pediatric clinical presentation of ascariasis, the most common helminth, as the intestinal obstruction is not only rare but also less described. We present a case of a 4-year-old girl with massive ascariasis. She presented with a 3-day history of acute abdominal pain associated with vomiting and an episode of passing long white roundworms, about 5 cm in length, through the nose. The child had mild constipation and passed pellets of hard stool once in the last 72 hours. She was in fair general condition at the examination but had significant findings on abdominal examination. On palpation, there was a soft mass localized in the left paraumbilical area and no tenderness, with normal bowel sounds on auscultation. Exploratory laparotomy was sanctioned where roundworms (Ascaris lumbricoides), saucepan full, were delivered through a 2.5 cm enterotomy incision. Postoperative management was carried out, and the child discharged on the 7th day of treatment including a 3-day course of albendazole 400 mg daily.

scholarly journals Rapidly progressing HELLP syndrome and massive liver destruction in a 22-year-old female pregnant with monochorionic diamniotic gemelli

2020 ◽  
Vol 13 (1) ◽  
pp. e229458
Author(s):  
Julie Brøsen ◽  
Dorte Stærk ◽  
Anne-Dorthe Feldthusen ◽  
Allan Rasmussen ◽  
Mette Brimnes Damholt
Keyword(s):  
Abdominal Pain ◽  
Hellp Syndrome ◽  
Multidisciplinary Approach ◽  
Clinical Presentation ◽  
Good Prognosis ◽  
Rapid Progression ◽  
Local Hospital ◽  
Multiple Organs ◽  
Abdominal Bleeding ◽  
Liver Parameters

Haemolysis Elevated Liver parameters and Low Platelets (HELLP) syndrome can present with abdominal pain as the only symptom. It can be rapid with failure of multiple organs and is a cause of maternal death. A 22-year-old female pregnant with twins contacted her local hospital due to abdominal pain. Within 20 hours of the debut of the abdominal pain, a caesarean section was performed, the patient was re-operated due to the suspicion of abdominal bleeding. Bescause she was hypotensive and blood tests showed signs of liver destruction and acidosis, she was transferred to the intensive care unit (ICU). During an admission of 40 days, the patient received 5 plasmapheresis treatments and 10 courses of haemodialysis. CT scans showed massive liver haematomas intraparenchymal and subcapsular. The CT scan images are very interesting and included in the case report.This case presents a good prognosis after a rapid progression of HELLP in spite of a dramatic clinical presentation. This topic is of great interest to a wide spectre of clinicians, as an early multidisciplinary approach is necessary.

scholarly journals Ovarian torsion in a 20-year-old patient

CJEM ◽  
2006 ◽  
Vol 8 (02) ◽  
pp. 126-129 ◽  
Author(s):  
Chris Martin ◽  
Kirk Magee
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Ovarian Torsion ◽  
High Index ◽  
Reproductive Age ◽  
The Difference ◽  
High Index Of Suspicion

ABSTRACTOvarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females.

scholarly journals Idiopathic Renal Infarction Mimicking Appendicitis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Marco Di Serafino ◽  
Rosa Severino ◽  
Chiara Gullotto ◽  
Francesco Lisanti ◽  
Enrico Scarano
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Heart Disease ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Good Prognosis ◽  
Renal Infarction ◽  
Renal Infarct

Renal infarction is a rare cause of referral to the emergency department, with very low estimated incidence (0.004%–0.007%). Usually, it manifests in patients aged 60–70 with risk factors for thromboembolism, mostly related to heart disease, atrial fibrillation in particular. We report a case of idiopathic segmental renal infarction in a 38-year-old patient, presenting with acute abdominal pain with no previous known history or risk factors for thromboembolic diseases. Because of its aspecific clinical presentation, this condition can mimic more frequent pathologies including pyelonephritis, nephrolithiasis, or as in our case appendicitis. Here we highlight the extremely ambiguous presentation of renal infarct and the importance for clinicians to be aware of this condition, particularly in patients without clear risk factors, as it usually has a good prognosis after appropriate anticoagulant therapy.

scholarly journals A CASE REPORT ON SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING WITH ACUTE ABDOMINAL PAIN AND THE ROLE OF IMAGING IN LUPUS MESENTERIC VASCULITIS

2021 ◽  
pp. 1-2
Author(s):  
Vemuri Naga Varaprasad ◽  
Songa Ramya
Keyword(s):  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Acute Abdominal Pain ◽  
Clinical Symptoms ◽  
Active Phase ◽  
Mesenteric Vasculitis ◽  
Common Causes ◽  
Uncommon Condition ◽  
Lupus Mesenteric Vasculitis

Acute abdominal pain is seen during the active phase in around 8-40% of SLE patients. Lupus mesenteric vasculitis (LMV) is one of the common causes of acute abdomen in SLE patients; however, it is an uncommon condition with a global prevalence of 0.2-9.7%. Clinical symptoms and laboratory parameters are non-specific in the diagnosis of LMV. Nevertheless, radiological investigations like ultrasonography and computed tomography play a role in narrowing down the differential diagnosis and excluding other non SLE causes of acute pain abdomen and aids in the management of the patient.

Abdominal Pain in Sickle Cell Anaemia

1989 ◽  
Vol 19 (4) ◽  
pp. 177-178 ◽  
Author(s):  
M G Lee
Keyword(s):  
Abdominal Pain ◽  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Clinical Judgement ◽  
Symptomatic Therapy ◽  
Management Problem ◽  
Upper Abdominal ◽  
Surgical Condition

Acute abdominal pain occurs frequently in patients with sickle cell anaemia (SCA), and presents a difficult diagnostic and management problem as the clinical presentation may mimic an acute surgical condition. Good clinical judgement and careful observation are necessary to avoid increased morbidity and mortality. Chronic recurrent upper abdominal pain is also a common problem and in many the cause is unknown. These patients usually respond to simple symptomatic therapy.

scholarly journals Torsion of Wandering Gallbladder following Colonoscopy

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Sean R. Warfe ◽  
Hannah Dobson ◽  
Matthew K. H. Hong ◽  
Weranja K. B. Ranasinghe ◽  
Peter R. Thomas ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Preoperative Diagnosis ◽  
Acute Abdominal Pain ◽  
First Case ◽  
Torsion Of The Gallbladder ◽  
Uncommon Condition ◽  
Variable Presentation

Torsion of the gallbladder is an uncommon condition that may present as an acute abdomen. Its preoperative diagnosis can often be challenging due to its variable presentation, with specific sonographic signs seen infrequently. We describe, to our knowledge, the first case of torsion of a wandering gallbladder following a colonoscopy in a 69-year-old female who presented with acute abdominal pain after procedure. This was discovered intraoperatively, and after a subsequent cholecystectomy, she had an uncomplicated recovery.

scholarly journals A Case Series on Epiploic Appendagitis: An Underdog in Acute Abdomen

2021 ◽  
Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Pradeep Joshua Christopher ◽  
Sudha Kanthasamy ◽  
Jeyakumar Sundaraj
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Case Series ◽  
Lower Abdominal Pain ◽  
Surgical Excision ◽  
Epiploic Appendagitis ◽  
Common Causes ◽  
Epiploic Appendage

Epiploic appendagitis is an uncommon yet a significant surgical diagnosis that every surgeon should be aware. It occurs due to the torsion of the epiploic appendage which gives rise to acute abdominal pain that can mimic other common causes of acute abdominal pain like appendicitis or cholecystitis. The treatment of epiploic appendagitis depend on clinical presentation, severity and it varies from conservative management to surgical excision. This case series is about eight patients presented with complaints of lower abdominal pain. After clinical examination they were initially diagnosed to have appendicitis or diverticulitis. The Computed Tomography (CT) -based diagnoses were appendicitis, omental infarct, diverticulitis or epiploic appendagitis. All of them were subjected to diagnostic laparoscopy and found to have an inflammed epiploic appendage which was excised laparoscopically.

scholarly journals Acute Abdominal Pain in Children: Causes and Development Factors

2017 ◽  
Vol 14 (1) ◽  
pp. 55-59
Author(s):  
E. A. Romanova ◽  
L. S. Namazova-Baranova ◽  
E. Yu. Dyakonova ◽  
A. Yu. Romanov ◽  
K. S. Mezhidov ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Primary Care Physicians ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Prehospital Care ◽  
Pain Syndrome ◽  
Diagnostic Methods ◽  
Problem Solution ◽  
Technical Equipment

Currently differential diagnosis of acute abdominal pain syndrome in children at prehospital care units is vital and urgent problem which requires solution. Unfortunately, embarrassing mistakes are still followed by late or inadequate treatment and complications as a result. The problem solution requires both medical stuff alert and diagnosis algorithm revision and improvement. Improvement of technical equipment and availability of instrumental diagnostic methods at the out-hospital settings is a pressing need. The article provides a classification, detailed pathogenesis, and clinical presentation of acute abdominal pain in children under different nosologies (therapeutic and surgical). We considered the problem of adequate differential diagnosis of acute abdominal pain in children when the diagnostics is performed by primary care physicians and specialists of emergency medical services at the prehospital stage.

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