Ureterocele as a cause of chronic intractable abdominal pain

2021 ◽  
Vol 14 (11) ◽  
pp. e245262
Author(s):  
Gaurav Chauhan ◽  
Isaiah Levy ◽  
Samuel Wadie Samuel
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Characteristics ◽  
Incidental Finding ◽  
Obstructive Uropathy ◽  
Therapeutic Interventions ◽  
Pain Clinic ◽  
Diagnostic Challenge ◽  
Underlying Disorder ◽  
Chronic Pain Clinic

A ureterocele is a submucosal, cystic dilation of the terminal ureter, either congenital or acquired, as it enters the bladder. It is a rare clinical entity that can be entirely asymptomatic and present as an incidental finding or can manifest in the form of distressing symptoms such as unremitting abdominal pain, haematuria, obstructive uropathy, to name a few. The authors present a case of abdominal pain in a 43-year-old woman who was presumptively attributed to various clinical entities and was finally referred to the chronic pain clinic. The patient underwent numerous diagnostic tests, psychological evaluations and therapeutic interventions, including surgeries, over the years that failed to mitigate her symptoms until urologic imaging reported intravesical ureterocele as the underlying disorder. The case report entails the diagnostic challenge faced by the authors along with the clinical characteristics of ureterocele.

scholarly journals A Giant Egg-like symptomatic Loose Body in the Peritoneal Cavity: A Case Report

1970 ◽  
Vol 29 (6) ◽  
Author(s):  
Berhanetsehay Teklewold ◽  
Anteneh Kehaliw ◽  
Melat Teka ◽  
Bereket Berhane
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Incidental Finding ◽  
Loose Body ◽  
Loose Bodies ◽  
Diagnostic Challenge ◽  
First Case ◽  
Appendices Epiploicae ◽  
The One ◽  
High Index Of Suspicion

Background: Peritoneal loose bodies are rare lesions that are usually found as an incidental finding during abdominal surgery. Large loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. Peritoneal loose bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity.Case Presentation: We report here the first case, in the local Ethiopian context, of a giant “egg-like” loose peritoneal body measuring 7 × 6 cm found in a 50-year-old man who presented with a cramping abdominal pain and features of abdominal obstruction. The current hypothesis as regards these bodies and the diagnostic challenges is discussed.Conclusion: Small peritoneal loose bodies are common but giant and symptomatic ones’, like the one discussed here, are very rare and a diagnostic challenge. And, in the context of intestinal obstruction, a high index of suspicion is needed in order to diagnose them.

Outcome of patients with chronic abdominal pain referred to chronic pain clinic

2000 ◽  
Vol 95 (7) ◽  
pp. 1812-1816 ◽  
Author(s):  
Thomas J. McGarrity ◽  
David J. Peters ◽  
Christopher Thompson ◽  
Susan J. McGarrity
Keyword(s):  
Chronic Pain ◽  
Abdominal Pain ◽  
Chronic Abdominal Pain ◽  
Pain Clinic ◽  
Chronic Pain Clinic

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals NeuroTec Sitem-Insel Bern: Closing the Last Mile in Neurology

2021 ◽  
Vol 5 (2) ◽  
pp. 13
Author(s):  
Kaspar A. Schindler ◽  
Tobias Nef ◽  
Maxime O. Baud ◽  
Athina Tzovara ◽  
Gürkan Yilmaz ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Current Model ◽  
Disease Process ◽  
Therapeutic Interventions ◽  
Sleep Studies ◽  
Last Mile ◽  
Specialized Equipment ◽  
The One ◽  
Treatment Procedures ◽  
Digital Biomarkers

Neurology is focused on a model where patients receive their care through repeated visits to clinics and doctor’s offices. Diagnostic tests often require expensive and specialized equipment that are only available in clinics. However, this current model has significant drawbacks. First, diagnostic tests, such as daytime EEG and sleep studies, occur under artificial conditions in the clinic, which may mask or wrongly emphasize clinically important features. Second, early detection and high-quality management of chronic neurological disorders require repeat measurements to accurately capture the dynamics of the disease process, which is impractical to execute in the clinic for economical and logistical reasons. Third, clinic visits remain inaccessible to many patients due to geographical and economical circumstances. Fourth, global disruptions to daily life, such as the one caused by COVID-19, can seriously harm patients if access to in-person clinical visits for diagnostic and treatment purposes is throttled. Thus, translating diagnostic and treatment procedures to patients’ homes will convey multiple substantial benefits and has the potential to substantially improve clinical outcomes while reducing cost. NeuroTec was founded to accelerate the re-imagining of neurology and to promote the convergence of technological, scientific, medical and societal processes. The goal is to identify and validate new digital biomarkers that can close the last mile in neurology by enabling the translation of personalized diagnostics and therapeutic interventions from the clinic to the patient’s home.

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

2020 ◽  
pp. 1-5
Author(s):  
João Machado Nogueira ◽  
Inês Fonseca ◽  
Marco Duarte
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Symptoms ◽  
Definitive Diagnosis ◽  
Hot Water ◽  
Illustrative Case ◽  
Raising Awareness ◽  
Detailed Medical History ◽  
Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

Central sensitization in chronic lumbar spine pain – possibilities of therapeutic interventions

Ból ◽  
2020 ◽  
Vol 21 (2) ◽  
pp. 45-53
Author(s):  
Barbara Kosińska ◽  
Paweł Turczyn ◽  
Krzysztof Wesołowski ◽  
Beata Tarnacka ◽  
Małgorzata Malec-Milewska
Keyword(s):  
Low Back Pain ◽  
Central Sensitization ◽  
Diagnostic Tests ◽  
Multimodal Therapy ◽  
Underlying Mechanism ◽  
Therapeutic Interventions ◽  
Low Back ◽  
Pain Mechanisms ◽  
Factors Affecting ◽  
Spine Pain

Patients with chronic low back pain are a heterogeneous group. Therapeutic management of these patients should address the underlying mechanism of pain, which can be revealed after performing diagnostic tests. The management of patients with the predominant central sensitization component of includes multimodal therapy consisting of pharmacological and non-pharmacological treatment. An important element is also the identification and exclusion of the most important pathophysiological factors affecting the maintenance of central sensitization mechanisms in each patient. The paper describes pharmacological and non-pharmacological therapeutic options in patients with central sensitization component, considering that these methods may differ significantly in the patients. It should be stated that despite the individualized, multimodal therapy based on pain mechanisms, in some patients substantial pain relief may not be achieved.

scholarly journals The Positive Predictive Value of Diagnostic Ultrasound for Occult Herniae

2006 ◽  
Vol 88 (2) ◽  
pp. 165-167 ◽  
Author(s):  
M Bradley ◽  
J Morgan ◽  
B Pentlow ◽  
A Roe
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Diagnostic Tests ◽  
Diagnostic Ultrasound ◽  
Pain Clinic ◽  
Diagnostic Problem ◽  
Clinical Criteria ◽  
Negative Results ◽  
Positive Results

INTRODUCTION The aim of this study is to ascertain the accuracy of diagnostic ultrasound in the assessment of the occult abdominal and groin herniae. The authors have previously demonstrated its efficacy in diagnosing the type of clinical groin herniae but occult herniae provide a further diagnostic problem. PATIENTS AND METHODS A total of 113 consecutive patients were referred prospectively for ultrasound examinations with clinically suspected occult herniae. All positive scans were offered surgery whilst the negative results were offered further imaging or other diagnostic tests depending on the clinical criteria. The end point for negative scans was based on 18-month follow-up or resolution of symptoms. RESULTS Overall, 59 scans showed positive results for herniae and 56 of these had surgery. In the other three patients, two refused an operation, and one had no hernia detected at operation. In the remaining 57 scans, ultrasound offered alternative soft tissue diagnoses in 23 patients and surgical/endoscopic diagnoses accounted for a further 8 patients. CONCLUSIONS Ultrasound offered a diagnosis for the symptomology in 82 patients (70.6%) of which 59 were herniae. The positive predictive value for hernia is 98.3%. Twenty-six patients with no diagnosis or confirmation of herniae on follow-up showed symptom resolution in 22 cases, and four patients were treated by the pain clinic.

Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP)

2018 ◽  
Vol 14 (4) ◽  
pp. 268-275
Author(s):  
Arun Sondhi ◽  
Tina Garrett
Keyword(s):  
Cancer Pain ◽  
Substance Misuse ◽  
Emotional Health ◽  
Secondary Analysis ◽  
Therapeutic Interventions ◽  
Pain Clinic ◽  
Practical Implementation ◽  
Physical And Mental Health ◽  
Content Type ◽  
Female Patients

Purpose Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues. Design/methodology/approach Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis. Findings Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions. Social implications The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered. Originality/value Few studies of CNCP have been conducted within a prison environment.

scholarly journals The Effect of Initiatives to Overcome Language Barriers and Improve Attendance: A Cross-Sectional Analysis of Adherence in an Inner City Chronic Pain Clinic

Pain Medicine ◽  
2016 ◽  
Vol 18 (2) ◽  
pp. 265-274 ◽  
Author(s):  
Michael H. Andreae ◽  
Robert S. White ◽  
Kelly Yan Chen ◽  
Singh Nair ◽  
Charles Hall ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inner City ◽  
Language Barriers ◽  
Pain Clinic ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
Chronic Pain Clinic

scholarly journals Intraocular Tuberculosis

2013 ◽  
Vol 47 (4) ◽  
pp. 193-201 ◽  
Author(s):  
Swapnil Parchand ◽  
Vishali Gupta
Keyword(s):  
Diagnostic Tests ◽  
Early Stage ◽  
Specific Treatment ◽  
Good Prognosis ◽  
Molecular Diagnostic ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Challenge ◽  
Global Epidemiology ◽  
Tuberculosis Therapy ◽  
Intraocular Tuberculosis

ABSTRACT Intraocular tuberculosis remains a major diagnostic challenge and it is extremely important to establish the diagnosis as the specific treatment helps in reducing the recurrences, thus reducing ocular morbidity. The present review aims to describe the global epidemiology and pathogenesis of intraocular tuberculosis with clinical spectrum and different presentations. The challenges in establishing the diagnosis with role of conventional tests like PPD skin test as well as current diagnostic tests including interferon gamma release assay and molecular diagnostic tests are discussed. The treatment requires anti-tuberculosis therapy with the use of concomitant corticosteroids and carries good prognosis provided the treatment is started in the early stage. How to cite this article Parchand S, Gupta V, Gupta A, Sharma A. Intraocular Tuberculosis. J Postgrad Med Edu Res 2013;47(4):193-201.

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