scholarly journals The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon’s point of view

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Belinda De Simone ◽  
◽  
Luca Ansaloni ◽  
Massimo Sartelli ◽  
Yoram Kluger ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Operative Management ◽  
Steering Committee ◽  
Point Of View ◽  
Morbidity Rate ◽  
Web Survey ◽  
Bariatric Surgery Complications

Abstract Background The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons’ experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12–24 h, to have good outcomes and decrease morbidity rate.

scholarly journals Pregnant patient with acute abdominal pain and previous bariatric surgery

2019 ◽  
Vol 12 (8) ◽  
pp. e228962 ◽  
Author(s):  
Wouter KG Leclercq ◽  
Martine Uittenbogaart ◽  
Hendrik J Niemarkt ◽  
Judith OEH van Laar
Keyword(s):  
Bariatric Surgery ◽  
Abdominal Pain ◽  
Gestational Age ◽  
Acute Abdominal Pain ◽  
Gastric Bypass Surgery ◽  
Pregnant Patient ◽  
Internal Herniation ◽  
Diffuse Abdominal Pain ◽  
Imaging Patient

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric–obstetric–neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen’s space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.

scholarly journals Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Miral Subhani ◽  
Kaleem Rizvon ◽  
Paul Mustacchia
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Drug Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Comorbid Conditions ◽  
Endoscopic Evaluation ◽  
Number Of Patients ◽  
Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

Use of Computerized Tomography in Abdominal Pain

2018 ◽  
Vol 84 (6) ◽  
pp. 1091-1096 ◽  
Author(s):  
Astha Bhatt ◽  
Xihua Yang ◽  
Nihaal Karnik ◽  
Anne Sill ◽  
Gopal Kowdley
Keyword(s):  
Abdominal Pain ◽  
Incidental Findings ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Fold Increase ◽  
The United States ◽  
Presenting Symptoms ◽  
Left Flank Pain ◽  
Level Of Agreement

Annually, approximately 70 million computed tomography (CT) scans are performed in emergency department (ED) settings in the United States of America. From 1995 to 2007, there has been a 5.9-fold increase in the use of CTscans nationally. The radiation risks and high costs associated with CTscans underscore the fact that the imaging modality, although necessary, carries a myriad of long-term risks to both patients and providers. For the workup of abdominal pain, most algorithms include the use of CTscan as an early step. To understand better the use of CTscans in our ED, we performed a retrospective review of patients presenting to the ED with abdominal pain. Two main questions were addressed: 1) what were the reasons for scans and how often did the scans reveal pathology related to the presenting symptoms, 2) how often were incidental findings identified. Our results showed that among patients presenting with abdominal pain to the ED, 50 per cent of the scans were normal, about 20 per cent of the patients had findings correlating with acute abdominal pain, whereas the rest (30%) had incidental findings that may have led to further outpatient studies or long standing abdominal pain. Most patients who presented to the ED had nonspecific abdominal pain i.e. 64.4 per cent. There was a low agreement between the presenting quadrant of pain and final pathological diagnosis (9.5–33.3% concordance), with left flank pain presentation having the highest level of agreement with the final pathologic diagnosis.

Involvement of stakeholders during the preparedness phase of post-accident situation management

2021 ◽  
pp. 014664532110068
Author(s):  
J.M. Bertho ◽  
F. Gabillaud-Poillion ◽  
C. Reuter ◽  
O. Rivière ◽  
J.L. Lachaume
Keyword(s):  
Civil Society ◽  
Steering Committee ◽  
Point Of View ◽  
Nuclear Operators ◽  
Accident Management ◽  
New Strategy ◽  
Working Groups ◽  
Technical Issues ◽  
Set Up

The Steering Committee for Post-accident Management Preparedness (CODIRPA) was commissioned by the French Government in 2005 with the aim of establishing the main principles to be set up for population protection and recovery in the long term. From the beginning, one of the main principles was the pluralistic nature of the working groups (WGs), including scientific and technical experts, representatives from state departments, nuclear operators, and representatives of civil society (i.e. stakeholders). Stakeholders were mainly associated with the various WGs of CODIRPA. In order to foster the involvement of stakeholders from civil society in the works of CODIRPA, a new organisation was implemented with two WGs: one mainly composed of technical experts for tackling technical issues, and one for evaluating the proposals made by the experts from the stakeholders’ point of view. This article presents the results of this new strategy.

scholarly journals Non Traumatic Acute Abdominal pain (100 days study in Emergency Department)

2019 ◽  
Vol 13 (2) ◽  
pp. 83-90
Author(s):  
Taqi Saadoon Atiyah
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Old Patients ◽  
Abdominal Symptoms ◽  
Medical City

Background: Abdominal symptoms are possibly the most frequent of all symptoms encountered in surgical practice.  Pain is the most common of all abdominal symptoms.  Causes of acute abdominal pain include both medical and surgical. Most symptoms arise from intra-abdominal organs or systems while some may originate extra abdominally and are then referred to the abdomen. Medical causes of abdominal pain are encountered more frequently. Objective: To study the causes of acute abdominal pain in patients attending emergency department in Al- Imamain Al- Kadhimain Medical City. Type of the study: A prospective cross sectional study Methods: The patients attending Emergency Department in Al- Imamain Al- Kadhimain Medical City over the period from April-2014 to April 2016. There was a one day call duty per week managed by the same surgical team (total one hundred days study). Onlypatients above 12 years old with acute non-traumatic abdominal pain were included in this study. Results: The total number was 1217 patients over hundred days study. Their age ranges from 12-83 years; average age was 36.18 ±17 year. There was slight female predominance, 638 (52.42%) female patients and 579 (47.58%) male patients.  The most common cause of abdominal pain was acute appendicitis 252 (20.70%), followed by ureteric colic 251 (20.62%), and acute cholecystitis249 (20.46%). Conservative management was done for 836 (68.69%) patients, while operative management done for 379 (31.14%) patients.  Postoperative mortality was 8 (2.11%) patients.Medical causes of acute abdominal pain were found in 48 (5.74%) patients. Conclusion: Not all the patients attending surgical emergency department needs operations. Causes of acute abdominal pain include both medical and surgical diseases, some of the medical diseases are very serious like acute viral hepatitis, myocardial infarction , and diabetic ketoacidosis; and should not submit those patients to unnecessary operations with serious and may be fatal postoperative complications. General urine examination is a must in all patients with acute abdominal pain. Electrocardiography (ECG) may be needed in old patients.

scholarly journals Recurrent and acute abdominal pain as the main clinical manifestation in patients with hereditary angioedema

2021 ◽  
Vol 42 (2) ◽  
pp. 131-135
Author(s):  
Yang Cao ◽  
Shuang Liu ◽  
Yuxiang Zhi
Keyword(s):  
Abdominal Pain ◽  
Hereditary Angioedema ◽  
Acute Abdominal Pain ◽  
Clinical Symptoms ◽  
Gastrointestinal Diseases ◽  
Chinese Patients ◽  
Abdominal Symptoms ◽  
Before And After ◽  
Delay Of Diagnosis

Background: Hereditary angioedema (HAE) is a rare disease that often leads to misdiagnosis. The delay of diagnosis is > 10 years in China. Recurrent and acute abdominal pain is one of the common symptoms of HAE. Because of the high misdiagnosis rate, it usually results in unnecessary surgical procedures. This study focused on the clinical symptoms and management of HAE-related abdominal attacks in Chinese patients to provide some new insight for the emergency department (ED) physicians and gastroenterologists. Methods: A Web-based survey was conducted among 107 patients with HAE from 94 unrelated families. Detailed questions with respect to the abdominal attacks were asked, including the frequency, symptoms, and duration before and after confirmed diagnosis. The demographic characteristics, diagnosis process, and treatment outcomes were also included. Results: Approximately 70% of the patients with HAE presented with abdominal symptoms during the onset of edema, mostly characterized by pain (94.8%), nausea (83.1%), vomiting (83.1%), diarrhea (59.7%), and constipation (23.4%). The patients were easily misdiagnosed as having gastroenteritis (35.1%) and appendicitis (10.4%), and 24.7% of them received unnecessary appendectomy or laparotomy. Danazol, a widely used drug for long-term prophylaxis of HAE in China, can reduce the attack frequency and alleviate the abdominal symptoms, but the adverse effects are also significant and more severe in women. Conclusions: Abdominal symptoms are common and important clinical features of HAE but are easily confused with other gastrointestinal diseases. ED physicians and gastroenterologists should consider HAE when patients experience recurrent and unexplained abdominal pain. Proper medical treatment should be administered in a timely manner if an HAE diagnosis is confirmed and efforts are required to increase access in China to medications both for on-demand treatment and long-term prophylaxis.

scholarly journals Obstructive Ileus Secondary to Acute Mesenteric Ischaemia: Internal Medicine Perspective

2021 ◽  
Vol 22 (1) ◽  
pp. 74-78
Author(s):  
M Rosyid Narendra ◽  
Herry Purbayu
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Signs And Symptoms ◽  
Point Of View ◽  
Blood Flows ◽  
Threatening Condition ◽  
Life Threatening ◽  
Obstructive Ileus

Acute mesenteric ischemia (AMI) could be a rare but potentially life-threatening condition due to poor understanding of the clinical presentation of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. A 59 years old man was brought to the hospital with abdominal pain, accompanied by obstructive ileus and sepsis. An urgent CT-scan showed the feature of intestinal infarction and portal vein thrombus. After giving fluid resuscitation and antibiotic injection, he was consulted to the surgery division and had jejunum resection. Since the etiology of the disease was suspected to be acute mesenteric venous thrombosis, he was given intravenous anticoagulants postoperatively and the condition improved. The clinical diagnosis of acute mesenteric ischemia is troublesome, and in most cases, abdominal pain is the main symptom. Ileus and sepsis are two complications that may mask the initial signs and symptoms of AMI. From the internal medicine’s point of view, the proper treatment of this disease is early diagnosis, the rebuilding of blood flows with anticoagulants, surgery division discussion, and post-operative supportive care. The underlying cause should be established to determine long-term management essential to anticipate a repeat.

scholarly journals Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum

2019 ◽  
Vol 12 (8) ◽  
pp. e229769
Author(s):  
Jelle E Bousema ◽  
Koen M van de Luijtgaarden ◽  
Suzanne Wilhelmus ◽  
Marijn M Poelman
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Asbestos Exposure ◽  
Lower Abdominal Pain ◽  
Common Symptom ◽  
Abdominal Ultrasonography ◽  
Acute Ischaemia ◽  
Long Term Prognosis ◽  
Well Differentiated

Acute abdominal pain is a common symptom in young women. We describe a patient with acute illness and severe lower abdominal pain. Laboratory tests were normal except for mildly deranged inflammatory markers. No abnormalities were reported on abdominal ultrasonography and MRI, whereas diagnostic laparoscopy revealed a tumour located dorsally from the uterus. We resected the tumour and pathology results showed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). Microscopy showed evidence of acute ischaemia in the resected lesion, which was likely the cause of the acute abdominal pain. WDPMP is a rare disease that arises from the serous membranes which does not seem to have a relation to asbestos exposure. Generally, WDPMP has a mild clinical course and good long-term prognosis.

In the Era of Routine Use of CT Scan for Acute Abdominal Vain, Should All Adults with Small Bowel Intussusception Undergo Surgery?

2009 ◽  
Vol 75 (10) ◽  
pp. 958-961 ◽  
Author(s):  
Jaisa Olasky ◽  
Ashkan Moazzez ◽  
Kaylene Barrera ◽  
Tatyan Clarke ◽  
Jabi Shriki ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Acute Abdominal Pain ◽  
Operative Management ◽  
Lead Point ◽  
Small Bowel Intussusception

In contrast to adult colonic intussusception in which malignancy is the dominant cause, small bowel intussusceptions are mostly benign. Although surgery is the accepted standard treatment, its necessity in small bowel intussusceptions identified by CT scan is unknown. Twenty-three patients from 2005 to 2008 (16 males; median age, 44 years) with acute abdominal pain and CT-proven small bowel intussusception were studied. Factors associated with the necessity for surgery were determined. Among 11 patients who were managed operatively, surgery was deemed unnecessary in two patients based on negative explorations. Follow up in 10 of 12 patients managed nonoperatively was not associated with any recurrence of intussusception or malignancy (median follow up, 14 months). The only predictor of the need for surgery was CT evidence of small bowel obstruction and/or a radiologically identified lead point, which was present in 7 of 9 (78%) patients having a necessary operation and absent in 12 of 14 (86%) with no indication for surgery (P = 0.008). All small bowel intussusceptions found on CT scan in patients with acute abdominal pain do not require operative management. CT findings of small bowel obstruction and/or presence of a lead point are indications for surgery.

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