scholarly journals ACUTE ABDOMEN systemic sonographic approach to acute abdomen in emergency department: a case series

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Maryam Al Ali ◽  
Sarah Jabbour ◽  
Salma Alrajaby
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Patient Management ◽  
Physical Exam ◽  
Bedside Ultrasound ◽  
Free Fluid ◽  
Bowel Loop ◽  
Point Of Care Ultrasound ◽  
Diagnosis And Management ◽  
History Of

Abstract Background Acute abdomen is a medical emergency with a wide spectrum of etiologies. Point-of-care ultrasound (POCUS) can help in early identification and management of the causes. The ACUTE–ABDOMEN protocol was created by the authors to aid in the evaluation of acute abdominal pain using a systematic sonographic approach, integrating the same core ultrasound techniques already in use—into one mnemonic. This mnemonic ACUTE means: A: abdominal aortic aneurysm; C: collapsed inferior vena cava; U: ulcer (perforated viscus); T: trauma (free fluid); E: ectopic pregnancy, followed by ABDOMEN which stands: A: appendicitis; B: biliary tract; D: distended bowel loop; O: obstructive uropathy; Men: testicular torsion/Women: ovarian torsion. The article discusses two cases of abdominal pain the diagnosis and management of which were directed and expedited as a result of using the ACUTE–ABDOMEN protocol. The first case was of a 33-year-old male, who presented with a 3-day history of abdominal pain, vomiting and constipation. Physical exam revealed a soft abdomen with generalized tenderness and normal bowel sounds. Laboratory tests were normal. A bedside ultrasound done using the ACUTE–ABDOMEN protocol showed signs of intussusception. This was confirmed by CT-abdomen. The second case was of a 70-year-old female, a known case of diabetes and hypertension, who presented with a 3-hour history of abdominal pain, vomiting and diarrhea. She had a normal physical exam and laboratory studies. Her symptoms mimicking simple gastroenteritis had improved. However, bedside ultrasound, using the ACUTE–ABDOMEN protocol showed localized free fluid with dilated small bowel loop in right lower quadrant with absent peristalsis. A CT abdomen confirmed a diagnosis of intestinal obstruction. These two cases demonstrate that the usefulness of applying POCUS in a systematic method—like the “ACUTE–ABDOMEN” approach—can aid in patient diagnosis and management. Case presentation We are presenting two cases of undifferentiated acute abdomen pain, where ACUTE ABDOMEN sonographic approach was applied and facilitated the accurate patient management and disposition. Conclusion ACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.

scholarly journals Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue Zhang ◽  
Shuo Yuan ◽  
Rami W. A. Alshayyah ◽  
Wankai Liu ◽  
Yang Yu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Urinary Bladder ◽  
Antibiotic Therapy ◽  
Acute Abdomen ◽  
Spontaneous Rupture ◽  
Bladder Tumor ◽  
Bladder Rupture ◽  
Intraperitoneal Rupture ◽  
History Of ◽  
Ct Cystography

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB.Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords “spontaneous bladder rupture” or “spontaneous rupture of bladder” or “spontaneous rupture of urinary bladder.” All statistical analyses were conducted using SPSS 20.0 software.Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment.Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

Adolescent with abdominal pain poorly responsive to analgesia

2020 ◽  
pp. edpract-2020-320772
Author(s):  
Neil Chanchlani ◽  
Philip Jarvis ◽  
James W Hart ◽  
Christine H McMillan ◽  
Christopher R Moudiotis
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
White Cell Count ◽  
Autism Spectrum ◽  
Free Fluid ◽  
List Type ◽  
Reactive Protein ◽  
Normal Limits ◽  
History Of ◽  
Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

scholarly journals Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

2020 ◽  
Vol 7 (5) ◽  
pp. 1623
Author(s):  
Ruru Ray ◽  
Ann Sunny ◽  
Giridhar Ashwath ◽  
Anthony Prakash Rozario ◽  
Rahul Sima
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Surgical Intervention ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Abdominal Abscess ◽  
Short History ◽  
Omental Infarction ◽  
History Of

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

scholarly journals An Ovarian Pregnancy in a Patient with a History of Bilateral Salpingectomies: A Rare Case

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Sadia Khandaker ◽  
Pranav Chitkara ◽  
Eric Cochran ◽  
Jed Cutler
Keyword(s):  
Abdominal Pain ◽  
Emergency Room ◽  
Rare Case ◽  
Adnexal Mass ◽  
Case Reports ◽  
Free Fluid ◽  
Ovarian Pregnancy ◽  
History Of ◽  
Multiple Case ◽  
Ectopic Pregnancies

Background. 1 in 200 ectopic pregnancies are true ovarian pregnancies that fulfill the Spiegelberg criteria. Despite being rare, multiple case reports and series have been reported. Few cases have been published in which the event was preceded by salpingectomy.Case. The patient is a 32-year-old female who presented to the emergency room with abdominal pain. She was found to be pregnant, despite a history of two previous ectopic pregnancies treated with salpingectomies. Sonography confirmed a left adnexal mass and free fluid. Surgery revealed a ruptured ovarian pregnancy which was also confirmed by pathology.Conclusion. This is a case of an ovarian pregnancy in a patient with two previous salpingectomies. It underscores the importance of searching for an ectopic pregnancy in patients with abdominal pain after fertility impairing surgery.

scholarly journals Can I Be Pregnant? – Diagnostic Challenges in Ruptured Chronic Ectopic Pregnancy

2021 ◽  
Vol 16 (2) ◽  
pp. 301-308
Author(s):  
Bhasyani Nagaretnam ◽  
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Acute Abdomen ◽  
Free Fluid ◽  
Operation Theatre ◽  
Pregnancy Test ◽  
Obstetric Emergency ◽  
Child Bearing ◽  
Urine Pregnancy Test

Ectopic pregnancy is an obstetric emergency which accounts for 4% of all pregnancy-related deaths. All women of child bearing age with abdominal pain or vaginal bleeding presenting to the Emergency Department should be evaluated for ectopic pregnancy. However, there have been many reported cases of diagnostic challenges of ectopic pregnancy. One rare variant of ectopic pregnancy that can be easily overlooked is chronic ectopic pregnancy. We present this case of a 39-yearold female, who presented with acute abdomen and free fluid in her abdomen. Urine pregnancy test indicated she was not pregnant. However, intraoperative findings confirmed left tubular pregnancy. We would like to highlight three major diagnostic challenges we faced in this case i.e.; (i) women of child bearing age with abdominal pain should always be evaluated for ectopic pregnancy; (ii) diagnosis of ectopic pregnancy should not be dismissed even though the pregnancy test is negative; and (iii) the role of computed tomography (CT) scan in acute abdomen of unclear aetiology. As a rule, all haemodynamically unstable acute abdomen should be sent to the operation theatre. Haemodynamically stable patients should be carefully evaluated to facilitate surgical management.

scholarly journals Laparoscopy in acute abdomen between encouragement and inhibition

2019 ◽  
Vol 6 (10) ◽  
pp. 3507
Author(s):  
Mena Zarif Helmy ◽  
Ahmed Abdel Kahaar Aldardeer
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Acute Abdominal Pain ◽  
Past History ◽  
Abdominal Distension ◽  
X Ray ◽  
Main Complaint ◽  
Number Of Patients ◽  
History Of

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study.Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

Abdominal Trauma - Child Abuse

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 892-892
Author(s):  
MARCIA DWORKIND ◽  
GEORGE MCGOWAN ◽  
JEFFREY HYAMS
Keyword(s):  
Differential Diagnosis ◽  
Child Abuse ◽  
Abdominal Pain ◽  
Acute Abdomen ◽  
Abdominal Trauma ◽  
Acute Onset ◽  
Severe Abdominal Pain ◽  
Midgut Volvulus ◽  
Incarcerated Hernia ◽  
History Of

To the Editor.— The development of severe abdominal pain and vomiting in an infant is frequently an ominous event with a large differential diagnosis including midgut volvulus, intussusception, and incarcerated hernia. Recently we cared for an infant who developed an acute abdomen as a result of child abuse which was not appreciated until after laparotomy. A 3-month-old girl was transferred to our hospital with a history of an acute onset of vomiting, diarrhea, fever, and lethargy.

scholarly journals A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis byDokdonella koreensis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Jamie Bee Xian Tan ◽  
Alvin Ren Kwang Tng ◽  
Htay Htay
Keyword(s):  
Renal Failure ◽  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Tract Infection ◽  
Patient Management ◽  
Significant Morbidity ◽  
Exit Site ◽  
First Case ◽  
Rrna Sequencing ◽  
History Of

Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsingDokdonella koreensisperitonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yieldedDokdonella koreensiswhich was initially misidentified asWeeksella virosaandBrevundimonasspecies by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.

scholarly journals A rare case of lupus-related gastrointestinal vasculitis presenting as rectal gangrene

2019 ◽  
Vol 2019 (4) ◽  
Author(s):  
Yi Liang ◽  
Angelina Di Re ◽  
Toufic El Khoury
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Acute Abdomen ◽  
Case Studies ◽  
Lupus Erythematosus ◽  
Rare Case ◽  
Rare Condition ◽  
Free Fluid ◽  
Systemic Lupus ◽  
Current Case

Abstract Systemic lupus erythematosus (SLE) related gastrointestinal vasculitis is a rare condition limited to case studies within the literature however, no cases of rectal gangrene and perforation have been previously described. A 32-year-old male presented with abdominal pain, vomiting and fevers. CT demonstrated free gas and free fluid around the rectum indicative of a perforation. He proceeded to urgent laparotomy, confirming a diagnosis of rectal infarction and perforation. Uniquely, the involved segment of gangrene extended from the rectosigmoid to the anorectal junction. A Hartmanns procedure was performed. Histopathology confirmed underlying stenosis of the rectal arteries secondary to chronic vasculitis related to the affected areas. The current case is a unique presentation of SLE-related vasculitis. It highlights the need to judiciously investigate SLE patients presenting with surgical acute abdomen.

scholarly journals Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain

2020 ◽  
Vol 19 (1) ◽  
pp. 49-51
Author(s):  
Jamaji C Nwanaji-Enwerem ◽  
◽  
Adaira Landry ◽  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Point Of Care ◽  
Sudden Onset ◽  
Point Of Care Ultrasound ◽  
Intermittent Abdominal Pain ◽  
Obesity Status ◽  
History Of ◽  
History Of Obesity ◽  
New Onset

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.

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