scholarly journals Acute abdominal pain and nephrotic syndrome: pediatric case reports and review of the literature

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Giovanni Conti ◽  
Nicolina Stefania Carucci ◽  
Valentina Comito ◽  
Pietro Impellizzeri ◽  
Carmela Visalli ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Case Reports ◽  
Team Approach ◽  
Pediatric Case ◽  
Correct Treatment ◽  
Spontaneous Reduction ◽  
Primary Peritonitis ◽  
First Case

Abstract Background Acute abdominal pain in nephrotic syndrome (NS) is a well-known clinical symptom and is mainly related to peritonitis. The presence, although rare, of red umbilicus may guide the diagnosis as a suggestive sign of peritonitis also in the non-neonatal period. Instead, the association between intussusception and NS is quite limited. We reviewed all published cases in the literature, and to our knowledge, this is one of the few pediatric cases of spontaneous resolution of intussusception in the setting of NS. Finally, a review of the causes of abdominal pain during the course of NS was made. Cases presentation We report two pediatric patient cases who complained of acute abdominal pain during a relapse episode of their NS. The first case is a 4-year-old boy with NS (fourth relapse) who presented with acute abdominal pain, ascites, and red umbilicus. Our suspect of primary peritonitis was clinically confirmed because of the subsequent appearance of the classical peritoneal signs. The second case is a 4-year-old boy who developed an ileo-ileal intussusception during the treatment of his first NS relapse, with spontaneous reduction. Conclusions Gastrointestinal disorders are frequently encountered in the course of NS. The appearance of acute abdominal pain in children with NS requires quick management, both clinical and instrumental. A multidisciplinary team approach needs to be encouraged to lead to an accurate diagnosis and a correct treatment.

scholarly journals Primary Peritonitis: An Index Case of Mycoplasma hominis Infection in a Healthy Female

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Sabrina Drexel ◽  
Daniel Tseng
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Fluid ◽  
Case Reports ◽  
Uterine Fibroids ◽  
Healthy Woman ◽  
Systemic Infection ◽  
Mycoplasma Hominis ◽  
Unknown Etiology ◽  
Primary Peritonitis ◽  
First Case

Introduction. Primary peritonitis in healthy immunocompetent individuals is rare. Several case reports of Streptococcus species causing peritonitis have been described. Here, we present the first case of Mycoplasma hominis as the cause of primary peritonitis in a healthy woman. Case Report. A 42-year-old female with history of uterine fibroids was admitted with abdominal pain and intraperitoneal fluid of unknown etiology. She was initially managed nonoperatively and empirically treated with broad spectrum antibiotics. Blood and urine cultures were unrevealing. Increasing abdominal pain and peritoneal fluid prompted diagnostic laparoscopy which revealed a dense fibrinous exudate covering the entire peritoneal cavity. Peritoneal fluid and biopsies were sent for cytology and culture. The peritoneal fluid was eventually sent for 16 s ribosomal analysis, which discovered Mycoplasma hominis RNA. Her antibiotics were narrowed, and she eventually made a full recovery. Discussion. M. hominis is a rare source of systemic infection but has been known to colonize the urogenital tract and cause localized infections. This is the first presentation of M. hominis causing primary peritonitis in a healthy immunocompetent female. Multidisciplinary management of these patients is critical to achieve a timely diagnosis. Surgical exploration is often unavoidable to rule out secondary peritonitis.

scholarly journals Double Perforated Kissing Ulcers of Duodenum: A Brief Report

2019 ◽  
Vol 103 (1-2) ◽  
pp. 36-39
Author(s):  
Tania Triantafyllou ◽  
Kokoroskos Nikolaos ◽  
Papailiou Joanna ◽  
Linardoutsos Dimitrios ◽  
Zografos Georgios ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Abdominal Pain ◽  
Case Reports ◽  
Duodenal Ulcers ◽  
Ulcer Disease ◽  
Surgical Department ◽  
Helicobactor Pylori ◽  
Urgent Surgery ◽  
First Case ◽  
Chest X Ray

Helicobactor pylori infection has been associated with peptic ulcer disease and is currently treated with proton pump inhibitors (PPIs), which have reduced the complications of the disease. Perforation of either a gastric or duodenal ulcer is rarely treated with surgery. We report the case of double-perforated synchronous duodenal ulcers, which is an extremely infrequent condition. To our knowledge, no English case reports have yet been published. Therefore, awareness of the physician in the field of diagnosis and treatment of this peptic ulcer is required. We report the case of a 46-year-old male patient who presented with acute abdominal pain at the emergency surgical department of our hospital. According to patient history, smoking, alcohol consumption, and frequent postprandial abdominal pain were noted. A physical examination revealed a rigid abdomen and tachycardia, and the temperature was 37.8°C. Laboratory testing showed increased levels of leukocytes, and free subdiaphragmatic air was found in the chest X-ray. Due to rapid deterioration of his clinical condition, the patient underwent urgent surgery. An explorative laparotomy showed 2 perforated kissing ulcers at the first segment of the duodenum, in the anterior and posterior walls. A peripheral gastrectomy was performed. Postoperative follow-up did not result in any complications. In regard to this case we present, simultaneous perforation of two synchronous duodenal ulcers is an uncommon but possible incident of which the clinician should be aware. To our knowledge, this is the first case published in the literature.

An Unusual Pediatric Case of Seronegative Systemic Lupus Erythematosus Presented With Acute Abdominal Pain and Gross Hematuria

2018 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eunjee Lee ◽  
Min-Kyung Yeo ◽  
Sun kyoung You ◽  
Yeo Koon Kim ◽  
Seung Ryu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Acute Abdominal Pain ◽  
Systemic Lupus ◽  
Gross Hematuria ◽  
Pediatric Case

scholarly journals Omental Infarction: Unusual Complication after Laparoscopic Proctocolectomy

2019 ◽  
Vol 6 (4) ◽  
pp. 1-3
Author(s):  
Awni D Shahait ◽  
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Ct Scans ◽  
Unusual Complication ◽  
Patient Evaluation ◽  
Omental Infarction ◽  
First Case ◽  
Low Incidence ◽  
Uncertain Etiology ◽  
Laparoscopic Proctocolectomy

Omental Infarction is an under-explored origin of acute abdominal pain and has uncertain etiology. Because of its low incidence and nonspecific presentation, it can be difficult to diagnose. However, the increasing use of CT scans in patient evaluation has unveiled this phenomenon. We present the first case of postoperative omental infarction after laparoscopic proctocolectomy with end ileostomy in a 71-year-old male patient, who was successfully treated by removal of the infarct.

Peritonitis in Children With Nephrotic Syndrome

PEDIATRICS ◽  
1988 ◽  
Vol 81 (6) ◽  
pp. 849-856
Author(s):  
Margaret J. Gorensek ◽  
Marc H. Lebel ◽  
John D. Nelson
Keyword(s):  
Nephrotic Syndrome ◽  
Abdominal Pain ◽  
Recent Trend ◽  
Medical Center ◽  
Gram Negative ◽  
Rebound Tenderness ◽  
Primary Peritonitis ◽  
Negative Culture ◽  
Gram Negative Organisms ◽  
Nephrotic Children

In a retrospective review of 214 children with nephrotic syndrome seen at Children's Medical Center and Parkland Memorial Hospital in Dallas throughout the 20-year period from 1967 to 1986, 62 cases of primary peritonitis were identified in 37 patients (17.3% rate). Streptococcus pneumoniae was the major pathogen, accounting for 38% of the cases. An additional 27% of patients had negative culture results but were clinically responsive to penicillin. Gram-negative organisms were cultured from only 3% of patients; 5% were caused by α-streptococci and 2% each by enterococcus and anaerobes. In 23% of cases the cause was unknown. Our findings differ from the recent trend in the literature in which Gram-negative organisms associated with these infections are increasingly implicated. The incidence and bacteriology of peritonitis do not appear to have changed significantly during the 20-year period. Clinically, peritonitis was characterized by abdominal pain (98%), fever (95%), rebound tenderness (85%), and nausea and vomiting (71%). A total of 79% of patients were either in relapse or receiving steroid therapy at the time peritonitis was diagnosed; 13% had infiltrates visible on their chest radiographs. Based on our data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin. This regimen should continue until culture results are available, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which case penicillin alone should suffice.

Severe acute abdominal pain in a patient with steroid-sensitive idiopathic nephrotic syndrome

2002 ◽  
Vol 17 (10) ◽  
pp. 875-876 ◽  
Author(s):  
Benito Amil ◽  
Fernando Santos ◽  
Flor Ordoñez ◽  
Venancio Martínez ◽  
Serafín Málaga
Keyword(s):  
Nephrotic Syndrome ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Idiopathic Nephrotic Syndrome ◽  
Steroid Sensitive

scholarly journals Spontaneous Splenic Rupture in Melanoma

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Hadi Mirfazaelian ◽  
Ahmad Oryan ◽  
Aida Davari ◽  
Khosrow Daneshbod ◽  
Yahya Daneshbod
Keyword(s):  
Abdominal Pain ◽  
Malignant Melanoma ◽  
Spontaneous Rupture ◽  
Splenic Rupture ◽  
Acute Abdominal Pain ◽  
Past History ◽  
Case Reports ◽  
Metastatic Malignant Melanoma ◽  
Free Fluid ◽  
Diffuse Infiltration

Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin) confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic) rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

Metformin-Associated Exacerbation of Chronic Pancreatitis: A Possible Adverse Drug-Disease Interaction

2012 ◽  
Vol 28 (5) ◽  
pp. 208-210 ◽  
Author(s):  
Thomas G Wadsworth ◽  
Jo Kiester ◽  
E Gregory Thompson
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Case Reports ◽  
Severe Exacerbation ◽  
Metformin Therapy ◽  
First Case ◽  
Persistent Abdominal Pain ◽  
Elevated Glucose ◽  
The Right

Objective: To report a case of metformin-associated exacerbation of chronic pancreatitis and examine this possible drug-disease interaction. Case Summary: A 59-year-old woman with chronic pancreatitis (CP) experienced a severe exacerbation of her characteristic chronic abdominal pain 3 weeks after initiation and titration of metformin therapy; the exacerbation resolved upon discontinuation of metformin. The patient presented to the emergency department experiencing nausea and severe right upper quadrant abdominal pain with radiation to the right flank. Persistent abdominal pain, which had been a primary feature of CP, was previously mild and easily controlled with oral analgesics. Laboratory studies ruled out acute pancreatitis and were significant only for elevated glucose (168 mg/dL). Subsequently, she was given intravenous pain and nausea medications and discharged to home. The pain and nausea shortly returned and continued for 3 more days, at which point she telephoned her gastroenterologist, who advised that she discontinue metformin because of possible adverse reaction. Within a few days of discontinuing metformin, the nausea resolved and abdominal pain gradually returned to baseline level. Discussion: Metformin is not generally known to cause or exacerbate pancreatitis, although cases of acute pancreatitis associated with metformin therapy have been reported in the literature. No cases involving chronic pancreatitis have been reported. Consequently, metformin's prescribing guidelines do not contain precautions or contraindications for patients with chronic pancreatitis. Use of the Naranjo probability scale for assessment of this case revealed that the adverse drug effect was possible, reflecting the symptomatic resolution upon discontinuation while accounting for the lack of causative certainty, previous conclusive case reports, as well as the presence of possible nondrug causes. Conclusions: To our knowledge, this is the first case describing metformin-associated exacerbation of chronic pancreatitis. Although this occurrence may be rare, cautionary consideration, education, and monitoring should accompany initiation of metformin therapy in select patients with chronic pancreatitis.

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