Sudden Onset of Lower Abdominal Pain Without Peritonitis or Ileus

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

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Management of hemoperitoneum due to rupture of the ovarian cyst

10.25083/2559.5555/6.1.2 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6-10

Author(s):

Oana Denisa Balalau ◽

Ileana Maria Conea ◽

Nicolae Bacalbasa ◽

Anca Silvia Dumitriu ◽

Stana Paunica ◽

...

Keyword(s):

Abdominal Pain ◽

Ovarian Cyst ◽

Lower Abdominal Pain ◽

Physical Exertion ◽

Sudden Onset ◽

Reproductive Age ◽

Adnexal Torsion ◽

Ultrasound Monitoring ◽

Chemical Peritonitis ◽

Rule Out

Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.

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940 Mesenteric Haematoma Complicated by A Perforated Sigmoid Diverticulum Following Extracorporeal Shockwave Lithotripsy

British Journal of Surgery ◽

10.1093/bjs/znab134.181 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

P Sorooshian ◽

A Luangsomboon ◽

B Al-Robaie

Keyword(s):

Abdominal Pain ◽

Renal Stone ◽

Rare Complication ◽

Lower Abdominal Pain ◽

Sudden Onset ◽

Extracorporeal Shockwave Lithotripsy ◽

Shockwave Lithotripsy ◽

Extracorporeal Shockwave ◽

End Colostomy ◽

Left Hemi

Abstract A 78 year old female presented with sudden onset lower abdominal pain, vomiting and fresh rectal bleeding. She had undergone extracorporeal shockwave lithotripsy (ECSL) for a left renal stone two weeks earlier and was taking Rivaroxaban for atrial fibrillation. A CT Abdomen & Pelvis revealed a large mesenteric haematoma and a contained sigmoid perforation secondary to compressive forces of the haematoma on the sigmoid artery, resulting in ischaemia. While mesenteric angiogram-guided embolisation initially controlled the active sigmoid artery bleed, the patient clinically deteriorated the following day warranting a laparotomy. This revealed an ischaemic sigmoid colon with contained faeculent material within the mesentery. An extended left hemi-colectomy with end-colostomy was performed. Despite optimal critical care input, the patient developed multi-organ failure and passed away one week later. Mesenteric haematoma should be considered as a rare complication in patients with sudden onset abdominal pain following ECSL; especially with concurrent anti-coagulation use.

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Hypovolaemic shock due to intra-abdominal haemorrhage from multiple uterine fibroids

BMJ Case Reports ◽

10.1136/bcr-2021-241782 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241782

Author(s):

Erika Takaki ◽

Mayako Goto ◽

Kensuke Hori ◽

Kimihiko Ito

Keyword(s):

Abdominal Pain ◽

Preoperative Diagnosis ◽

Surgical Intervention ◽

Uterine Fibroids ◽

Lower Abdominal Pain ◽

Sudden Onset ◽

Abdominal Ct ◽

Hypovolaemic Shock ◽

Total Hysterectomy ◽

Abdominal Bleeding

Intra-abdominal bleeding due to uterine fibroids is extremely rare, and preoperative diagnosis is difficult. Herein, we report a case of preoperatively diagnosed hypovolaemic shock due to intra-abdominal haemorrhage, in which fatal sequelae were prevented. A 46-year-old non-pregnant woman was brought to the hospital with a sudden-onset lower abdominal pain. On admission, she was in shock, and abdominal CT showed severe intra-abdominal haemorrhage. Since bleeding from uterine fibroids was suspected, an emergency simple total hysterectomy was performed, and her condition became stable after the operation. Intra-abdominal haemorrhage with hypovolaemic shock requires prompt surgical intervention. Although it occurs very rarely due to bleeding from uterine fibroids, imaging shows large fibroids; if the patient is not pregnant, bleeding from the fibroids should be considered.

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Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0036-1593045 ◽

2016 ◽

Vol 76 (10) ◽

Author(s):

A Jurga-Karwacka ◽

GM Karwacki ◽

FD Schwab ◽

A Schötzau ◽

C Zech ◽

...

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Sudden-Onset Abdominal Pain in a 76-Year-Old Woman With Graft-vs-Host Disease

CHEST Journal ◽

10.1016/j.chest.2019.04.138 ◽

2019 ◽

Vol 156 (4) ◽

pp. e77-e79 ◽

Cited By ~ 2

Author(s):

Vishal J. Tolia ◽

Danielle N. O’Hara ◽

Kazi I. Ullah ◽

Sahar Ahmad

Keyword(s):

Abdominal Pain ◽

Sudden Onset ◽

Host Disease ◽

Graft Vs Host Disease

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Pyometra: An Atypical Cause of Abdominal Pain

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211022481 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110224

Author(s):

Leonidas Walthall ◽

Marc Heincelman

Keyword(s):

Abdominal Pain ◽

Vaginal Discharge ◽

Elderly Women ◽

Lower Abdominal Pain ◽

Endometrial Biopsy ◽

Laboratory Evaluation ◽

Inpatient Service ◽

Gynecologic Malignancy ◽

Intravenous Contrast ◽

Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01007-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Michio Itabashi ◽

Yoshiko Bamba ◽

Hisako Aihara ◽

Kimitaka Tani ◽

Ryousuke Nakagawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Lower Abdominal Pain ◽

Anterior Wall ◽

Middle Part ◽

Presacral Space ◽

Previous Surgery ◽

Afferent Limb ◽

Radiographic Findings ◽

Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Spontaneous Perinephric Urinoma Secondary to Drug Induced Acute Interstitial Nephritis: A Case Report

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1723924 ◽

2021 ◽

Author(s):

Rajesh Kumar Varatharajaperumal ◽

Rupa Renganathan ◽

V Mangalakumar ◽

Sriman Rajasekaran ◽

Venkatesh Kasi Arunachalam

Keyword(s):

Abdominal Pain ◽

Interstitial Nephritis ◽

Lower Abdominal Pain ◽

Acute Interstitial Nephritis ◽

Computed Tomography Scan ◽

Drug Induced ◽

Significant Deterioration ◽

Loin Pain ◽

Tomography Scan ◽

Collecting System

AbstractUrinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

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Roberts uterus: a rare congenital anomaly

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175304 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5657

Author(s):

Nagendra Sardeshpande ◽

Pratima Chipalkatti ◽

Jainesh Doctor

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Adnexal Mass ◽

Lower Abdominal Pain ◽

Uterine Horn ◽

Transabdominal Ultrasound ◽

Septate Uterus ◽

Bicornuate Uterus ◽

Rare Congenital Anomaly ◽

Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

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