scholarly journals Missed Diagnosis of Cholangiocarcinoma Presenting with Atypical Symptoms

2021 ◽  
Author(s):  
Ren Kawamura ◽  
Yukinori Harada ◽  
Taro Shimizu
Keyword(s):  
Abdominal Pain ◽  
Distribution Pattern ◽  
Diagnostic Test ◽  
Acute Abdominal Pain ◽  
Delayed Diagnosis ◽  
Referred Pain ◽  
Good Communication ◽  
Atypical Symptoms ◽  
Missed Diagnosis ◽  
Prompt Diagnosis

We report a case of delayed diagnosis of cholangiocarcinoma. A 62-year-old man developed acute abdominal pain in multiple sites. As the distribution pattern of the abdominal pain was not correctly interpreted based on the mechanisms of visceral and referred pain, the patient was not investigated with the best diagnostic test at first presentation. Moreover, miscommunication between physicians in a clinic and separate hospital delayed diagnosis. For prompt diagnosis, physicians should be practice careful reasoning and focus on good communication with physicians outside their hospital.

scholarly journals Paediatric ovarian torsion: a case report and review of literature

2020 ◽  
Vol 9 (6) ◽  
pp. 2638
Author(s):  
Umang . ◽  
Harleen Kaur Cheema ◽  
Sidharth Khullar ◽  
Madhu Nagpal
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Conservative Surgery ◽  
Ovarian Torsion ◽  
High Clinical Suspicion ◽  
Abdominal And Pelvic Pain ◽  
Intra Abdominal Infection ◽  
Prompt Diagnosis

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.

scholarly journals Wandering spleen with torsion presenting as a rare case of acute abdomen

2021 ◽  
Vol 5 (4) ◽  
pp. 09-12
Author(s):  
Solomon Bekele Abebe ◽  
◽  
Yonas Ademe Teferi ◽  
Henok T/Silassie Zeleke
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Rare Case ◽  
Acute Abdominal Pain ◽  
Abdominal Mass ◽  
Chronic Abdominal Pain ◽  
Wandering Spleen ◽  
Vascular Pedicle ◽  
Prompt Diagnosis

Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy

scholarly journals Congenital Internal Hernia: Rare Cause of Acute Abdominal Pain

2021 ◽  
pp. 791-794
Author(s):  
Jay Patel ◽  
Antoine Hamedi ◽  
Muhammad Khalil ◽  
Jessica El-Bahri
Keyword(s):  
Abdominal Pain ◽  
Early Diagnosis ◽  
Internal Hernia ◽  
Poor Prognosis ◽  
Surgical Intervention ◽  
Acute Abdominal Pain ◽  
Rare Condition ◽  
Internal Hernias ◽  
Congenital Internal Hernia ◽  
Prompt Diagnosis

Acute abdominal pain is a common presenting symptom that possesses a wide differential. Congenital internal hernias are a rare condition that often presents with abdominal pain and can lead to obstruction. Early diagnosis is often difficult and therefore can present acutely and in an emergent setting. Prompt recognition of symptoms and evaluation are important to prevent poor prognosis. We are presenting a case of a congenital internal hernia in a patient presenting with nonspecific symptoms. Prompt diagnosis and subsequent surgical intervention allowed for appropriate management and resolution of symptoms.

scholarly journals Spontaneous Hemoperitoneum from a Ruptured Superficial Uterine Vessel in Third Trimester of Pregnancy

1970 ◽  
Vol 23 (1) ◽  
pp. 32-34
Author(s):  
Khairun Nahar ◽  
Hamida Begum ◽  
Mahmuda Khatun
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Hypovolemic Shock ◽  
Exploratory Laparotomy ◽  
Posterior Surface ◽  
Third Trimester ◽  
Uterine Vessel ◽  
Spontaneous Hemoperitoneum ◽  
Operative Recovery ◽  
Prompt Diagnosis

Spontaneous hemoperitoneum in third trimester of pregnancy is a very rare but lethal condition which demands prompt diagnosis and management for the survival of both mother and fetus. A 30 years old multipara woman presented at 34 weeks of pregnancy with acute abdominal pain and hypovolemic shock. Emergency exploratory laparotomy was done; an asphyxiated baby was born by cesarean section. One of multiple engorged superficial vessels on posterior surface of the uterus was found bleeding actively, which was then sutured. Post operative recovery of the patient was good.   doi: 10.3329/bjog.v23i1.3055   Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 32-34

scholarly journals Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes

2020 ◽  
Vol 9 (4) ◽  
pp. 899
Author(s):  
Isabelle Osterwalder ◽  
Merve Özkan ◽  
Alexandra Malinovska ◽  
Christian H. Nickel ◽  
Roland Bingisser
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Time Frame ◽  
Index Visit ◽  
Open Time ◽  
High Incidence ◽  
Induce Change ◽  
Missed Diagnosis ◽  
Missed Diagnoses

Abdominal pain (AP) is a common reason for presentation to an emergency department (ED). With this prospective, observational all-comer study, we aimed to answer three questions: Which diagnoses are most often missed? What is the incidence of extra-abdominal causes? What is the prognosis of abdominal pain in a tertiary urban European ED? Participants were systematically interviewed for the presence of 35 predefined symptoms. For all patients with abdominal pain, the index visit diagnoses were recorded. Related representation was defined as any representation, investigation, or surgery related to the index visit (open time frame). If a diagnosis changed between index visit and representation, it was classified as missed diagnosis. Among 3960 screened presentations, 480 (12.1%) were due to AP. Among 63 (13.1%) related representations, the most prevalent causes were cholelithiasis, gastroenteritis, and urinary retention. A missed diagnosis was attributed to 27 (5.6%) presentations. Extra-abdominal causes were identified in 162 (43%) presentations. Thirty-day mortality was comparable to that of all other ED patients (2.2% vs. 2.1%). Patients with abdominal pain had a low risk of representation, and the majority of representations due to missed diagnoses were of benign origin. The high incidence of extra-abdominal causes is noteworthy, as this may induce change to differential diagnosis of abdominal pain.

scholarly journals Acute abdominal pain: An unusual medical cause

2009 ◽  
Vol 8 (1) ◽  
pp. 26-28
Author(s):  
James Chan ◽  
◽  
Adil Ahmed ◽  
Bernard Stacey ◽  
◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lyme Disease ◽  
Acute Abdominal Pain ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Ixodid Ticks ◽  
Protection Agency ◽  
The United Kingdom ◽  
Suboptimal Outcome ◽  
Intestinal Dysmotility

Lyme disease is an infectious illness that arises from the spirochete, Borrelia burgdorferi transmitted via a bite by Ixodid ticks. There were 768 cases in the United Kingdom (incidence 1.46/100,000) identified by the Health Protection Agency in 2006. Clinical manifestations of Lyme disease can be multi-systemic. It is important for the acute physician to be aware of this condition. Its relative infrequency and unusual presentation can result in delayed diagnosis with potential for suboptimal outcome. Here, we present a case of Lyme disease presenting with abdominal pain and intestinal dysmotility.

scholarly journals 26 COVID-19 Diagnosis in Patients with Acute Abdominal Pain Without Respiratory Symptoms: A UK Emergency General Surgical Unit Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Zuberi ◽  
Y Mushtaq ◽  
K Patel ◽  
S Vickramarajah ◽  
A Askari ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Acute Abdominal Pain ◽  
Rt Pcr ◽  
Thoracic Imaging ◽  
Atypical Symptoms ◽  
Thoracic Ct ◽  
Surgical Unit ◽  
Positive Half

Abstract Introduction Evidence has emerged reporting atypical symptoms of the coronavirus (COVID-19). There is a sparsity of existing studies examining COVID-19 related abdominal pain and the role of investigative imaging for the virus in these patients. Study aims were to determine COVID-19 incidence in those with acute abdominal pain in the absence of respiratory symptoms and to assess the performance of Computer Tomography (CT) thoracic imaging. Method Retrospective analysis of all patients admitted to our emergency general surgical unit between 1st March 2020 and 31st May 2020 was performed. All patients underwent nasal and oro-pharyngeal COVID-19 RT-PCR swabs as well as CT on admission. Results From 112 patients admitted with acute abdominal pain in the absence of respiratory symptoms, 16 (14.3%) tested positive for COVID-19 on RT-PCR swab testing. 50% (8/16) of these patients had no intra-abdominal pathology on CT. The sensitivity and specificity of CT thoracic imaging for COVID-19 was 43.8% and 91.7%. Conclusions One in seven patients with abdominal pain without any respiratory symptoms tested positive. Half these patients represented COVID-19 manifesting primarily as acute abdominal pain. Combined swab testing and CT imaging should be performed in all abdominal pain presentations due to the varying diagnostic performance of thoracic CT in diagnosing COVID-19.

Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

1991 ◽  
Vol 30 (01) ◽  
pp. 15-22 ◽  
Author(s):  
A. Gammerman ◽  
A. R. Thatcher
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Bayes Theorem ◽  
Bayes Method ◽  
Hospital Records ◽  
Computer Diagnosis ◽  
Bayes Model ◽  
Chi Squared ◽  
Past Data

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.

Esophageal Atresia and Associated Duodenal Atresia: A Cohort Study and Review of the Literature

2020 ◽  
Author(s):  
Maria Enrica Miscia ◽  
Giuseppe Lauriti ◽  
Dacia Di Renzo ◽  
Angela Riccio ◽  
Gabriele Lisi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Esophageal Atresia ◽  
Primary Repair ◽  
English Literature ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Primary Treatment ◽  
Duodenal Atresia ◽  
Staged Approach ◽  
Missed Diagnosis

Abstract Introduction Esophageal atresia (EA) is associated with duodenal atresia (DA) in 3 to 6% of cases. The management of this association is controversial and literature is scarce on the topic. Materials and Methods We aimed to (1) review the patients with EA + DA treated at our institution and (2) systematically review the English literature, including case series of three or more patients. Results Cohort study: Five of seventy-four patients with EA had an associated DA (6.8%). Four of five cases (80%) underwent primary repair of both atresia, one of them with gastrostomy placement (25%). One of five cases (20%) had a delayed diagnosis of DA. No mortality has occurred. Systematic Review: Six of six-hundred forty-five abstract screened were included (78 patients). Twenty-four of sixty-eight (35.3%) underwent primary correction of EA + DA, and 36/68 (52.9%) underwent staged correction. Nine of thirty-six (25%) had a missed diagnosis of DA. Thirty-six of sixty-eight underwent gastrostomy placement. Complications were observed in 14/36 patients (38.9 ± 8.2%). Overall mortality reported was 41.0 ± 30.1% (32/78 patients), in particular its incidence was 41.7 ± 27.0% after a primary treatment and 37.0 ± 44.1% following a staged approach. Conclusion The management of associated EA and DA remains controversial. It seems that the staged or primary correction does not affect the mortality. Surgeons should not overlook DA when correcting an EA.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

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