Tratamiento quirúrgico conservador en un paciente con invaginación yeyuno-yeyunal secundaria a síndrome de Peutz-Jeghers. Reporte de un caso

INTRODUCCIÓN: el síndrome de Peutz-Jeghers es una enfermedad autosómica dominante, poco frecuente, caracterizada por hiperpigmentación mucocutánea y pólipos gastrointestinales; estos últimos causantes de obstrucciones intestinales recurrentes, secundarias a invaginación.PRESENTACIÓN DEL CASO: adolescente femenina, de 13 años, que acudió a urgencias debido a un cuadro de dolor abdominal intenso, con un cuadro de obstrucción intestinal secundario a invaginación yeyuno-yeyunal. Siete años antes tuvo un cuadro clínico similar que desapareció espontáneamente. A la exploración física se observaron lesiones hiperpigmentadas en el labio inferior y anemia microcítica e hipocrómica con los que se integró el diagnóstico de síndrome de Peutz-Jeghers. Debido a que en la tomografía axial computada de abdomen se evidenció invaginación intestinal se realizó una laparotomía exploradora, con el hallazgo de dos pólipos hamartomatosos de 2 y 3 cm de diámetro a 15 cm del ligamento de Treitz. Se trató la invaginación intestinal y, posteriormente, se efectuaron enterotomía y polipectomía. Mediante enteroscopia transoperatoria se descartaron otras alteraciones. Luego de tratar el cuadro clínico la paciente fue dada de alta del hospital en buenas condiciones. CONCLUSIÓN: la invaginación intestinal en adolescentes es una situación excepcional que requiere un alto índice de sospecha para enfermedades polipósicas. Se reporta un caso de invaginación intestinal que se trató existosamente con cirugía conservadora, sin necesidad de resecciones intestinales que, a largo plazo, condicionan síndrome de intestino corto: uno de los principales problemas a los que se enfrentan esto pacientes. PALABRAS CLAVE: Peutz-Jeghers, pólipos gastrointestinales, obstrucción intestinal recurrente, dolor abdominal agudo, yeyuno-yeyunal, adolescentes. Abstract INTRODUCTION: Peutz-Jeghers syndrome is an uncommon autosomal dominant disease, characterized by mucocutaneous hyperpigmentation and gastrointestinal polyps, which are the cause of recurrent intestinal obstructions, secondary to invagination. This case provides evidence to consider more conservative surgical treatments and prevent these patients from being constantly subjected to extensive bowel resections, which in many cases, can condition short bowel disease. CASE PRESENTATION: A 13-year-old female patient who came to the emergency room with acute abdominal pain due to intestinal obstruction secondary to jejuno-jejunal intussusception. 7 years ago, the patient reported similar clinical manifestations that solved spontaneously. Physical examination showed hyperpigmented lesions on the lower lip, and microcytic hypochromic anemia; Peutz-Jeghers syndrome was established. Intestinal intussusception was evidenced by computed axial tomography of the abdomen, so exploratory laparotomy was performed, with the finding of two hamartomatous polyps 2 and 3 cm in diameter at 15 cm of the Treitz ligament. Intestinal intussusception was resolved with subsequently, enterotomy and polypectomy. Other alterations were ruled out by trans-operative enteroscopy. At the resolution of clinical manifestations, the patient was discharged from the hospital in good clinical conditions. CONCLUSION: Intestinal intussusception in adolescents is an exceptional situation, which requires a high index of suspicion for polysposis diseases. We present a case of intestinal intussusception, successfully resolved with conservative surgical treatment, without requiring intestinal resections, which can condition short bowel syndrome in the long-term, one of the major problems these patients face. KEYWORDS: Peutz-Jeghers; gastrontestinal polyps; recurrent intestinal obstructions; acute abdominal pain; jejuno jejunal; adolescents.

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Pediatric Intussusception: The Cinnamon Bun Sign

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318771612 ◽

2018 ◽

Vol 34 (4) ◽

pp. 275-280

Author(s):

Erica Poole ◽

Steven M. Penny

Keyword(s):

Abdominal Pain ◽

Clinical Symptom ◽

Pediatric Patient ◽

Acute Abdominal Pain ◽

Pediatric Population ◽

Clinical Manifestations ◽

Distal Segment ◽

Sonographic Examination ◽

Severe Disorder

Acute abdominal pain in the pediatric patient is a common clinical symptom often resulting in uncertainty and thus often subsequently leads to a sonographic examination of the abdomen. Sonography is often the modality of choice for pediatric abdominal imaging, and consequently, sonographers should have a fundamental appreciation for the causes of acute abdominal pain in the pediatric population. Intussusception, which is the telescoping of a proximal segment of bowel into a distal segment, is one potential cause of acute abdominal pain for these patients. This review clarifies the etiology and classification of intussusception and provides an overview of the clinical manifestations, sonographic identification, and treatment of this potentially severe disorder. Also, this review provides a novel imaging sign, called the “cinnamon bun” sign, that sonographers can employ while examining patients for possible intussusception. The cinnamon bun sign is a descriptive term that may be used to illustrate a transverse sonographic plane through an intussusception.

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The Measurement of Performance in Probabilistic Diagnosis

Methods of Information in Medicine ◽

10.1055/s-0038-1636685 ◽

1978 ◽

Vol 17 (04) ◽

pp. 217-226 ◽

Cited By ~ 47

Author(s):

J. D. F. Habbema ◽

J. Hilden ◽

B. Bjerregaard

Keyword(s):

Abdominal Pain ◽

General Framework ◽

Acute Abdominal Pain ◽

Error Rates ◽

Complete Analysis ◽

Evaluation Tools ◽

Triangular Diagram ◽

Disease Case ◽

First Impression ◽

Probabilistic Diagnosis

Owing to the inherent uncertainty of diagnostic tasks, diagnostic advice should be offered in a probabilistic, rather than deterministic form. Since the late fifties a lot of effort has been invested in constructing probabilistic diagnosis rules. Much less has been done to devise rational tools for evaluating them ; conventional error rates reflect but one aspect of performance in a rather crude way. The aim of this paper and its successors is to offer a body of evaluation tools. After defining a general framework and stating its limitations we apply some graphical techniques to the acute abdominal pain data that will serve as illustration in the next papers as well: dot diagrams, the triangular diagram for the three-disease case, and three tabular representations based on categorization of the probabilities, viz. the usual (forced) classification matrix, from which various classification rates are read off; the classification matrix with doubt, in which uncertain and confident diagnoses are distinguished; and the exclusion matrix, which spots diseases that are judged improbable. Together these matrices give a good first impression of the behaviour of a probabilistic diagnosis system. The outlined techniques of later papers are needed for a more complete analysis.

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The Measurement of Performance in Probabilistic Diagnosis

Methods of Information in Medicine ◽

10.1055/s-0038-1636441 ◽

1978 ◽

Vol 17 (04) ◽

pp. 217-226

Author(s):

J. D. F. Habbbma ◽

J. Hilden ◽

B. Bjerregaard

Keyword(s):

Abdominal Pain ◽

General Framework ◽

Acute Abdominal Pain ◽

Error Rates ◽

Complete Analysis ◽

Evaluation Tools ◽

Triangular Diagram ◽

Disease Case ◽

First Impression ◽

Probabilistic Diagnosis

Owing to the inherent uncertainty of diagnostic tasks, diagnostic advice should be offered in a probabilistic, rather than deterministic form. Since the late fifties a lot of effort has been invested in constructing probabilistic diagnosis rules. Much less has been done to devise rational tools for evaluating them; conventional error rates reflect but one aspect of performance in a rather crude way. The aim of this paper and its successors is to offer a body of evaluation tools. After defining a general framework and stating its limitations we apply some graphical techniques to the acute abdominal pain data that will serve as illustration in the next papers as well: dot diagrams, the triangular diagram for the three-disease case, and three tabular representations based 011 categorization of the probabilities, viz. the usual (forced) classification matrix, from which various classification rates are read off; the classification matrix with doubt, in which uncertain and confident diagnoses are distinguished; and the exclusion matrix, which spots diseases that are judged improbable. Together these matrices give a good first impression of the behaviour of a probabilistic diagnosis system. The outlined techniques of later papers are needed for a more complete analysis.

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Psychometric evaluation of the Danish version of a modified Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-D) for patients hospitalized with acute abdominal pain

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0106 ◽

2019 ◽

Vol 19 (1) ◽

pp. 117-130 ◽

Cited By ~ 2

Author(s):

Helen Schultz ◽

Ulla Skræp ◽

Tanja Schultz Larsen ◽

Lise Ewald Rekvad ◽

Jette Littau-Larsen ◽

...

Keyword(s):

Patient Outcome ◽

Abdominal Pain ◽

Pain Management ◽

Pain Perception ◽

Acute Abdominal Pain ◽

Outcome Questionnaire ◽

Cronbach’S Alpha ◽

American Pain Society ◽

Cronbach's Alpha ◽

Patient Reported

Abstract Background and aims This paper forms part of a study evaluating the effect of patient-controlled oral analgesia for patients admitted to hospital with acute abdominal pain. Pain is a subjective experience, and a multifaceted evaluation tool concerning patient-reported outcome measures is needed to monitor, evaluate, and guide health care professionals in the quality of pain management. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) is a validated multifaceted evaluation tool for measuring patient-reported pain experiences to evaluate different pain management interventions. The aim of this study was to evaluate the psychometric properties of a modified Danish version of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-D) used during and after hospitalization for patients with acute abdominal pain. Methods The APS-POQ-R was translated into Danish and two slightly different questionnaires were formed. Questionnaire one had 39 items and the six subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), and patient-related barriers to pain management. The questionnaire focused on time during hospital stay and was to be completed at discharge. Questionnaire two included 25 items and the five subscales pain, satisfaction, activity, emotion, and safety and focused on time at home and was to be completed daily 1 week after discharge. The questionnaires were tested on 156 patients with acute abdominal pain. Internal consistency reliability and construct validity was examined. Results In both questionnaires, the results of correlations and tests for internal consistency reliability showed a Cronbach’s alpha of >0.7 for the pain, activity, and emotion subscales, but the value was ≥0.69 for the satisfaction subscale. In questionnaire one, Cronbach’s alpha was ≤0.64 for the safety subscale, but this was 0.73 when the item “itching” was deleted. In questionnaire two, Cronbach’s alpha was ≤0.51 for the safety subscale. For the patient-barrier subscale in questionnaire one, Cronbach’s alpha was ≤0.62 for any combination of the items in the subscale. The results of the construct validity and factor analysis showed a five-factor structure in questionnaire one and a three-factor structure in questionnaire two. In questionnaire one, items from the pain, activity, emotion, and safety subscales, except for the items “least pain” and “itching,” loaded on factor one. In questionnaire two, all items from the pain, activity, and emotion subscales loaded on factor one. Conclusions The modified APS-POQ-R-D demonstrated adequate psychometric properties for the five subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), but not for the patient-barrier subscale for patients hospitalized with acute abdominal pain. Consequently, the APS-POQ-R-D may be used without the patient-barrier subscale. Implications The clinical implications of this study may help clinicians with investigating how acute patients manage pain during and after hospital admission.

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Acute abdominal pain: An unusual medical cause

Acute Medicine Journal ◽

10.52964/amja.0227 ◽

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.

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Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

Methods of Information in Medicine ◽

10.1055/s-0038-1634813 ◽

1991 ◽

Vol 30 (01) ◽

pp. 15-22 ◽

Cited By ~ 23

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.

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

The Heart Surgery Forum ◽

10.1532/hsf.1322 ◽

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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