scholarly journals An unusual case of pediatric abdominal pain

CJEM ◽  
2011 ◽  
Vol 13 (02) ◽  
pp. 133-138 ◽  
Author(s):  
Lars P. Bjoernsen ◽  
M. Bruce Lindsay
Keyword(s):  
Abdominal Pain ◽  
Colonic Obstruction ◽  
Exploratory Laparotomy ◽  
Symptomatic Treatment ◽  
Systematic Evaluation ◽  
White Female ◽  
Symptomatic Therapy ◽  
Regional Lymph Nodes ◽  
Diffuse Abdominal Pain ◽  
Gastrografin Enema

ABSTRACTChronic and recurrent abdominal pains are common complaints in children and adolescents, but the evaluation in the emergency department (ED) can be challenging. We present a rare yet serious case of a 17-year-old white female who presented to the ED with a 2-day history of diffuse abdominal pain, nausea, and intractable vomiting. Abdominal examination and imaging, including computed tomography (CT), were negative during an episode 6 weeks previously. This was her fifth similar episode in a 2-month period, and she had been seen at three different hospitals and admitted on each occasion. Three days prior to presentation to our ED, she was seen at a gastroenterology clinic and diagnosed with irritable bowel syndrome and an ovarian cyst. Symptomatic therapy during the current presentation, with intravenous fluids, antiemetics, and parenteral narcotics, failed to alleviate her abdominal pain and vomiting. Emergent CT evaluation revealed a high-grade colonic obstruction with focal circumferential narrowing in the transverse colon and a lower gastrointestinal follow-through radiograph with Gastrografin enema showed a classic “apple-core” lesion. Colonic adenocarcinoma with positive regional lymph nodes was found during emergent exploratory laparotomy. Pediatric patients with recurrent, episodic abdominal pain should undergo systematic evaluation and symptomatic treatment. A previous negative workup should not dissuade emergency physicians from proceeding with a systematic and thorough evaluation of the pediatric patient presenting with abdominal pain and vomiting.

scholarly journals Mysterious Gelly Belly: a Case Report of Pseudomyxoma Peritonei and Literature Review

2020 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Literature Review ◽  
Pseudomyxoma Peritonei ◽  
Clinical Condition ◽  
Imaging Techniques ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Primary Site ◽  
Diffuse Abdominal Pain

Pseudomyxoma peritonei (PMP) is a rare clinical condition defined as extensive intraperitoneal spread of mucus associated with a variety of mucinous tumors. Although appendix has usually been implicated as the primary site, some reports found no cause. This case also describes a PMP with no identifiable primary site. A 52-year-old male presented with an abdominal distension evolving for 3 months associated with diffuse abdominal pain, imaging techniques objective intra peritoneal mucoid materials with septated ascites but it failed to identify the primary site. Exploratory laparotomy with Biopsy confirmed PMP but also failed to found the original site.

scholarly journals Pneumoperitoneum due to perforated appendicitis: a rare anatomo-radiologic correlation

2008 ◽  
Vol 21 (3) ◽  
pp. 142-143
Author(s):  
André Luiz Santos Rodrigues ◽  
Marcelino Ferreira Lobato ◽  
Augusto César Santana ◽  
Lucas Crociati Meguins ◽  
Daniel Felgueiras Rolo
Keyword(s):  
Peptic Ulcer ◽  
Severe Sepsis ◽  
Abdominal Pain ◽  
Case Report ◽  
Medical Literature ◽  
Perforated Appendicitis ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Diffuse Peritonitis ◽  
Diffuse Abdominal Pain

BACKGROUND: Pneumoperitoneum is usually associated with a perforated peptic ulcer. However, perforated appendicits may be evolved on it. In the medical literature, the anatomo-radiologic correlation between them is an uncommon event. CASE REPORT: Man with 56-year-old look for assistance with diffuse abdominal pain and distension associated with fever, vomit and absence of flatus and evacuation for about 14 days. The chest radiography revealed a pneumoperitoneum. Diffuse peritonitis was found during the exploratory laparotomy. Appendectomy, peritoneal cavity cleaning and drainage with tubular drains were carried out. However, severe sepsis occurred and the patient died on the 16th post-operative day with multiple systemic organ failure. CONCLUSION: Although rare as pneumoperitoneum ethiology, acute appendicitis may be thought as it's cause.

scholarly journals A Case of Carcinoid Likely Causing Jejunal Intussusception

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Jennifer Matulich ◽  
Kelly Thurston ◽  
Dan Galvan ◽  
Subhasis Misra
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Bowel Resection ◽  
Exploratory Laparotomy ◽  
Abrupt Onset ◽  
Proximal Jejunum ◽  
Multiple Target ◽  
Ileocolic Anastomosis ◽  
Diffuse Abdominal Pain ◽  
Rare Finding

A 34-year-old female was admitted to Emergency Department with an abrupt onset of diffuse abdominal pain. A CT scan done prior to her transfer revealed significant dilated loops of bowel as well as multiple target signs with likely torsed bowel. The patient consented to an exploratory laparotomy. During surgery, the proximal jejunum was found to be intussuscepted, a rare finding in an adult. There was evidence of mesenteric foreshortening throughout the small bowel and multiple whitish lesions within the mesentery, both consistent with the desmoplastic response that is characteristic of carcinoid. The interest for this case report comes from the patient’s surgical findings of jejunal intussusception as well as her extensive history, which includes a bowel resection with an ileocolic anastomosis for presumed ischemia and a carcinoid tumor in the stomach which had been removed endoscopically.

scholarly journals Mysterious Gelly Belly: a Case Report of Pseudomyxoma Peritonei and Literature Review

2020 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Literature Review ◽  
Pseudomyxoma Peritonei ◽  
Clinical Condition ◽  
Imaging Techniques ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Primary Site ◽  
Diffuse Abdominal Pain

Pseudomyxoma peritonei (PMP) is a rare clinical condition defined as extensive intraperitoneal spread of mucus associated with a variety of mucinous tumors. Although appendix has usually been implicated as the primary site, some reports found no cause. This case also describes a PMP with no identifiable primary site. A 52-year-old male presented with an abdominal distension evolving for 3 months associated with diffuse abdominal pain, imaging techniques objective intra peritoneal mucoid materials with septated ascites but it failed to identify the primary site. Exploratory laparotomy with Biopsy confirmed PMP but also failed to found the original site.

scholarly journals A rare case of adult colocolonic intussusception of the descending colon

2019 ◽  
Vol 12 (11) ◽  
pp. e231590
Author(s):  
Randa Taher ◽  
Yael Kopelman ◽  
Aurwa Younis ◽  
Daniel Sheffer
Keyword(s):  
Rare Case ◽  
Pathological Condition ◽  
Primary Anastomosis ◽  
Colonic Obstruction ◽  
Exploratory Laparotomy ◽  
Tubulovillous Adenoma ◽  
Abdominal Ct ◽  
Diffuse Abdominal Pain ◽  
Abdominal Ct Scan ◽  
Descending Colon

A 28-year-old woman approached the emergency department because of recent diffuse abdominal pain and diarrhoea. Peritoneal signs on physical exam led to abdominal CT scan which demonstrated colonic obstruction, resulting from colocolonic intussusception of the descending colon. An exploratory laparotomy confirmed the diagnosis as well as the aetiology of a 4 cm intraluminal polyp. Left hemicolectomy with primary anastomosis was performed. The final pathology revealed a tubulovillous adenoma with multiple foci of high-grade dysplasia. Intussusception is a rare cause for colonic obstruction, and ~90% of cases in adults are secondary to an anatomical or pathological condition. Therefore, we recommend oncological resection of the affected part.

scholarly journals LO69: Haloperidol versus ondansetron for hyperemesis due to cannabis (HaVOC): a randomized, controlled clinical trial

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S32-S33
Author(s):  
A. Ruberto ◽  
M. Sivilotti ◽  
S. Forrester ◽  
A. Hall ◽  
F. Crawford ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Symptomatic Treatment ◽  
Cannabis Use ◽  
Controlled Clinical Trial ◽  
Primary Analysis ◽  
Return Visits ◽  
Topical Capsaicin ◽  
Insight Into ◽  
Haloperidol Group ◽  
Cannabis Hyperemesis Syndrome

Introduction: One of the most common adverse effects of habitual cannabis use is hyperemesis—recurrent bouts of protracted vomiting, retching and abdominal pain superimposed on a baseline of daily nausea and anorexia. Largely anecdotal evidence supports the use of haloperidol, benzodiazepines or topical capsaicin over traditional antiemetics, yet little is known about the cause or optimal treatment of this newly recognized disorder. We report the results of one of the first clinical trials on so-called cannabis hyperemesis syndrome (NCT03056482). Methods: We approached adults with a working diagnosis of hyperemesis due to cannabis, provided they had ongoing emesis for >2 hours, a cyclic pattern of 3+ episodes in the last 2 years, and near daily use of cannabis by inhalation. We excluded those who were pregnant, deemed unreliable, or using opioids. Subjects provided written consent to be randomized during the index or any subsequent visit to either haloperidol (with a nested randomization to either 0.05 mg/kg or 0.1 mg/kg) or ondansetron 8 mg intravenously in a quadruple-blind fashion, and to be followed for 7 days. The primary outcome was the average reduction from baseline in abdominal pain and nausea (each measured on a 10-cm VAS) at 2 hours. While the original trial design allowed for crossover, the primary analysis used only the first treatment period since fewer than the prespecified threshold of 20% of subjects crossed over. Results: We enrolled 33 subjects, of whom 30 (16 men, 29+/-11 years old, using 1.5+/-0.9 g/day since age 19+/-2 years) were treated at least once (haloperidol 13, ondansetron 17). Haloperidol at either dose was superior to ondansetron (difference 2.3 cm [95%CI 0.6, 4.0]; p = 0.01), with similar improvements in both pain and nausea, as well as less rescue antiemetics (27% vs 61%; p = 0.04), and shorter time to ED departure (3.1+/-1.7 vs 5.6+/-4.5 hours; p = 0.03 Wilcoxon rank sum). There were two (haloperidol) vs six (ondansetron) return visits for ongoing nausea/vomiting, as well as two return visits for acute dystonia, both in the higher dose haloperidol group. Conclusion: Haloperidol is superior to ondansetron for the acute symptomatic treatment of patients with ongoing hyperemesis attributed to habitual cannabis use. The efficacy of this agent over ondansetron provides insight into the mechanism of this new disorder, now almost a daily diagnosis in many Canadian emergency departments.

Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

2013 ◽  
Vol 79 (11) ◽  
pp. 1140-1141 ◽  
Author(s):  
Ann A. Albert ◽  
Tracy L. Nolan ◽  
Bryan C. Weidner
Keyword(s):  
Abdominal Pain ◽  
African American Male ◽  
Pediatric Patients ◽  
Primary Anastomosis ◽  
Exploratory Laparotomy ◽  
Sigmoid Volvulus ◽  
Sudden Onset ◽  
Contrast Enema ◽  
Pediatric Age Group ◽  
History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

scholarly journals Hydatid Disease Simulating Acute Abdomen: A Case Report and Brief Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Georgios Lianos ◽  
Georgios Baltogiannis ◽  
Avrilios Lazaros ◽  
Konstantinos Vlachos
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Hydatid Disease ◽  
Acute Abdominal Pain ◽  
Abdominal Distension ◽  
The Body ◽  
Parasitic Disease ◽  
Review Of The Literature ◽  
Diffuse Abdominal Pain ◽  
Operating Surgeon

Introduction. Hydatid disease is caused by the tapewormEchinococcus granulosusand is still a matter of public health in many regions of the world, where it is an endemic parasitic disease. Although the liver is the most involved organ, hydatidosis can be found anywhere in the human body. Rare forms of location may lead to diagnostic and therapeutic dilemmas.Case Report. Herein we report a rare case of acute abdominal pain and progressively increasing abdominal distension due to abdominal and multiple splenic echinococcosis in a 72-year-old Caucasian male. We also provide a brief review of the literature.Conclusion. Although hydatid disease is found most often in the liver and lungs, rarely any organ of the body can be involved by this zoonosis. Though rare, the possibility of unusual location of echinococcosis must always be considered by the operating surgeon, when dealing with diffuse abdominal pain in endemic areas, because any misinterpretation may result in unfavorable outcomes.

Appendiceal adenocarcinoma with breast metastases

2021 ◽  
Vol 14 (5) ◽  
pp. e240808
Author(s):  
Timothy Davies ◽  
Tarak Chouari ◽  
Christopher Ray ◽  
Suzanne Elgammal
Keyword(s):  
Colorectal Cancer ◽  
Incidental Finding ◽  
Symptomatic Treatment ◽  
Vermiform Appendix ◽  
Left Breast ◽  
Regional Lymph Nodes ◽  
Appendiceal Adenocarcinoma ◽  
First Case ◽  
Simple Mastectomy ◽  
Malignant Lesions

Malignant lesions of the vermiform appendix make up a rare subset of colorectal cancer. While colorectal cancer frequently metastasises to the liver, lung, regional lymph nodes and peritoneum, metastasis to the breast is extremely rare. Here, we describe the case of an 84-year-old woman who had the incidental finding of appendiceal adenocarcinoma following emergency laparoscopic appendectomy. She declined further operative or adjuvant treatment for her disease. She represented 1 year later with metastatic appendiceal adenocarcinoma disease to her left breast. A simple mastectomy for symptomatic treatment was performed. In this report, we describe the first case of appendiceal adenocarcinoma metastases to the breast. Due to its rarity, there is a paucity of evidence related to the management of this condition. The limited evidence is reviewed and discussed.

scholarly journals Adrenal Crisis in Long Term Use of Exogenous Steroid With Inappropriate Tapering off Process

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A108-A109
Author(s):  
Nani Oktavia ◽  
Chici Pratiwi ◽  
Jerry Nasaruddin ◽  
Muhammad Ikhsan Mokoagow ◽  
Marina Epriliawati ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Blood Glucose ◽  
Adrenal Insufficiency ◽  
Clinical Manifestations ◽  
Adrenal Crisis ◽  
High Dose ◽  
Symptomatic Therapy ◽  
Bowel Sound ◽  
Primary Adrenal Insufficiency

Abstract Background: Adrenal crisis is an emergency condition in endocrinology that commonly found in primary adrenal insufficiency but also occur in chronic adrenal insufficiency triggered by various conditions such as sepsis, infection, trauma, burns, surgery, and myocardial infarction. In chronic adrenal insufficiency, adrenal crisis can be induced by excessive reductions or inadequate discontinuation of steroid treatment. Case Illustration: A 40-year old-man admitted with chief complaint abdominal pain since seven days before admission. He felt pain in the umbilical area and slowly radiated to all the part of abdomen. Other than that, he also felt nausea, had vomitus, fever, and constipation for five days. He was immobilized for four months, with muscles weakness and atrophy. He was diagnosed with Focal Segmented Glomerulosclerosis and had a high dose of methylprednisolone (48 mg) for 6 months, 40 mg for the next 2 months and methylprednisolone 12 mg for the last 2 months. The last two month, he began to have severe general weakness and hypotension. On physical examination we found hypotension, fever (38.1o C), pale conjunctiva, moon face, buffalo hump, slightly distended and tenderness of abdomen, normal bowel sound, and purple striae all over the abdomen and extremities. On laboratory examination, Hb was 8.2 (n 11.7 – 15.5 g/dl), leukocytes 10,400 (5.00 – 10.00 x 103/μL), Na 123 (n 135 – 147 mmol/L), random blood glucose 74 (n 70 – 140 mg/dL). On abdominal X ray, there was prominent faecal material and no signs of ileus. No sign of infection found in urinalysis. He had sodium correction, packed red cell transfusion, symptomatic therapy including laxative, methylprednisolone 12 mg, but no improvement of signs and symptoms beside be able to defecate. The abdominal ultrasound gave a normal result. The morning cortisol level was then examined, with the result 14.4 (n 3.7–19.4). The patient was then diagnosed with adrenal crisis based on the clinical manifestations and had hydrocortisone therapy 100 mg a day for 2 consecutive days. After hydrocortisone administration, the symptoms improved, no fever and abdominal pain, he had normotension, increased sodium level 132 (n 135 – 147 mmol/L) and blood glucose level 118 (n 70 – 140 mg/dL). On the third day the patient discharged with oral hydrocortisone 15 mg in the morning and 10 mg in the afternoon. Conclusion: Adrenal crisis was generally found in primary adrenal insufficiency but could also occur in secondary adrenal insufficiency due to inappropriate tapering off process of long term glucocorticoid use.

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