scholarly journals CLINICAL MANIFESTATIONS, VITAL SIGNS, AND BOWEL VIABILITY IN PEDIATRIC INTUSSUSCEPTION

2020 ◽  
pp. 1-3
Author(s):  
Erwin Siregar
Keyword(s):  
Abdominal Pain ◽  
Abdominal Mass ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Bloody Stool ◽  
Classic Triad ◽  
Common Location ◽  
Adjacent Part ◽  
Abdominal Colic ◽  
Red Currant

INTRODUCTION: Intussusception is a condition in which part of the intestine slides into an adjacent part of the intestine. Intussusception is an important cause of an acute abdomen and the second most common cause of bowel obstruction in children. The classic triad of intussusception, including vomiting, abdominal colic pain, and bloody stool. However, the triad has only been reported in <50% cases. This study is aimed to evaluate the clinical manifestation, vital signs, and bowel viability in pediatric intussusception. METHODS: This is an observational retrospective study with total sampling. RESULTS: Based on clinical characteristics, there were 44.44% subjects who had manifestations for 2-3 days. Ileocolic was the most common location (77.78%). Majority of the subjects did not have the classic triad (66.67%), had red currant jelly stool (62.96%), did not have abdominal mass (59.26%), complained of abdominal pain (70.37%), did not have abdominal distention (74.07%), did not vomit (55.5%), was lethargic (59.26%), and had viable bowel (62.96%). CONCLUSION: This study found that the most common manifestations of intussusception in children were abdominal pain, red currant jelly stool, and lethargy, with viable bowel and located at ileocolic.

Tummy Ouchie

2020 ◽  
pp. 103-110
Author(s):  
Nkeiruka Orajiaka ◽  
Meghan Dishong
Keyword(s):  
Abdominal Pain ◽  
Early Diagnosis ◽  
Gold Standard ◽  
Care Management ◽  
Nonoperative Management ◽  
Abdominal Mass ◽  
Abdominal Ultrasound ◽  
Abdominal Emergencies ◽  
Morbidity Risk ◽  
Red Currant

Intussusception is one of the most common abdominal emergencies in children. The classic triad of symptoms involves colicky abdominal pain, an abdominal mass, and red currant jelly stools, but this is seen in only about 15% of cases of children with intussusception. Early diagnosis and management reduce morbidity, risk for complications, and surgical intervention. Abdominal ultrasound is generally accepted as the gold standard for diagnosis. Treatment typically involves an air or hydrostatic enema; however, variability and controversies still exist in treatment and post-care management for nonsurgical cases. Variability also still exists in post-reduction care of children with intussusception. Feeding and monitoring times after nonoperative management differ between institutions. Some patients are advanced to feeds as tolerated while some others are placed in fasting to rest the bowel and prevent recurrence.

scholarly journals Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

2017 ◽  
Vol 40 (3) ◽  
pp. 160-165
Author(s):  
Nadira Musabbir ◽  
ASM Bazlul Karim ◽  
Md Wahiduzzaman Mazumder ◽  
Kaniz Sultana ◽  
Syeda Afria Anwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Abdominal Mass ◽  
Elevated Serum ◽  
Clinical Feature ◽  
Cross Sectional ◽  
Female Ratio ◽  
Epigastric Region ◽  
Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

scholarly journals Clinical Characteristics of Pediatric with Germ Cell Tumor: Experience in a Developing Country

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lelani Reniarti ◽  
Anisah Febri ◽  
Nur Melani Sari
Keyword(s):  
Nutritional Status ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Clinical Characteristics ◽  
Abdominal Mass ◽  
Clinical Manifestations ◽  
Cell Tumor ◽  
Cross Sectional ◽  
Common Location ◽  
End Of Treatment

Background: Germ cell tumor (GCT) occurs in 3% of pregnancy malignancies and increases by 15% during adolescence. In developing countries, the five-year survival rate is 98% and 80% for GCT earlier stage and malignant tumor, respectively. This study aimed to gather information about clinical manifestations of GCT and to evaluate the treatment outcome in pediatric GCT patients at Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaMethods: A descriptive cross-sectional study design with a total sampling method was conducted using secondary data from the medical record of pediatric patients diagnosed with GCT from 2015 to 2018. Data on nutritional status, clinical characteristics, histopathology stage, hematological profiles, chemical markers, treatment methods, completeness of treatment, and outcome at the end of treatment were collected and presented using tables and charts.Results: Of the 44 subjects, girls (77.3%) were predominant, with a mean age of 2 years old and normal nutritional status (59.1%). Patients generally had abdominal mass (97.7%) and most had intragonadal GCT (95.5%), with ovarium (76.2%) as the most common location. The most frequent GCT histopathology was yolk sac tumor (34.1%), with an Alpha-fetoprotein (AFP) level of >100.000 (6.8%). Almost all patients (97.7%) had undergone surgery; however, 47% of patients did not complete their treatment. At the end of treatment, the majority of patients survived (86.4%).Conclusion: Germ cell tumor has various clinical characteristics. Understanding these characteristics will enable clinicians to make a proper diagnosis and provide immediate management that will lead to a better prognosis.

scholarly journals Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

2020 ◽  
Author(s):  
Jeong-Yong Lee ◽  
Jung Heon Kim ◽  
Seung Jun Choi ◽  
Jong Seung Lee ◽  
Jeong-Min Ryu
Keyword(s):  
Abdominal Pain ◽  
Early Stage ◽  
Point Of Care ◽  
Abdominal Mass ◽  
Pediatric Emergency ◽  
Symptom Duration ◽  
Point Of Care Ultrasound ◽  
Bloody Stool ◽  
Emergency Physicians ◽  
Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

scholarly journals Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

2019 ◽  
Author(s):  
Jeong-Yong Lee ◽  
Jung Heon Kim ◽  
Seung Jun Choi ◽  
Jong Seung Lee ◽  
Jeong-Min Ryu
Keyword(s):  
Abdominal Pain ◽  
Early Stage ◽  
Point Of Care ◽  
Abdominal Mass ◽  
Pediatric Emergency ◽  
Symptom Duration ◽  
Point Of Care Ultrasound ◽  
Bloody Stool ◽  
Emergency Physicians ◽  
Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children who underwent POCUS for the detection of intussusception in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to lower standards wherein POCUS was performed in the presence of any one of the following symptoms: intermittent abdominal pain, bloody stool, ≥2 causes of nonspecific abdominal pain, abdominal mass, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain (P < 0.001), but less vomiting (P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to lower standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

Assessment of Clinical Symptomatology and Diagnostic Features of Intestinal Intussusception associated with Malignant Tumor in Children: Results of the Retrospective Non-randomized Controlled Study

2018 ◽  
Vol 5 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Maria Yu. Yanitskaya ◽  
Ivan A. Turabov ◽  
Тatiana V. Turobova
Keyword(s):  
Weight Loss ◽  
Malignant Tumor ◽  
Clinical Picture ◽  
Malignant Tumors ◽  
Abdominal Mass ◽  
Clinical Manifestations ◽  
Diagnostic Methods ◽  
Controlled Study ◽  
Tumor Identification ◽  
Abdominal Colic

Background. Treatment tactics for the intussusception (IS) in children is mainly defined the formation cause. Non operative IS treatment is most preferable. The surgery is often unreasonably performed in children over three years as the cause for IS occurrence can be a malignant tumor. Objective. Our aim was to define the features of clinical picture and diagnostics for IS associated with malignant tumors in children. Methods. We conducted the retrospective comparative assessment of reasons, registered clinical manifestations, and applied diagnostic methods in IS cases (n=373) at Arkhangelsk children's clinical hospital in 1981–2016. Two groups were analyzed: the first group (n=7) enrolled patients with IS caused by malignant tumor, the second one (n=366) — patients with IS caused by other reasons (idiopathic, mesenteric nodes hyperplasia, diverticulum, postoperative). Results. The typical combination was detected in the first group: symptoms of gastrointestinal tract (GIT) diseases and significant (8–12%) weight loss. In the first group, IS associated with tumor was observed in a few cases (1.9%), proceeded chronically (1–3 months), relapses did not occur, acute intestinal obstructions (р<0.001) were not registered; all the patients over five years were diagnosed with non-Hodgkin lymphomas if compare with the second group. The most informative diagnostic method was ultrasound imaging including hydrocolonic sonography which allowed IS diagnosing and tumor identification. In the second group, the clinical picture changed eventually: «triad» of symptoms typical for IS (abdominal colic pain, blood from rectum, abdominal mass) was registered in 1/3 of cases, significantly more often (p=0.001) the disease was demonstrated by «dyad» of symptoms (vomiting and abdominal colic pain) but always progressed to the acute form. Conclusion. The IS clinical course in children following its usual pattern significantly differs from the clinical picture associated with the tumor (though it occurs rarely, commonly in children over five years): the disease proceeds chronically with symptoms of GIT diseases and significant weight loss, relapses did not occur, no symptoms of acute intestinal obstruction are registered.

scholarly journals Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

2020 ◽  
Author(s):  
Jeong-Yong Lee ◽  
Jung Heon Kim ◽  
Seung Jun Choi ◽  
Jong Seung Lee ◽  
Jeong-Min Ryu
Keyword(s):  
Abdominal Pain ◽  
Early Stage ◽  
Point Of Care ◽  
Abdominal Mass ◽  
Pediatric Emergency ◽  
Symptom Duration ◽  
Point Of Care Ultrasound ◽  
Bloody Stool ◽  
Emergency Physicians ◽  
Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

scholarly journals Ovarian Torsion Presentation, Treatment and Iatrogenic Surgical Management

2021 ◽  
pp. 70-76
Author(s):  
Sheema Sabahath ◽  
Hussain Salah AL Sinan ◽  
Asalah Tariq Alsaigh ◽  
Rawan AlSalamah AlFadhli ◽  
Tahani Salman Al Mansour ◽  
...  
Keyword(s):  
Blood Flow ◽  
Abdominal Pain ◽  
Side Effects ◽  
Adverse Events ◽  
Surgical Intervention ◽  
Clinical Manifestations ◽  
Ovarian Torsion ◽  
Adult Females ◽  
Uterine Ligaments ◽  
Life Threatening

Ovarian torsion is among the gynecological life-threatening conditions that may require urgent surgical intervention among the appearance of clinical manifestations. The most common clinical manifestations include severe abdominal pain, nausea extending to vomiting. The ovarian torsion is not limited to children only. However, it can also occur in adult females, either pregnant or non-pregnant. The etiology of the disease tends to be related to the weakness of the uterine ligaments or malpositioning of it due to known and unknown causes. Despite that, the surgical intervention is needed to release the torsion. Sometimes, it can lead to adverse events or side effects such as decreased blood flow to the surrounding structures. Which by role may lead to unpleasant complications and clinical manifestations of hemorrhage and shock. In this article, we reviewed the topic of ovarian torsion from different aspects, including the definition, causes, clinical evaluation, and clinical management and its common complications.

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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