Clinical, laboratory, and imaging predictors of surgical exploration in nontraumatic acute abdomen

Satish Deshmukh; AbhiramRamesh Mundle; Murtaza Akhtar

doi:10.4103/ssj.ssj_8_20

Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

Terapevticheskii arkhiv ◽

10.17116/terarkh2017891160-68 ◽

2017 ◽

Vol 89 (11) ◽

pp. 60-68 ◽

Cited By ~ 1

Author(s):

V I Vasilyev ◽

S G Palshina ◽

B D Chaltsev ◽

S G Radenska-Lopovok ◽

T N Safonova

Keyword(s):

Acute Abdomen ◽

Clinical Laboratory ◽

Morphological Changes ◽

Abdominal Cavity ◽

High Dose ◽

Drug Induced ◽

Serological Tests ◽

Surgical Interventions ◽

First Case ◽

Clinical Presentations

The authors have described the world’s first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

Download Full-text

Case Report of Presumed (In)voluntary Capsaicin Intoxication Mimicking an Acute Abdomen

Case Reports in Medicine ◽

10.1155/2020/3610401 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Simona Koprdova ◽

Christine Schürmann ◽

Dirk Peetz ◽

Thomas Dürbye ◽

Frank Kolligs ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Abdomen ◽

Clinical Laboratory ◽

Severe Abdominal Pain ◽

Complete Regression ◽

Food Tolerance ◽

Case Presentation ◽

Spicy Food ◽

Chili Peppers ◽

Bhut Jolokia

Background. The clinical features of a presumed capsaicin intoxication have not been reported so far. Case Presentation. A 27-year-old man took part in a qualifying for a competition in spicy food tolerance. During this qualifying, he swallowed 4 chili peppers type Bhut jolokia (about 1 million Scoville units) and other extremely spicy foods; the total amount of capsaicin ingested (roughly calculated retrospectively) accounted for at least 600 mg. After 2½ hours, the patient developed severe abdominal pain, which led to hospital admission. In contrast to the severe symptoms, clinical, laboratory, and imaging examinations (ultrasound and plain X-ray of the abdomen) did not reveal any significant abnormalities. Treatment with analgesics resulted in complete regression of the abdominal pain within 30 hours. Conclusions. The clinical picture in the view of pharmacological investigations on intestinal capsaicin infusions suggests that excessive doses of capsaicin can induce severe abdominal pain; the prolonged symptoms were probably due to the failure to vomit. Thus, a capsaicin intoxication must be considered in the differential diagnosis of an acute abdomen.

Download Full-text

LYMPHANGIOMA AS A CAUSE OF ILEUS

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-2-91-94 ◽

2019 ◽

Vol 23 (2) ◽

pp. 91-94

Author(s):

Olga V. Karaseva ◽

V. A. Kapustin ◽

A. O. Agayants ◽

A. L. Gorelik ◽

A. N. Kislyakov

Keyword(s):

Acute Abdomen ◽

Clinical Picture ◽

Clinical Laboratory ◽

Rare Complication ◽

Abdominal Cavity ◽

Lymphatic Vessels ◽

Benign Tumors ◽

Mesenteric Lymphangioma ◽

Specialized Hospital ◽

Surgical Tactics

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

Download Full-text

A CASE OF APPENDIX CARCINOID IN A PEDIATRIC PATIENT. A SUBTILE CLINICAL PRESENTATION

Journal of the Siena Academy of Sciences ◽

10.4081/jsas.2014.5886 ◽

2014 ◽

Vol 6 (1) ◽

Author(s):

E. Bindi ◽

R. Angotti ◽

A.L. Bulotta ◽

M. Sica ◽

E. Cerchia ◽

...

Keyword(s):

Acute Abdomen ◽

Pediatric Patient ◽

Clinical Presentation ◽

Perforated Appendicitis ◽

Gastrointestinal Tumor ◽

Surgical Exploration ◽

Long Term Follow Up

The appendix carcinoid, although rare (with an incidence of 0,08%), is the more frequent gastrointestinal tumor in children and teen. In most cases these tumors cannot be diagnosed or they can be incidentally found during a surgical exploration for acute abdomen. Only in few cases there are symptoms of a carcinoid’s syndrome (flushing, diarrhea and wheezing). In this work we present the manegement of a patient with an appendix carcinoid revealed during an appendicectomy performed for a peritonitis caused by a perforated appendicitis, underlining the importance of diagnosis and long term follow-up.

Download Full-text