Left Lower Abdominal Pain as an Initial Symptom of Multiple Myeloma

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01007-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Michio Itabashi ◽

Yoshiko Bamba ◽

Hisako Aihara ◽

Kimitaka Tani ◽

Ryousuke Nakagawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Lower Abdominal Pain ◽

Anterior Wall ◽

Middle Part ◽

Presacral Space ◽

Previous Surgery ◽

Afferent Limb ◽

Radiographic Findings ◽

Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma

BMJ Case Reports ◽

10.1136/bcr-2021-243093 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243093

Author(s):

Koichi Hata ◽

Chikara Sakaguchi ◽

Michiko Tsuchiya ◽

Yukio Nagasaka

Keyword(s):

Abdominal Pain ◽

Adverse Events ◽

Adrenal Insufficiency ◽

Malignant Mesothelioma ◽

Adrenocorticotropic Hormone ◽

Hormone Deficiency ◽

Initial Symptom ◽

Isolated Acth Deficiency ◽

Wide Range ◽

Isolated Adrenocorticotropic Hormone Deficiency

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

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Spontaneous Perinephric Urinoma Secondary to Drug Induced Acute Interstitial Nephritis: A Case Report

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1723924 ◽

2021 ◽

Author(s):

Rajesh Kumar Varatharajaperumal ◽

Rupa Renganathan ◽

V Mangalakumar ◽

Sriman Rajasekaran ◽

Venkatesh Kasi Arunachalam

Keyword(s):

Abdominal Pain ◽

Interstitial Nephritis ◽

Lower Abdominal Pain ◽

Acute Interstitial Nephritis ◽

Computed Tomography Scan ◽

Drug Induced ◽

Significant Deterioration ◽

Loin Pain ◽

Tomography Scan ◽

Collecting System

AbstractUrinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

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Roberts uterus: a rare congenital anomaly

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175304 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5657

Author(s):

Nagendra Sardeshpande ◽

Pratima Chipalkatti ◽

Jainesh Doctor

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Adnexal Mass ◽

Lower Abdominal Pain ◽

Uterine Horn ◽

Transabdominal Ultrasound ◽

Septate Uterus ◽

Bicornuate Uterus ◽

Rare Congenital Anomaly ◽

Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

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Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/5372839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yu Chen ◽

Shaobin Wei ◽

Li Huang ◽

Mei Luo ◽

Yang Wu ◽

...

Keyword(s):

Abdominal Pain ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Meta Analysis ◽

Lower Abdominal Pain ◽

Effective Rate ◽

Chinese Patent ◽

Meta Analyses

Background. Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID. Methods. Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate. Results. Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I2 = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I2 = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I2 = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I2 = 0%). Conclusions. Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

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ACE inhibitor induced visceral angioedema: an elusive diagnosis

BMJ Case Reports ◽

10.1136/bcr-2020-236391 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236391 ◽

Cited By ~ 1

Author(s):

Metlapalli Venkata Sravanthi ◽

Sharmil Suma Kumaran ◽

Nishant Sharma ◽

Bojana Milekic

Keyword(s):

Adverse Effect ◽

African American ◽

Abdominal Pain ◽

Ace Inhibitors ◽

Ace Inhibitor ◽

Lower Abdominal Pain ◽

Supportive Treatment ◽

Newly Diagnosed ◽

Radiographic Findings ◽

Missed Diagnosis

ACE inhibitors are widely used and well-tolerated drugs. Angioedema is a well-known adverse effect, which involves the viscera rarely. This is a case of a 44-year-old African-American man with newly diagnosed hypertension, who presented with lower abdominal pain and diarrhoea. Based on the clinical picture and radiographic findings, lisinopril-induced intestinal angioedema was diagnosed. He recovered with supportive treatment, and the lisinopril was permanently discontinued. The mechanism of angioedema is thought to be the inhibition of ACE-mediated degradation of bradykinin, which is a peptide responsible for vasodilation and increased vascular permeability. While the external angioedema is unmistakable, intestinal angioedema has a relatively non-specific presentation and chronology, often leading to missed diagnosis and unnecessary interventions. Most common symptoms are abdominal pain and diarrhoea. Characteristic radiographic findings include ‘doughnut sign’ and ‘stacked coin’ appearance. Treatment is supportive. ACE inhibitors should be discontinued to prevent a recurrence.

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A case of hereditary angioedema due to C1-inhibitor deficiency with recurrent abdominal pain diagnosed 40 years after the occurrence of the initial symptom

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01338-1 ◽

2021 ◽

Author(s):

Daisuke Honda ◽

Isao Ohsawa ◽

Keiichi Iwanami ◽

Hisaki Rinno ◽

Yasuhiko Tomino ◽

...

Keyword(s):

Abdominal Pain ◽

Hereditary Angioedema ◽

Recurrent Abdominal Pain ◽

Acute Attack ◽

Severe Abdominal Pain ◽

Initial Symptom ◽

C1 Inhibitor ◽

Self Administration ◽

C1 Inhibitor Deficiency ◽

Appropriate Treatment

AbstractHereditary angioedema due to C1-inhibitor deficiency (HAE-C1-INH) is a rare disease, which induces an acute attack of angioedema mediated by bradykinin. HAE-C1-INH can cause serious abdominal pain when severe edema develops in the gastrointestinal tract. However, because it takes a long time, 13.8 years on average in Japan, from the occurrence of the initial symptom to the diagnosis due to low awareness of the disease, undiagnosed HAE-C1-INH patients sometimes undergo unnecessary surgical procedures for severe abdominal pain. We herein present a 56-year-old patient with HAE-C1-INH, who underwent numerous abdominal operations. He frequently needed hospitalization with the administration of opioid due to severe abdominal pain. However, after he was accurately diagnosed with HAE-C1-INH at 55 years of age, he could start self-administration for an acute attack with icatibant, a selective bradykinin B2 receptor antagonist. Consequently, he did not need hospitalizing for ten months after the beginning of the treatment. A series of an accurate diagnosis and appropriate treatment for HAE-C1-INH improved his quality of life. Thus, HAE-C1-INH should be considered, when we meet patients with unidentified recurrent abdominal pain. This case highlights significance of an early diagnosis and appropriate treatment for HAE-C1-INH.

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A rare cause of acute lower abdominal pain: Emphysematous cystitis

Türk Üroloji Dergisi/Turkish Journal of Urology ◽

10.5152/tud.2014.32744 ◽

2014 ◽

Vol 40 (1) ◽

pp. 65-67 ◽

Cited By ~ 2

Author(s):

Tarkan Ergun ◽

Halil Olcay Eldem ◽

Hatice Lakadamyali

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Emphysematous Cystitis

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