1/8. 'Acute abdomen' with a rash.A previously fit and healthy 17-year-old male presented with the clinical symptoms and signs of an acute abdomen and with the secondary complaint of a rash. In view of the primary presenting complaint he was admitted to the surgical ward. The patient was initially booked for an emergency exploratory laparotomy, but after reassessment on the ward a clinical diagnosis of meningococcal septicaemia was made. The patient was treated medically with intravenous antibiotics and supportive therapy, and made a complete recovery. Medical causes of abdominal pain, as exemplified here, can be more life threatening than surgical causes and should be considered in all patients.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
2/8. Midgut volvulus in an adult patient.The authors report on a case of midgut volvulus in a 27-year-old man who presented with bilious vomiting and acute abdominal pain. US demonstrated a reversal of the normal relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). A clockwise whirlpool sign, diagnostic for midgut volvulus, was not visualised. In a further assessment, upper gastrointestinal series demonstrated obstruction in the second part of the duodenum highly suspicious of Ladd's bands. Malpositioning of bowel structures, as already suggested by the reversal of the SMA and SMV on ultrasound, and a distinctive whirl pattern due to the bowel wrapping around the SMA was demonstrated on CT. Furthermore angiography revealed focal twisting of the SMA. US is the first imaging modality to perform in suspicion of midgut volvulus. When inconclusive, CT is in our opinion the next stage in the diagnostic work-up.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
3/8. Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary.BACKGROUND: The health risks associated with sickle cell trait are minimal in this sizable sector of the world's population, and many of these patients have no information about their sickle cell status. Splenic syndrome at high altitude is well known to be associated with sickle cell trait, and unless this complication is kept in mind these patients may be subjected to unnecessary surgery when they present with altitude-induced acute abdomen. methods: Four patients were admitted to the surgical ward with a similar complaint of acute severe left upper abdominal pain after arrival to the mountainous resort city of Abha, saudi arabia. All were subjected to splenectomy because of lack of suspicion regarding sickle cell status. RESULTS: Histologic examination of the spleen showed all patients had sickle cells in the red pulp. On further assessment all were found to have sickle cell trait with splenic infarction. In a similar study of 6 patients with known sickle cell disease who had comparable problems when they travelled to the colorado mountains, all made an uncomplicated recovery with conservative management. CONCLUSIONS: In ethnically vulnerable patients with splenic syndrome, sickle cell trait should be ruled out before considering splenectomy. These patients could respond well to supportive management, and splenectomy would be avoided.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
4/8. Upper gastrointestinal endoscopy in systemic vasculitis presenting as an acute abdomen.Three cases of upper gastrointestinal vasculitis presenting as acute abdominal emergencies highlight an uncommon but often fatal presentation of systemic vasculitis. Although abdominal symptoms are common in such diseases, there may be a doubt during assessment of the patient as to whether the gastrointestinal tract is the prime target organ. radiology is often negative during the acute illness. endoscopy was important in documenting early and more advanced bleeding lesions of polyarteritis nodosa (PAN) and Henoch-Schoenlein disease, both conditions in which upper gastrointestinal lesions are rare. The gastric and duodenal vasculitic lesions demonstrated by endoscopy in such a clinical setting were confirmed histologically. Endoscopic assessment and early aggressive medical therapy contributed significantly towards the overall successful outcome. Gastroduodenoscopy has not been used either routinely or as an emergency investigation for the assessment of patients with vasculitis who present with acute abdominal pain. Involvement of the stomach and duodenum by vasculitis is therefore poorly appreciated, but remains a serious complication of vasculitic disease when the gastrointestinal tract is the prime target organ, and the information gained by endoscopy in a difficult clinical situation might alter the overall outcome of the disease.- - - - - - - - - - ranking = 3keywords = assessment (Clic here for more details about this article) |
5/8. Atypical presentation in the elderly--case report of an acute abdomen.An elderly woman with an acute abdomen due to a perforated peptic ulcer is discussed to illustrate the problem of atypical presentation of illness in the elderly. The importance of not dismissing non-specific symptoms and signs such as confusion, restlessness, abdominal distention and non-localising abdominal tenderness in the elderly, is highlighted. In addition, the useful radiological features of pneumoperitoneum are described. The need for functional assessment and rehabilitation are emphasised as important components in the practice of geriatric medicine.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
6/8. Duodenal diverticula--diagnosis and management of complicated forms: report of two clinical cases and review of the literature.Duodenal diverticula are frequent, they are present in 22% of the cases at autopsy. However, radiological assessment demonstrates duodenal diverticula in 1 to 5% of the patients only. Perforation, the main complication, is very rare. Preoperative diagnosis is exceptional. In a 69-year patient admitted for diffuse abdominal pain, a computerized abdominal tomography, completed by opacification of the gastroduodenal transit allowed diagnosis. In the second case, diagnosis was made peroperatively. Based on these two observations, the authors review the elements of diagnosis and management in complicated duodenal diverticula.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
7/8. Lupus peritonitis mimicking acute surgical abdomen in a patient with systemic lupus erythematosus: report of a case.A 25-year-old Japanese woman who had been suffering from systemic lupus erythematosus (SLE) for 12 years was admitted to our hospital with a suspected diagnosis of peritonitis after suddenly developing severe abdominal pain and distention which could not be relieved by treatment with anodyne. Noninvasive examinations did not provide enough evidence to rule out acute appendicitis, bowel perforation, or ischemia due to vasculitis. Therefore, in consideration of the severity of her uncontrollable abdominal pain, an exploratory laparotomy was performed. The operative findings revealed nonbacterial peritonitis with a large amount of ascites and an edematous small bowel. No perforation of the intestine was found. On post-operative day (POD) 3, the severe abdominal pain redeveloped, but responded well to steroid pulse therapy. Based on the operative findings and her clinical course, the most likely diagnosis was thought to be acute lupus peritonitis. It is often difficult to ascertain whether abdominal pain in an SLE patients is due to lupus peritonitis or to an underlying cause requiring surgery. Thus, it is essential that continuous and careful assessment of the surgical abdomen is performed when a patient with SLE develops acute abdominal pain, and if a surgical condition cannot be ruled out, a laparotomy should be performed without delay.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |
8/8. Bringing acute abdomen into focus.When you care for a patient with acute abdominal pain, you can't waste time-his life could depend on fast assessment and treatment. Follow this systematic approach to zero in on the diagnosis and intervene appropriately.- - - - - - - - - - ranking = 1keywords = assessment (Clic here for more details about this article) |