1/6. Early appendicitis--a safe diagnosis?INTRODUCTION: Serosal inflammation of the appendix in association with a significant peritoneal exudate can be mistaken for early acute appendicitis. We highlight the importance of looking for other sources of intra-abdominal sepsis in this clinical setting. CLINICAL PICTURE: We present 3 cases of so-called "mild" appendicitis with serosal inflammation that was ultimately shown to be caused by Meckel's diverticulitis. TREATMENT: All 3 patients initially underwent an appendicectomy. In 2 of these cases, a further laparotomy and excision of a Meckel's diverticulum was carried out. All 3 made an uneventful recovery. CONCLUSION: Meckel's diverticulitis can mimic acute appendicitis in clinical history, physical findings and operative findings. It is important to always consider this as a possible cause for an acute abdomen.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. The curious umbilicus: clue to the cause of abdominal pain.Omphalomesenteric duct derivatives cause an assortment of complications, most notably intestinal hemorrhage and obstruction. intestinal obstruction is the most lethal complication and usually results from a diverticulum with an attachment to the umbilicus. This cause of intestinal obstruction is not generally recognized preoperatively. We report a teenager with episodic abdominal pain, acute small bowel obstruction, and a curious umbilical deformity with an underlying omphalomesenteric duct remnant. We believe that this physical finding suggests the diagnosis in patients with intestinal obstruction who have experienced unexplained episodes of abdominal pain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Meckel's diverticulum.Meckel's diverticulum, a relatively common congenital anomaly of the gastrointestinal tract, is present in approximately 2 percent of the population. When symptoms develop, they are usually the result of inflammation, hemorrhage or obstruction. diagnosis is made by maintaining a high index of suspicion, carefully reviewing data from the history and physical examination, and performing a radionuclide scan. Surgical removal is usually indicated when symptoms occur. An asymptomatic Meckel's diverticulum that is discovered incidentally at surgery should usually be removed unless contraindications exist.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Laparoscopic management of volvulated Meckel's diverticulum.laparoscopy in the emergency setting is a logical extension of this technique. Open laparoscopy is particularly useful in the management of the acute abdomen. In our institution, after a sequential work-out that includes physical examination, laboratory data, plain abdominal roentgenograms and ultrasonography, diagnostic laparoscopy is advocated. We present the laparoscopic treatment of an intestinal obstruction caused by a volvulus around Meckel's diverticulum. The efficacy and safety of the diagnostic and/or therapeutic laparoscopic procedures in the emergency setting are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Perforation of a Meckel's diverticulum caused by ingestion of a coin.A 25-year-old woman ingested a quarter. Three days later, lower abdominal pain, fever, chills, and physical findings compatible with pelvic inflammatory disease developed. Radiographic examination showed the coin in the middle pelvis. Persistent abdominal complaints, abnormal physical examination, and failure of the coin to progress through the gastrointestinal tract despite conservative management led to surgical intervention. Exploration revealed an inflammatory process in the posterior uterine culde-sac with multiple omental, small bowel, and uterine adhesions due to perforation of a Meckel's diverticulum. Excision of the Meckel's diverticulum was done, and the patient recovered satisfactorily.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/6. Nongynecologic causes of unexplained lower abdominal pain in adolescent girls.Unexplained lower abdominal pain in young women can present a challenge for even the most experienced clinicians. Although the cause is usually benign and self-limited, occasionally a serious underlying disorder exists. Clinicians should have an organized approach for diagnosis and management in an effort to avoid any unnecessary tests or referrals. The most important elements of the evaluation are thorough history, careful physical, and sequential follow-up as needed. Selective use of the laboratory and radiographic studies should be considered on an individual basis. This paper describes four disorders in adolescent girls that may present with pain in the lower abdominal region and closely resemble pathologic conditions within the gynecologic tract. Practitioners who provide services to young women should be aware of these entities so that the correct diagnosis is established as soon as possible and appropriate therapy initiated in a timely fashion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |