Chronic relapsing pancreatitis from a scorpion sting in Trinidad

Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. Thorough clinical evaluation, including CT scanning, disclosed unabated pancreatitis, particularly in children, a scorpion sting should be considered an aetiologically possibility(AU)

A scoring system for use in the diagnosis of acute abdominal pain in childhood

A statistical analysis was undertaken of 1158 children admitted to a surgical ward for the management of acute abdominal pain. Over two-thirds (40 percent) of the children had non-specific abdominal pain while 29.7 percent had appendicitis. The remainder were found to have had urinary tract infections (11.7 percent), constipation (7.5 percent), gastroenteritis (5.8 percent) or intussusception (5.3 percent). A stepwise discriminant analysis of the data collected during their evaluation was performed, using the BMDP statistical software package. Demographic and clinical features, as well as the results of ancillary investigations, were included in the data. The programme generated a classification function of a sub-set of 18 variables which best discriminated among the diagnostic groups. The coefficients of the classification functions were then combined with the rank order of selection of the variables to derive a scoring method for predicting the diagnosis. The results of urine culture were excluded since these would be unavailable during early clinical assessment. The scores for the diagnostic groups fell within the following ranges: - 1 - 23 non-specific abdominal pain; 20 - 48 appendicitis; 35 - 84 gastroenteritis; 75 - 88 constipation and 89 - 140 intussusception. It is suggested that this scoring method be evaluated by a prospective study to test its validity (AU)

A multivariate analysis of childhood abdominal pain in Trinidad

This is a multivariate anaylysis of the data recorded in assessing 1158 consecutive admissions presenting to a children's surgical ward with acute abdominal pain. There were 56 binary variables available for entry into the analysis. A statistical software package was used to perform a stepwise discriminant analysis on the data. The program selected 18 variables as having discriminating power in assigning patients to the six diagnostic groups. In order of discriminating power these were, mainly, a positive urine culture, the bowel history, the findings on rectal examination, the location of abdominal tenderness, the presence of a mass, and the white cell count. Lesser discriminating potential was assigned to the presence of dehydration; fluid levels on erect abdominal films, a rise in temperature, an increased pulse rate, the presence of urinary symptoms, and the general appearance of the child. Use of these data led to an overall correct classification of 80.7 percent of cases. It is concluded that these variables should be included in the assessment of children with acute abdominal pain (AU)

Cholestatic jaundice due to ackee fruit poisoning

A 27 year old Jamaican male presented with a 2 month history of jaundice, pruritus, intermittent diarrhea, and right upper quadrant abdominal pain. Over the next month, his abdominal pain and diarrhea improved, but his jaundice and pruritus worsened. He was afebrile and profound jaundice, with a benign abdominal examination. Medical workup included a normal abdominal ultrasound, iron studies, ceruloplasm, and serum electrophoresis. Negative viral (Epstein Barr virus, cytomegalovirus, mononucleosis, hepatitis A, B, C) studies, ANA, AMA, ASMA, RPR, were noted. He denied any alcohol, drug, or toxin exposure. Liver tests revealed total bilirubin of 25.6 mg/dl, direct bilirubin of 13.9 mg/dl, alkaline phosphate 278 IU/L, AST 45 IU/L, and ALT 71 IU/L. Liver biopsy demonstrated centrilobular zonal necrosis and cholestasis most consistent with a toxic reaction. The patient was again interviewed regarding potential toxins, and he admitted to the ingestion of ackee fruit, a native Jamaican fruit that is illegal in the United States. Shortly after he had ceased intake of the fruit, his symptoms resolved and his liver function tests returned to normal. We present a case of chronic ackee fruit ingestion that led to cholestatic jaundice, vomiting, and abdominal pain (AU)

The rectus sheath block for post-operative pain: a medical intra-operative approach - abstract

This study was designed to test the hypothesis that if early post-operative pain is adequately controlled then subsequent analgesia would be more effectively maintained. An intraoperative rectus sheath block was designed in which about 20 cc of 0.5 per cent bupivacaine were infiltrated into the plane containing the segmental spinal nerves within the rectal sheath just prior to wound closure. Twenty-six adult patients undergoing abdominal surgery via a mid-line incision were randomly allocated to 2 groups which were matched for age, sex, type of procedure and size of patient. The control group of 10 patients received pethidine 100 mg/i.m. every 4 hours for the first 24 post-operative hours. The rectus sheath group of 16 patients, in addition to the rectus sheath block, also received pethidine 100 mg/i.m. every 4 hours for 24 hours post-operatively. Pain scoring was done at six hours and twenty-four hours post-operatively, using a verbal rating scale. Statistical analysis, using The Mann-Whitney U test at the 5 per cent level, showed that post-operative analgesia, using the rectus sheath block and intra muscular pethidine, was superior to that obtained by pethidine alone at both 6 and 24 hours post-operatively (AU)

Portal vein thrombosis in a child with homozygous sickle-cell disease

A 13-year old boy with homozygous sickle-cell (SS) disease died suddenly at home folllowing a short history of abdominal pain. Autopsy revealed venous thrombosis of the hepatic, portal, superior mesenteric and splenic veins. Venous thrombosis is rare in SS disease and thrombosis of mesenteric vessels is most frequently seen in chronic myeloproliferative disorders. Its occurrence in SS disease raises the possibility of a common pathogenesis and adds another pathology to the causes of abdominal painful crisis. (AU)

Chronic pancreatitis in Jamaica

Thirty-five patients with chronic pancreatitis (CP) treated with over a 15-year period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77 percent) were chronic alcoholics, two (6 percent) had gallstones, one had stenosis of the Ampulla of Vater and in five (14 percent) no obvious cause was found. Thirty patients (86 percent) presented with abdominal pain. Chronic diarrhoea was present in 8 (23 percent), and steatorrhoea was documented in 6 of these. Fifteen (43 percent) had pancreatic calcifications. Five developed pseudocysts and 16 (46 percent) developed diabeted mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91 percent) have had a relatively stable course with medical management. (AU)

Abdominal pain in sickle cell anaemia

Acute abdominal pain occurs frequently in patients with sickle cell anaemia (SCA), and presents a difficult diagnostic and management problem as the clinical presentation may mimic an acute surgical condition. Good clinical judgement and careful observation are necessary to avoid increased morbidity and mortality. Chronic recurrent upper abdominal pain is also a common problem and in many the cause is unknown. These patients usually respond to simple symptomatic therapy. (Summary)

Gallstones in Jamaican children with homozygous sickle-cell disease - abstract

Gallstones were detected by ultrasonography in 30/226 (13 per cent) children with SS disease, aged 5-13 years, participating in a cohort study from birth. Children with gallstones had significantly lower total haemoglobin and foetal haemoglobin and higher bilirubin levels. Further analysis revealed that the apparent effects of Hb and HbF were secondary to their relationship with bilirubin levels. Abdominal pain crises were significantly associated with gallstones but both factors appeared to reflect an increased clinical severity and were probably not casually related. No patient had symptoms specific for gallstones. An association with abdominal pain crisis should not, of itself, be considered an indication for surgery (AU)

Abdominal pain in children

In summary, one may state that many cases of abdominal pain in children may have a psychosomatic origin, but one must also be aware and look for abdominal as well as extra-abdominal causes of abdominal pain. Loss of weight and anaemia are signs of organic disease in patients with abdominal pain. X-ray and laboratory studies should be kept to a minimum. Patients who are considered to have non-organic abdominal pain must be followed up to avoid unnecessary additional procedures and psychotherapy should be instituted if necessary. A psychosomatic diagnosis means more than a diagnosis by exclusion. It means the utilization of physiological and psychological techniques simultaneously in preparation for comprehensive medical care. Diagnosis by exclusion is dangerous in these cases and leads to greater invalidism. The physician may perpetuate the illness by his well meaning but mistaken and never-ending efforts to find a "physical cause" (AU)

Abdominal pain in childhood: another look at a common problem

Of 617 patients admitted to a children's surgical ward with a primary complaint of abdominal pain, the diagnosis of acute appendicitis, suspected prior to admission in the majority, was confirmed in only 18 percent. A review of the records indicates that a careful history and physical examination supplemented by minimal laboratory investigations, continue to remain the main-stays of diagnosis in this condition. The avoidance of delay in referral for admission, and of blind therapy, especially antibiotics, prior to diagnosis, would be of benefit to children with this very common complaint. (AU)

Preliminary report on clinical trials of hycanthone in s. mansoni infections - abstract

Hycanthone, a therapeutically active metabolite of lucanthone, was identified in 1965. In experimental schistosoma infections it was found to be three times as active as lucanthone in mice and ten times as active in hamsters. A single intramuscular dose was found to be as effective as a 5 day oral regimen. The present study was undertaken to evaluate the chemotherapeutic effect of hycanthone administered parenterally in patients infected with s. mansoni. All patients were admitted to the hospital ward for treatment. S.mansoni eggs in fecal specimens were counted by the filtration-staining technique. Three stool specimens were examined before treatment and at each follow-up visit. At the time of abstract preparation, sixty-one patients have been treated with intramuscular hycanthone at a dose level of 3mg/kg. Thirty-three (54 percent) of these had vomiting as the major side effect. Other side effects included anorexia, nausea and abdominal pain. For the most part side effects did not last beyond 24 hours. Thirty four patients have been seen at 6 weeks follow up examination. Seventeen (50 percent) have no eggs in three specimens. In those who are still excreting eggs, the average percent reduction in egg excretion is 97.92 percent. Of those not excreting eggs at six weeks eight (47 percent) had an initial egg count of less than 50 eggs/gm faeces; five (29.4 percent) of those still excreting eggs had initial egg counts of less than 50. The mean reduction in egg excretion for the entire group is 98.96 percent (AU)