Diagnosing and managing acute abdominal pain in children.

ABSTRACT: Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.

Emergency Laparotomy in a COVID-19 patient with acute abdomen.

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Type 1 gallbladder perforation: A rare cause of acute abdomen.

Gallbladder perforation is rare. Diagnosis is usually made during operative intervention. Delay in recognition is associated with high morbidity and mortality. We report a case of type 1 gall bladder perforation in a male patient with no previous complaints related to gallstones.

Unusual cause of acute abdomen in a child--torsion of greater omentum: report of two cases.

INTRODUCTION: Torsion of the omentum is twisting along its long axis and a rare cause of acute abdomen. Depending on associated conditions, it is classified as primary and secondary. It may mimic different pathologies presenting as acute abdomen, most common of them being acute appendicitis. Current choice for management of omental torsion is laparoscopic surgery. CASE PRESENTATION: We present two cases of omental torsion of two boys who presented with abdominal pain, nausea and vomiting and underwent emergency laparoscopy. CONCLUSION: Omental torsion is very rare, and its diagnosis is usually made only after surgery. At laparoscopy, omental torsion is suspected when the appendix is normal and the symptoms and findings of torsion are present. Laparoscopy is a safe and effective approach for the diagnosis and management of omental torsion, with the advantages of reduced postoperative pain and hospital stay.

Segmental absence of intestinal musculature -presentation in a 10-year-old boy with an extensive involved segment.

Segmental absence of the intestinal musculature is a rare cause of acute abdomen most likely associated with intestinal perforation and sepsis in neonates and adults. We present a case of a 10-year-old boy who developed acute abdomen and was treated with right hemicolectomy and partial resection of the ileum. The ileum showed a 20-cm-long stenotic segment showing prominent thinning of the intestinal wall. This case occurred in an older child, which appears to be rare when comparing the literature. The bowel defect was also the largest described to date, indicating the potential effect of an atonic segment leading to obstructive disease.

Acute abdomen due to primary omental torsion: case report.

BACKGROUND: Primary torsion of the greater omentum is an uncommon cause of acute abdominal pain that mainly affects adults in their fourth or fifth decade. It was first described by Eitel in 1899. Since then, more than 300 cases have been reported in the published literature. Clinical presentation and imaging findings are often of limited value in the diagnosis of primary omental torsion (POT). The patients usually undergo laparotomy for "acute appendicitis" or acute abdomen of poorly defined origin. OBJECTIVES: To provide a detailed description of this rare cause of acute abdomen. CASE REPORT: We report a case of POT in a woman of reproductive age and discuss contemporary methods in diagnosis and management of the condition. CONCLUSION: Nowadays, laparoscopy is a safe and effective approach for the diagnosis and management of POT, with the advantages of reduced postoperative pain and hospital stay. Conservative management has also been advocated by some authors in selected patients with a preoperative diagnosis of POT based on computed tomography findings.

Problems of diagnosis and treatment caused by ingested foreign bodies.

An ingested foreign body often passes the gastrointestinal tract without any complications. Foreign bodies, such as fish bones, chicken bones and toothpicks, have been known to cause perforation of the gastrointestinal tract. We present 4 cases: the first 2 of a 27-year-old male and a 48-years-old female respectively, with acute abdomen, diffuse purulent peritonitis, with ileum perforation, both caused by accidentally ingesting a wire, 1 case of a 64-year-old male with sigmoid perforation, caused by accidentally ingesting a toothpick and 1 case of a 52-year-old female presented with left buttock painful swelling for 1 week associated with fever,physical examination revealed an ischiorectal abscess.During incision and drainage a 3 cm chicken bone was found inside the abscess cavity. Evolution was favorable in all 4 cases.

Diagnosing and managing acute diverticulitis.

Diverticulosis is the most common structural abnormality of the colon and affects up to one third of those over the age of 60 years. Its complications account for more than 3,000 deaths per year. Acute diverticulitis is the most common complication and 10-25% of patients with diverticulosis may have one or more episodes. Patients present with left-sided abdominal pain that localises in the left iliac fossa. This left-sided pain reflects the underlying predominant left-sided distribution of the diverticula on this side. Patients may also present with right-sided or suprapubic pain, caused either by right-sided diverticulosis or a redundant sigmoid loop lying toward the right side, which may mimic appendicitis. The pain may be associated with changes in bowel habit. Dysuria and frequency may occur if the inflamed segment of bowel is adjacent to the bladder. Patients should be assessed according to their level of pain and associated systemic features of sepsis. In those in whom the pain is controlled and there are no signs of systemic sepsis and no high-risk features the patient may be treated in primary care but for those with systemic features of sepsis or high-risk features admission to hospital is required. The diagnosis of acute diverticulitis in all patients with a new presentation should be confirmed by CT scan on admission to hospital.

[Clinical case--voluminous diaphragmatic hernia--surgically acute abdomen: diagnostic and therapeutical challenges]. / Caz clinic--hernie diafragmatica voluminoasa--abdomen acut chirurgical: dificultati diagnostice si terapeutice.

We present the case of a 58-year old male patient admitted in the surgery section of the University Emergency Hospital of Bucharest and diagnosed with acute abdomen. The minimal clinical-paraclinical investigation (i.e., thorax-pulmonary Xray, biological probes) raises questions as to the differentiated diagnosis and other associated diseases, also suggesting the existence of voluminous diaphragmatic hernia. The CT thorax-abdomen examination confirms the diaphragmatic hernia suspicion, with intra-thorax ascent of the colon up to the anterior C4 level, but does not explain the abdominal suffering; thus we suspected a biliary ileus or acute appendicitis. Medial laparotomy was imperative. Intrasurgically peritonitis was noticed located by gangrenous acute apendicitis, perforated, with coprolite, for which apendictomy and lavage-drainage pf the peritoneal cavity was performed. Post-surgical status: favourable to recovery.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines.

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

Perforated jejunal diverticulum presenting as acute abdomen.

We present a case of a 66-year-old man, who was admitted with a 6-hour history of severe diffuse abdominal pain of acute onset, accompanied by nausea and flatulence. The patient underwent an exploratory laparotomy, which revealed the presence of multiple diverticules of the jejeunum, one of which was ruptured. The patient was treated with segmental resection of the jejunum carrying the ruptured diverticle. Perforation of a jejunal diverticulum has to be considered in the differential diagnosis of acute abdomen.

Primary torsion of the greater omentum: report of a case.

This is a case report of primary omental torsion that occurred in a 21-year-old man who presented with right lower quadrant abdominal pain. His provisional diagnosis was appendicitis. He was explored for appendicitis but the finding was twisted omentum.

[Haemoperitoneum secondary to avulsed short gastric arteries after vomiting]. / Emoperitoneo per rottura dei vasi gastrici brevi da conati di vomito.

We present the case of a rare and serious complication of vomiting. A 25-year-old man presented to the emergency room with acute abdomen secondary to haemoperitoneum. There was no evidence or history of trauma in the previous 30 days. The only antecedent was a history of violent vomiting in the afternoon. Laparoscopy showed a massive haemoperitoneum secondary to avulsed short gastric arteries.

[Biliary ascaris-induced obstructive jaundice: a case of acute abdomen]. / Biliyer askariazisin neden oldugu tikanma ikteri: Bir akut karin olgusu.

Ascaris lumbricoides is one of the most common helminthic diseases worldwide and it can cause various complications. The presence of this worm in the biliary tree, however, is a rare condition, especially in children. We describe a child with biliary ascariasis who was presenting clinical symptoms mimicking surgical acute abdomen. The diagnosis was made by ultrasound. The child was successfully treated with mebendazole and anti-spasmolytic. Biliary ascariasis should be added to the differential diagnosis of acute abdominal pain in patients, even in children, from endemic areas.

[Complicated Meckel's diverticulum in adult pathology]. / Diverticulul Meckel complicat în patologia adultului.

Meckel's diverticulum is the most prevalent abnormality of the gastrointestinal tract seen in approximately 2% of the population. Diagnosing complicated diverticulum is difficult, for its capacity to mime multiple disorders such as appendicitis, ulcer disease, enterocolitis, Chron disease, sigmoid diverticulitis, cholecystitis, and it should be considered in all patients with unexplained chronic abdominal pain, nausea, vomiting, gastrointestinal bleeding, unexpected cause of intestinal obstruction or acute abdomen. Herewith we provide an illustrative presentation, emphasizing the difficulties in preoperative diagnosis of complicated Meckel's diverticulum and underlining the nonspecific nature of the subjective and objective findings. Both cases were admitted to our clinic with acute abdomen diagnoses--first case as a intestinal obstruction and in second case was acute appendicitis. Laparatomy ascertain that the cause of symptoms was the complicated Meckel's diverticulum.

Some gallbladder-like pain demystified: three cases.

Over the course of the past several years, I have seen a number patients with intense pain in the right upper quadrant of the abdomen-classic "gallbladder" pain-for which no medical explanation could be found. These patients had been thoroughly checked by their physicians with diagnostic evaluations generally including sonograms and magnetic resonance imagings (MRIs) that were negative, adding to the mystery of the symptoms. Referred to me because acupuncture has a reputation of "being good for pain," these patients were in search of an explanation for and relief from their pain-pain that seemed to have no organic source. Described here are two cases of gallbladder-like pain with no medical diagnosis and one case of acute gallbladder pain with a diagnosis of acute cholecystitis and sludge confirmed on MRI. All three patients were free of pain after acupuncture treatment. Following the cases is a discussion of the rationale behind the approach used.

[Right atrial thrombosis with acute abdominal onset]. / Tromboza de atriu drept cu debut de abdomen acut.

Intracardiac masses are detected more frequently due to the availability of echocardiography. Right atrial thrombosis is rare comparatively with that of the left atrium. The clinical presentation of the patient with right atrial thrombosis is linked with a misleading association between cardiovascular signs and digestive signs (acute abdominal pain, vomiting and marmorated skin of flanks). Initial clinical suspicions of acute pancreatitis, entero-mesenteric infarction and complicated gastro-duodenal ulcer were invalidated by imagistic investigations -- echocardiography and CT. The massive thrombus located in the right atrium, prolapsing during diastole through the tricuspid valve, was associated with the increase in plasmatic D-dimers and new ECG modifications type right bundle block (hemodynamic straining of the right ventricle). The evolution was favorable, after heparin-therapy by infusing pump, with relief of cardiovascular and digestive symptoms after the first 6 hours; after 36 h from the beginning of the treatment the thrombus was lysed. Sudden death likelihood through complete obstruction of the tricuspid ostium was prevented due to the early diagnosis offered by imagistic methods.

[Acute Abdominal Pain: Hospital Admission or Not - And What Happens Then?] / Akuter Bauchschmerz: einweisen oder nicht? Und was dann?

Acute abdominal pain (AAP) is a common symptom and reason for encounter in family practices and emergency rooms. About every tenth hospital emergency room consultation is dealing with AAP, the most important reason is the "suspected acute abdomen". Important diagnostic considerations and clarification steps in family practice and emergency room are presented with the question: in which cases further treatment must be inpatient - or can be done on an outpatient basis. Acute abdominal pain has a complex differential diagnostic spectrum. Early detection of urgent cases is crucial to the outcome. The most important diagnostic means are history ("inductive foraging"), physical examination and sonography. "Yellow flags" provide valuable information for risk groups. Interdisciplinary cooperation is crucial, in doubt: "four eyes principle". If the cause is unclear, follow-up should be planned.

Schistosomal Peritonitis Presenting as Acute Abdomen: A Case Report.

BACKGROUND: Schistosomiasis is a trematode infestation causing a chronic granulomatous disease in various organs. Both S. mansoni & S. haematobium are endemic in Ethiopia. Most infected individuals are asymptomatic. Ectopic schistosomiasis can affect the lungs, genitalia, CNS, skin, peritoneum, Lymph nodes & other organs. Schistosomiasis as a cause of acute abdomen is seldom reported. CASE DETAIL: A 51 years-old male Ethiopian farmer presented with a two weeks history of abdominal pain with recent onset bilious vomiting and abdominal distention. Emergency laparotomy done & the finding was multiple tiny whitish nodule over the peritoneum & small bowel with multiple mesenteric lymphadenopathy. The diagnosis was confirmed with histopathology study. CONCLUSIONS: Schistosomal peritonitis is a very uncommon form of schistosomiasis. Physicians should be aware of such atypical presentation in patients from endemic areas of schistosomiasis. And biopsy should be considered in unsettled forms of peritonitis during laparotomy. The pathogenesis is not well known which warrants further study.