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1.
J Investig Med High Impact Case Rep ; 9: 23247096211009393, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33847153

RESUMO

The ongoing pandemic of the novel coronavirus disease 2019 (COVID-19) originated in Wuhan, China, in December 2019. Various manifestations of coronavirus (SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) have been reported since the pandemic began. Some articles have reported acute pancreatitis in several patients due to COVID-19 infection. In this case report, we introduce a patient in whom SARS-CoV-2 caused necrotizing pancreatitis. Acute abdomen is one of the manifestations of COVID-19. Various causes such as acute pancreatitis and necrotizing pancreatitis can be in the list of differential diagnoses.


Assuntos
/diagnóstico , Pancreatite Necrosante Aguda/virologia , Abdome Agudo/virologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Anticancer Res ; 41(4): 1959-1970, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813402

RESUMO

BACKGROUND/AIM: The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. PATIENTS AND METHODS: A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. CONCLUSION: The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.


Assuntos
Abdome Agudo/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Abdome Agudo/etiologia , Abdome Agudo/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/patologia , Doença Aguda , Área Sob a Curva , Estudos de Coortes , Conjuntos de Dados como Assunto , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/patologia , Anamnese , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Projetos de Pesquisa , Sensibilidade e Especificidade
3.
Radiologe ; 61(5): 497-510, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33860818

RESUMO

The acute abdomen is characterized by acute abdominal pain with defensive muscular tension, can be triggered by a variety of diseases and sometimes represents a life-threatening condition. After clinical inspection, in most cases dedicated imaging should be performed immediately. The frequently causal appendicitis and cholecystitis can mostly be diagnosed with ultrasound. In other cases with unclear ultrasound findings or unclear severe symptoms, computer tomography (CT) is usually necessary without delay. In contrast, magnetic resonance imaging (MRI) is predominantly indicated in pregnant women and children with unclear ultrasound findings. Thus, the radiologist is an important gatekeeper in the diagnostics of acute abdomen. The radiologist should therefore be familiar with the correct imaging indications, the frequent and rare causes as well as the corresponding morphological imaging characteristics.


Assuntos
Abdome Agudo , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Criança , Feminino , Vesícula Biliar/diagnóstico por imagem , Humanos , Fígado , Imagem por Ressonância Magnética , Pâncreas , Gravidez , Baço , Ultrassonografia
4.
BMC Gastroenterol ; 21(1): 187, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888085

RESUMO

BACKGROUND: The SARS-CoV-2 pandemic is a considerable public health problem, which has caused a burden on health systems in many countries. Despite the existence of multiple studies on the different digestive symptoms and their relationship with this disease, it is still vital to highlight the severity of the different symptoms, the need to diagnose it properly and quickly. Currently in Colombia there are no writings that highlight the above. CASE PRESENTATION: This article reports the case of a 37-year-old female patient, with no important history, who consulted for 10 h of a generalized intense abdominal pain, of sudden onset, associated with multiple stools of diarrheal consistency, and no respiratory symptoms and no epidemiological exposure. Physical examination with intense pain in the colic frame with tenderness. It was decided to rule out surgical pathology and a CT scan was performed finding no evidence of acute intra-abdominal pathology, but with a peripheral alveolar, and ground-glass opacities at lung bases, classic COVID-19 radiological pattern, confirmed by a positive RT-PCR for SARS-CoV-2, leading to consider that the gastrointestinal symptoms were secondary to this infection. Symptomatic management was given with subsequent improvement. CONCLUSIONS: It is extremely important to present this first case report of a young female COVID-19 patient with an acute abdominal pain as the main clinical manifestation, that almost culminates in a surgical procedure; demonstrating the scope of gastrointestinal symptoms secondary to SARS-CoV-2 infection.


Assuntos
Abdome Agudo/virologia , /diagnóstico , Adulto , Colômbia , Feminino , Humanos
6.
Med J Malaysia ; 76(2): 254-257, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33742640

RESUMO

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.


Assuntos
Abdome Agudo/cirurgia , /prevenção & controle , Colecistectomia , Colecistite/cirurgia , Laparotomia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Colecistite/diagnóstico , Colecistite/etiologia , Gangrena , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Equipamento de Proteção Individual
7.
J Forensic Leg Med ; 78: 102089, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33596513

RESUMO

Acute stomach disease in elderly patients often lacks characteristic clinical manifestations. Presentations may differ from those in younger patients and are often complicated by concomitant diseases, delayed presentation, and misdiagnosis. Incorrect diagnosis and treatment can lead to medical-related death claims. We investigated eight cases of elderly fatality due to acute abdominal diseases in forensic autopsy cases. Although most fatalities were unwitnessed, possibly due to the characteristics of elderly individuals, recent social backgrounds, and involvement with health care, some cases of possible misdiagnosis suggested that physicians should carefully consider atypical clinical manifestations and the characteristics of elderly individuals when the managing abdominal symptoms, particularly in primary health care. Our investigation of these forensic autopsy cases indicated the particular importance of peritoneal adhesions as an unexpected cause of acute abdomen in the elderly due to strangulation ileus, even among those with no history of abdominal surgery or trauma. Diagnosis of acute stomach symptoms can be difficult in elderly patients. Pathophysiological examination and autopsy analyses can thus contribute to early-stage diagnosis and prevention of acute stomach symptoms in elderly patient populations.


Assuntos
Abdome Agudo/etiologia , Dor Abdominal/etiologia , Idoso Fragilizado , Gastropatias/diagnóstico , Abdome/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Autopsia , Causas de Morte , Feminino , Humanos , Íleus/fisiopatologia , Pulmão/diagnóstico por imagem , Masculino , Peritonite/fisiopatologia
8.
Updates Surg ; 73(2): 763-768, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33625679

RESUMO

PURPOSE: COVID-19 is associated with high morbidity and mortality in patients undergoing surgery. Contrary to elective procedures, emergency operations should not be postponed. We aim to evaluate the profile and outcomes of COVID-19 patients who underwent emergency abdominal surgery. METHODS: We performed a retrospective analysis of perioperative data of COVID-19 patients undergoing emergency surgery from April 2020 to August 2020. RESULTS: Eighty-two patients were evaluated due to abdominal complaints, yielding 22 emergency surgeries. The mean APACHE II and SAPS were 18.7 and 68, respectively. Six patients had a PaO2/FiO2 lower than 200 and more than 50% of parenchymal compromise on chest tomography. The most common indications for emergency surgery were hernias (6; 27.2%). The median length of stay was 30 days, and only two patients required reoperation. Postoperatively, 10 (43.3%) patients needed mechanical ventilation for a mean of 6 days. The overall mortality rate was 31.8%. CONCLUSION: Both postoperative morbidity and mortality are high in COVID-19 patients with respiratory compromise and abdominal emergencies.


Assuntos
Abdome Agudo/cirurgia , Pneumonia Viral/complicações , APACHE , Abdome Agudo/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Emergências , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial , Estudos Retrospectivos
10.
Ulus Travma Acil Cerrahi Derg ; 27(1): 154-156, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394461

RESUMO

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.


Assuntos
Abdome Agudo , Anormalidade Torcional , Baço Flutuante , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Humanos , Laparoscopia , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Baço Flutuante/complicações , Baço Flutuante/diagnóstico , Adulto Jovem
11.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500302

RESUMO

Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.


Assuntos
Doenças das Tubas Uterinas/complicações , Hemoperitônio/etiologia , Salpingite/complicações , Abdome Agudo/etiologia , Adulto , Doenças das Tubas Uterinas/patologia , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Laparoscopia , Ruptura Espontânea , Salpingectomia , Salpingite/patologia , Salpingite/cirurgia
12.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33507637

RESUMO

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


Assuntos
Abdome Agudo/diagnóstico , Dor Abdominal/etiologia , /diagnóstico , Abdome Agudo/cirurgia , Abdome Agudo/virologia , Dor Abdominal/virologia , Adolescente , Apendicite/diagnóstico , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Peritonite/diagnóstico , Estudos Retrospectivos , Vômito/epidemiologia , Vômito/etiologia
13.
Br J Radiol ; 94(1117): 20200383, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32822245

RESUMO

Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.


Assuntos
Corpo Lúteo/diagnóstico por imagem , Hemoperitônio/etiologia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ultrassonografia/métodos , Abdome Agudo/etiologia , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Imagem Multimodal , Tomografia Computadorizada por Raios X
14.
Rev Fac Cien Med Univ Nac Cordoba ; 77(4): 356-359, 2020 12 19.
Artigo em Espanhol | MEDLINE | ID: mdl-33351370

RESUMO

Introduction: Congenital renal arteriovenous fistula is an abnormal connection between the arterial and venous system. Since the first case described in 1928 by Varela et al, no more than 200 cases have been published. Material and methods: A 45-year-old woman consulted for severe abdominal and low-back pain associated with arterial hypertension. The CT scan showed an infrarenal retroperitoneal lesion with invasion of neighboring structures. Results: During the abdominal exploration, a vascular-looking lesion of 60 x 34 x 41 mm was identified. It was associated with right nephrectomy. Discussion: The etiology of congenital fistulas remains unknown; it is believed that a congenital arterial aneurysm erodes into an adjacent vein and gradually increases its size. Other authors believe that the fistula exists since birth and gradually increases its size until it causes symptoms. Conclusion: Congenital arteriovenous fistulas are rare entities, representing less than 25% of all renal arteriovenous malformations.


Assuntos
Abdome Agudo , Fístula Arteriovenosa , Aneurisma , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Feminino , Humanos , Rim/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem
15.
Rev. cuba. cir ; 59(4): e923, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149843

RESUMO

RESUMEN Introducción: El abdomen agudo es causa frecuente de ingreso hospitalario en pacientes geriátricos. Objetivo: Caracterizar el comportamiento del abdomen agudo quirúrgico en el paciente geriátrico en un servicio de cirugía general. Métodos: Se realizó un estudio observacional descriptivo longitudinal de corte transversal en 169 pacientes. Los datos procedieron de las historias clínicas del Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2014 a diciembre de 2016 y se procesaron mediante estadística descriptiva, relacionándose algunas variables de manera no inferencial. Resultados: El 52,2 por ciento de los pacientes eran hombres. El 42,6 por ciento tenía edades entre 60 y 69 años. El 28,9 por ciento presentaron la oclusión intestinal como etiología. Hubo un 39,5 por ciento de complicaciones, el 54,5 por ciento de ellas fueron infecciosas. La mortalidad fue de un 22,5 por ciento. El 26,6 por ciento de los fallecidos presentaba oclusión intestinal. Conclusiones: Casi una décima parte de los pacientes fallecieron, la peritonitis fibropurulenta y el choque séptico fueron las causas más frecuentes de los decesos. La oclusión intestinal como causa de abdomen agudo pareció influir en la mortalidad de la muestra estudiada(AU)


ABSTRACT Introduction: Acute abdomen is a frequent cause of hospital admission in geriatric patients. Objective: To characterize the occurrence of acute surgical abdomen in the geriatric patient in a general surgery service. Methods: An observational, descriptive, longitudinal and cross-sectional study was carried out with 169 patients. The data were obtained from the medical records of Manuel Ascunce Domenech University Hospital in Camagüey, from January 2014 to December 2016, and were processed using descriptive statistics, relating some variables in a noninferential way. Results: 52.2 percent of the patients were men. 42.6 percent were aged between 60 and 69 years. 28.9 percent presented intestinal occlusion as an etiology. There were 39.5 percent of complications, 54.5 percent of which were infectious. Mortality was 22.5 percent. 26.6 percent of the deceased had intestinal obstruction. Conclusions: Almost one tenth of the patients died, with fibrinopurulent peritonitis and septic shock being the most frequent causes of death. Intestinal occlusion as a cause of acute abdomen appeared to influence mortality in the sample studied(AU)


Assuntos
Humanos , Masculino , Idoso , Choque Séptico/mortalidade , Abdome Agudo/cirurgia , Obstrução Intestinal/etiologia , Peritonite/mortalidade , Epidemiologia Descritiva , Estudos Transversais , Estudos Longitudinais , Estudos Observacionais como Assunto , Obstrução Intestinal/complicações
16.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318241

RESUMO

We present a case of a 50-year-old man admitted due to acute abdomen, icterus and fever. The patient had a history of sufficiently treated type 2 diabetes and a high daily alcohol consumption, no recent travel history and had a strictly heterosexual and monogamous way of living. A full blood count displayed severe elevated liver enzymes. A CT of the abdomen was performed and revealed steatosis but no acute abdominal pathology. During admission, the patient developed signs of meningoencephalitis. A lumbar puncture was performed, and the cerebrospinal fluid revealed lymphocytic pleocytosis consistent with mild inflammation. Furthermore, hepatitis E was found in the blood and the definitive diagnosis was established. The patient gradually recovered and was discharged within 8 days of admission. To the best of our knowledge, we present the second case describing concomitant hepatitis and meningoencephalitis, resolving spontaneously and not giving rise to sequelae.


Assuntos
Abdome Agudo/virologia , Hepatite E/diagnóstico , Meningoencefalite/virologia , Doença Aguda , Alcoolismo/complicações , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
BMJ Case Rep ; 13(12)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361138

RESUMO

Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks' gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients' pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.


Assuntos
Abdome Agudo/diagnóstico , Anexos Uterinos/diagnóstico por imagem , Hemoperitônio , Imagem por Ressonância Magnética/métodos , Gravidez Heterotópica , Salpingo-Ooforectomia/métodos , Abdome Agudo/etiologia , Anexos Uterinos/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Gravidez , Resultado da Gravidez , Gravidez Heterotópica/diagnóstico , Gravidez Heterotópica/fisiopatologia , Gravidez Heterotópica/cirurgia , Técnicas de Reprodução Assistida/efeitos adversos , Ruptura , Resultado do Tratamento , Ultrassonografia/métodos
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