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1.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653871

RESUMO

A 30-year-old, multiparous widow, with postpolio residual paralysis, presented with complaints of dull aching abdominal pain for 15 days. Ultrasound showed a mixed echogenic right adnexal mass with free fluid in the pelvis and abdomen. CT abdomen and pelvis revealed partially defined peripherally enhancing collection in lower abdomen and right adnexa suggestive of tubo-ovarian abscess. There was mild ileal wall thickening and few enlarged mesenteric lymph nodes. Ascitic fluid did not show acid fast bacilli and cultures were sterile. Extensive diagnostic laboratory work was done which was inconclusive. Diagnostic laparoscopy could not be performed due to non-availability of elective operation theatre in the COVID-19 pandemic. Presumptive extrapulmonary tuberculosis was clinically and radiologically diagnosed. She was started on daily anti tuberculosis treatment. This case shows us the importance of imaging as a diagnostic tool and as an alternative for laparoscopy in COVID-19 pandemic to diagnose abdomino-pelvic tuberculosis.


Assuntos
Abscesso Abdominal , Doenças dos Anexos , Antituberculosos/administração & dosagem , Tuberculose Urogenital , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Dor Abdominal/diagnóstico , Doenças dos Anexos/diagnóstico , Doenças dos Anexos/fisiopatologia , Doenças dos Anexos/terapia , Adulto , /terapia , Diagnóstico Diferencial , Feminino , Humanos , Pelve/diagnóstico por imagem , Síndrome Pós-Poliomielite/complicações , Tomografia Computadorizada por Raios X/métodos , Tuberculose Urogenital/complicações , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/fisiopatologia , Tuberculose Urogenital/terapia , Ultrassonografia/métodos
2.
Medicine (Baltimore) ; 100(10): e24024, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725815

RESUMO

INTRODUCTION: Uterine fibroids, which are common benign tumors, rarely cause acute complications. We herein report a case of hemoperitoneum associated with uterine fibroid that could be diagnosed preoperatively with contrast-enhanced computerized tomography (CT). PATIENT CONCERNS: A 48-year-old woman with uterine fibroid developed extremely severe lower abdominal pain on the first day of her menstrual period. DIAGNOSIS: Ultrasonography and contrast-enhanced CT revealed a uterine fibroid and extravasation from the dilated vessels of the uterine fibroid. INTERVENTION: Emergent abdominal hysterectomy was performed. OUTCOMES: The total amount of bleeding was 4,600 mL. Intraoperative blood salvage (1,357 mL), 6 units of red blood cells, 4 units of fresh frozen plasma, and 20 units of platelet concentrates were transfused. The postoperative course was uneventful. Pathological examination confirmed a benign uterine fibroid. CONCLUSION: CT could be useful to determine a diagnosis for bleeding from ruptured subserosal uterine fibroid.


Assuntos
Dor Abdominal/diagnóstico , Hemoperitônio/diagnóstico , Leiomioma/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Meios de Contraste/administração & dosagem , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Histerectomia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Recuperação de Sangue Operatório , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Útero/cirurgia
5.
Medicine (Baltimore) ; 100(7): e24815, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607846

RESUMO

RATIONALE: Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient. PATIENT CONCERNS: A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath. DIAGNOSIS: Based on radiological findings we diagnosed tension gastrothorax. INTERVENTIONS: Hernia reduction and diaphragmatic defect repair were performed under thoracotomy. OUTCOMES: After the operation, the patient's clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings. LESSONS: Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.


Assuntos
Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Toracotomia/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Pré-Escolar , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Radiografia Torácica/métodos , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563679

RESUMO

We present an adolescent girl with a 1-day history of acute urinary retention and lower abdominal pain. She was admitted to the paediatric ward for ongoing treatment and investigations. Due to a myriad of factors including pain and anxiety, challenges posed included an incomplete initial abdominal and external genital examination. This case report highlights the importance of a focused history and performing an appropriate sensitive examination at the time of presentation. Furthermore, we explore the common causes of new onset urinary retention and unravel the case as it unfolds. We also highlight differential diagnoses (however, uncommon), which must be considered and not overlooked to avoid unnecessary investigations and to ensure timely management.


Assuntos
Dor Abdominal/diagnóstico , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/cirurgia , Hímen/anormalidades , Retenção Urinária/diagnóstico , Dor Abdominal/terapia , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Hímen/cirurgia , Anamnese , Retenção Urinária/terapia
7.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431536

RESUMO

Changes of the hepatic subcapsular blood flow with the early appearance of hypervascularity near the falciform ligament are rare radiologic findings. They present most frequently in cases of superior vena cava (SVC) obstruction and are related to the recruitment of the cavo-mammary-phrenic-hepatic-capsule-portal and the cavo-superficial-umbilical-portal pathways. We present the case of a 52-year-old female patient with an highly aggressive retroperitoneal liposarcoma with SVC obstruction caused by external compression due to a mediastinal metastatic mass. The patient exhibited no symptoms of SVC obstruction due to the collateral cavo-portal pathways.


Assuntos
Dor Abdominal/etiologia , Lipossarcoma/diagnóstico , Neoplasias do Mediastino/diagnóstico , Cuidados Paliativos/legislação & jurisprudência , Neoplasias Retroperitoneais/diagnóstico , Síndrome da Veia Cava Superior/diagnóstico , Dor Abdominal/diagnóstico , Antibióticos Antineoplásicos/uso terapêutico , Doxorrubicina/uso terapêutico , Evolução Fatal , Feminino , Humanos , Biópsia Guiada por Imagem , Lipossarcoma/complicações , Lipossarcoma/patologia , Lipossarcoma/terapia , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/secundário , Neoplasias do Mediastino/terapia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/terapia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia , Tomografia Computadorizada por Raios X , Veia Cava Superior/diagnóstico por imagem
8.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472809

RESUMO

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient's abdominal pain resolved within 4 days.


Assuntos
Dor Abdominal/diagnóstico , Medicamentos Falsificados/efeitos adversos , Intoxicação por Chumbo/diagnóstico , Charlatanismo , Vômito/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Anemia/etiologia , Antieméticos/uso terapêutico , Quelantes/uso terapêutico , Clordiazepóxido/uso terapêutico , Antagonistas Colinérgicos , Constipação Intestinal/etiologia , Medicamentos Falsificados/química , Combinação de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Intoxicação por Chumbo/complicações , Intoxicação por Chumbo/tratamento farmacológico , Masculino , Parassimpatolíticos/uso terapêutico , Penicilamina/uso terapêutico , Fenetilaminas/uso terapêutico , Quinuclidinas/uso terapêutico , Tomografia Computadorizada por Raios X , Vômito/tratamento farmacológico , Vômito/etiologia
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431458

RESUMO

A 55-year-old man presented with severe right upper quadrant abdominal pain and hypertension up to 231/171 mm Hg on a background of a known adrenal mass, intravenous drug use and recurrent anxiety attacks. CT showed heterogenous lesion of the right adrenal gland but the sudden severe pain remained unexplained. After correction of the blood pressure with analgesia and antihypertensives, the patient developed a type 2 non-ST-elevation myocardial infarction that was treated with aspirin and therapeutic enoxaparin. This resulted in worsening pain and a repeat CT angiogram showed a haemoretroperitoneum around the right adrenal lesion. On review, an occult intra-adrenal haemorrhage was identified on the initial CT scan. Presumably this concealed haemorrhage caused the initial pain crisis and later decompressed into the retroperitoneal space. Raised metanephrine levels confirmed the diagnosis of pheochromocytoma and after preoperative optimisation with phenoxybenzamine, an open right adrenalectomy was performed.


Assuntos
Dor Abdominal/etiologia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Hemorragia/diagnóstico , Hipertensão/etiologia , Infarto do Miocárdio/diagnóstico , Feocromocitoma/diagnóstico , Dor Abdominal/diagnóstico , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Anti-Hipertensivos/administração & dosagem , Angiografia por Tomografia Computadorizada , Eletrocardiografia , Hemorragia/sangue , Hemorragia/etiologia , Hemorragia/cirurgia , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Masculino , Metanefrina/sangue , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Medição da Dor , Feocromocitoma/sangue , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Espaço Retroperitoneal , Tomografia Computadorizada por Raios X
11.
Anticancer Res ; 41(1): 297-306, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419824

RESUMO

AIM: The aim of the study was to compare the accuracy of common clinical findings, laboratory tests and diagnostic score (DS) in diagnosis of clinically confirmed acute appendicitis (AA) in children. PATIENTS AND METHODS: A cohort of 188 children under the age of 15 years presenting with acute abdominal pain (AAP) were included in the study. The clinical history (n=21), signs (n=14) and tests (n=3) were recorded in each child. RESULTS: The significant independent diagnostic predictors (disclosed by multivariate logistic regression model) were used to construct the DS formulas for AA diagnosis. These formulas were tested at six different cut-off levels to establish the most optimal diagnostic performance for clinically confirmed AA. In the receiver operating characteristic curve (ROC) comparison test, there was a statistically significant difference (p=0.0055) in the area under curve (AUC) values between i) clinical history and symptoms (AUC=0.594), and ii) signs and laboratory tests (AUC=0.734), whereas both were significantly inferior (p=0.0001) to the AUC value of the DS (AUC=0.952). CONCLUSION: In diagnosis of clinically confirmed AA in children, the DS formula is superior to both the clinical history/symptoms and signs/lab tests, justifying the use of DS as an integral part of the diagnostic algorithm of AA in all children presenting with AAP.


Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Adolescente , Fatores Etários , Apendicite/complicações , Biomarcadores , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Curva ROC , Avaliação de Sintomas
12.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310829

RESUMO

Thoracic radiculopathy is a rare cause of thoracic-abdominal or abdominal pain in subjects with poorly controlled diabetes. We present a case of a young woman with type I diabetes and a severe abdominal pain in both lower quadrants. An extensive diagnostic gastroenterological and gynaecological workup did not disclose abnormalities. Electromyography revealed an initial polyneuropathy and significant neurogenic abnormalities in the T10-T12 paravertebral muscles. Following the hypothesis that the radiculopathy-related abdominal pain might have an immuno-mediated pathogenesis, the patient underwent a complex trial of immunotherapy, which was accompanied by a sustained improvement over months to full recovery. This report would support the hypothesis that immune-mediated mechanisms are still active even months after onset of symptoms.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Imunoglobulinas Intravenosas/administração & dosagem , Radiculopatia/tratamento farmacológico , Dor Abdominal/diagnóstico , Adulto , Eletromiografia , Feminino , Humanos , Imunoterapia , Músculos/inervação , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento
13.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33371000

RESUMO

Intra-abdominal thromboses are a poorly characterised thrombotic complication of COVID-19 and are illustrated in this case. A 42-year-old man with chronic hepatitis B (undetectable viral load, FibroScan 7.4 kPa) developed fever and cough in March 2020. 14 days later, he developed right upper quadrant pain. After being discharged with reassurance, he re-presented with worsening pain on symptom day 25. Subsequent abdominal ultrasound suggested portal vein thrombosis. CT of the abdomen confirmed portal and mid-superior mesenteric vein thromboses. Concurrent CT of the chest suggested COVID-19 infection. While reverse transcription PCR was negative, subsequent antibody serology was positive. Thrombophilia screen excluded inherited and acquired thrombophilia. Having been commenced on apixaban 5 mg two times per day, he is currently asymptomatic. This is the first case of COVID-19-related portomesenteric thrombosis described in the UK. A recent meta-analysis suggests 9.2% of COVID-19 cases develop abdominal pain. Threshold for performing abdominal imaging must be lower to avoid this reversible complication.


Assuntos
Hepatite B Crônica/complicações , Isquemia Mesentérica , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , /isolamento & purificação , Dor Abdominal/diagnóstico , Adulto , /complicações , /métodos , Diagnóstico Diferencial , Inibidores do Fator Xa/administração & dosagem , Humanos , Masculino , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/fisiopatologia , Isquemia Mesentérica/terapia , Portografia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
14.
Lakartidningen ; 1172020 10 06.
Artigo em Sueco | MEDLINE | ID: mdl-33021327

RESUMO

BACKGROUND: Recurrent abdominal pain is highly prevalent in children. Functional abdominal pain disorders (FAPD) is the most common cause.  Aim: To investigate the adherence in a primary care setting to regional guidelines regarding children with recurrent abdominal pain.  Methods: Medical records 2014-2016 were analysed. Children aged 4-17 years who made a visit to their general practitioner due to abdominal pain were included. Patients with acute or non-functional pain were excluded.  Results: We identified 177 children. The physicians made notes about stool appearance in 88% of cases.  Serum antibodies against transglutaminase were analysed in 76% and blood count in 71%. In 54% the physician provided information about FAPD, according to medical records. CONCLUSIONS: The physicians seem to be aware of several diagnostic tools for ruling out other diagnoses, but improvements can be made in terms of communication about FAPD.


Assuntos
Síndrome do Intestino Irritável , Dor Abdominal/diagnóstico , Dor Abdominal/epidemiologia , Adolescente , Criança , Pré-Escolar , Humanos , Prevalência , Atenção Primária à Saúde , Estudos Retrospectivos
15.
PLoS One ; 15(10): e0239622, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052903

RESUMO

A scale with robust statistical validation is essential to diagnose pain and improve decision making for analgesia. This blind, randomised, prospective and opportunist study aimed to develop an ethogram to evaluate behaviour and validate a scale to assess acute ovine postoperative pain. Elective laparoscopy was performed in 48 healthy sheep, filmed at one preoperative and three postoperative moments, before and after rescue analgesia and 24 hours after. The videos were randomised and assessed twice by four evaluators, with a one-month interval between evaluations. Statistical analysis was performed using R software and differences were considered significant when p <0.05. Based on the multiple association, a unidimensional scale was adopted. The intra- and inter-observer reliability ranged from moderate to very good (intraclass correlation coefficient ≥ 0.53). The scale presented Spearman correlations > 0.80 with the numerical, simple descriptive, and visual analogue scales, and a correlation of 0.48 with the facial expression scale. According to the mixed linear model, the scale was responsive, due to the increase and decrease in pain scores of all items after surgery and analgesic intervention, respectively. All items on the scale demonstrated an acceptable Spearman item-total correlation (0.56-0.76), except for appetite (0.25). The internal consistency was excellent (Cronbach's α = 0.81) and all items presented specificity > 0.72 and sensitivity between 0.61-0.90, except for appetite. According to the Youden index, the cut-off point was ≥ 4 out of 12, with a diagnostic uncertainty zone of 4 to 5. The area under the curve > 0.95 demonstrated the excellent discriminatory capacity of the instrument. In conclusion, the Unesp-Botucatu pain scale in sheep submitted to laparoscopy is valid, reliable, specific, sensitive, with excellent internal consistency, accuracy, discriminatory capacity, and a defined cut-off point.


Assuntos
Dor Abdominal/veterinária , Medição da Dor/veterinária , Dor Pós-Operatória/veterinária , Carneiro Doméstico/cirurgia , Dor Abdominal/diagnóstico , Analgesia/métodos , Analgesia/veterinária , Animais , Brasil , Feminino , Laparoscopia/veterinária , Modelos Anatômicos , Modelos Animais , Variações Dependentes do Observador , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Estudos Prospectivos , Carneiro Doméstico/fisiologia , Gravação em Vídeo
16.
Medicine (Baltimore) ; 99(40): e22583, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019474

RESUMO

INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.


Assuntos
Antituberculosos/uso terapêutico , Púrpura de Schoenlein-Henoch/etiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Ácido Ascórbico/uso terapêutico , Clorfeniramina/uso terapêutico , Diagnóstico Diferencial , Febre/diagnóstico , Febre/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Resultado do Tratamento , Tuberculina , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico por imagem , Vitaminas/uso terapêutico , Adulto Jovem
17.
Medicine (Baltimore) ; 99(43): e22864, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120825

RESUMO

Video capsule endoscopy (VCE) can detect mucosal lesions in the intestine, especially in the small bowel.Our study aims to evaluate the applications of VCE for pediatric gastrointestinal diseases.In this retrospective study, we included all patients who underwent VCE between December 2012 and December 2018. Clinical information and VCE data were analyzed.Among 828 patients, the completion rate was 99.6% (n = 825), with an average age of 10.2 ±â€Š3.3 years old. A total of 459 VCE procedures showed abnormalities, and the overall diagnostic yield was 55.6%. The most common indications for VCE were abdominal pain among 505 (61.2%) patients and hematochezia (10.1%) among 83. Among the positive results of VCE, small bowel ulcers accounted for the highest percentage (57.7%), of which 164 cases were diagnosed as inflammatory bowel disease. For obscure gastrointestinal bleeding, 12 cases were diagnosed as Meckel's diverticulum. In terms of the small bowel transit time of VCE, compared with the negative group [288 (216.5, 390.3) min] and the enteritis group [277 (192.5, 374.8) min], a longer transit time was needed in the small bowel ulcer group [332.5 (240, 451.5) min, P < .01]. There were no correlations of positive VCE findings with anemia, the white blood cell count, the C-reactive protein level or the small bowel transit time according to Spearman rank analysis.VCE is relatively well tolerated and safe in children and has great value for the diagnosis and treatment of abdominal pain, especially inflammatory bowel disease and obscure gastrointestinal bleeding.


Assuntos
Endoscopia por Cápsula/métodos , Gastroenteropatias/patologia , Úlcera/diagnóstico por imagem , Dor Abdominal/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , China/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Divertículo Ileal/diagnóstico , Estudos Retrospectivos
18.
Am J Case Rep ; 21: e926785, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970653

RESUMO

BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Pneumonia Viral/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Técnicas de Laboratório Clínico/métodos , Indústria da Construção , Infecções por Coronavirus/diagnóstico , Humanos , Índia , Masculino , Oclusão Vascular Mesentérica/tratamento farmacológico , Oclusão Vascular Mesentérica/virologia , Veias Mesentéricas , Pandemias , Pneumonia Viral/diagnóstico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trombose Venosa/complicações
19.
Medicine (Baltimore) ; 99(28): e21175, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664157

RESUMO

To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.


Assuntos
Dor Abdominal/diagnóstico , Endoscopia Gastrointestinal , Gastroenterite/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Dor Abdominal/microbiologia , Adolescente , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Gastroenterite/microbiologia , Humanos , Intestino Delgado/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Eur Radiol ; 30(12): 6685-6693, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32623503

RESUMO

OBJECTIVE: To describe demographic, clinical, and lung base CT findings in COVID-19 patients presenting with abdominal complaints. METHODS: In this retrospective study, 76 COVID-19 patients who underwent abdominal CT for abdominal complaints from March 1 to April 15, 2020, in a large urban multihospital Health System were included. Those with positive abdominal CT findings (n = 14) were then excluded, with 62 patients undergoing final analysis (30M/32F; median age 63 years, interquartile range (IQR) 52-75 years, range 30-90 years). Demographic and clinical data were extracted. CT lung base assessment was performed by a cardiothoracic radiologist. Data were compared between discharged and hospitalised patients using Wilcoxon or Fisher's exact tests. RESULTS: The majority of the population was non-elderly (56.4%, < 65 years) and most (81%) had underlying health conditions. Nineteen percent were discharged and 81% were hospitalised. The most frequent abdominal symptoms were pain (83.9%) and nausea/vomiting/anorexia (46.8%). Lung base CT findings included ground-glass opacities (95.2%) in a multifocal (95.2%) and peripheral (66.1%) distribution. Elevated laboratory values (when available) included C-reactive protein (CRP) (97.3%), D-dimer (79.4%), and ferritin (68.8% of males and 81.8% of females). Older age (p = 0.045), hypertension (p = 0.019), and lower haemoglobin in women (p = 0.042) were more frequent in hospitalised patients. There was no difference in lung base CT findings between discharged and hospitalised patients (p > 0.165). CONCLUSIONS: COVID-19 patients can present with abdominal symptoms, especially in non-elderly patients with underlying health conditions. Lung base findings on abdominal CT are consistent with published reports. Radiologists should be aware of atypical presentations of COVID-19. KEY POINTS: • COVID-19 infected patients can present with acute abdominal symptoms, especially in non-elderly patients with underlying health conditions, and may frequently require hospitalisation (81%). • There was no difference in lung base CT findings between patients who were discharged and those who were hospitalised. • Lung base CT findings included multifocal and peripheral ground-glass opacities, consistent with published reports.


Assuntos
Dor Abdominal/diagnóstico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
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